2012 Release of Tout savoir sur le narguile : societe, histoire, culture et sante” [Everything about hookahs: societies, culture, history ; health] (Paris, L'Harmattan, 2012, 256 pages); (2) "Le narguile" (Paris, L’Harmattan, 261 pages). Includes the full text critique of the WHO flawed report on hookah smoking. BROCHURE in English availaible HERE
2002-2012. Kamal’s Masterpiece: “Ten Post-11/9 Great Myths about Hookah (Shisha, Narghile) Smoking & Public Health”
REVELATIONS 2011. How the TOBACCO INDUSTRY (CIGARETTES) has also been funding anti-hookah research over the past years:
Big Tobacco & Big Pharma Against "Oriental" Hookah Outsider
Subject: Evidence about One ("Unexpected"...) Undeclared Funding Source of WHO Shisha (““Waterpipe””-Coded) Antismoking Research.
OPEN XENOPHOBIA in the Bristish Medical Journal (Hookah as a Pretext):
The British Medical Journal's Hookah Smoking Prophet : Another Twist of the Danish “Caricatures”?
Subject: "An article of the British Medical Journal targets a certain religion for being permissive and even promoting smoking..."(March 18, 2011).
The Most Beautiful Girl in the World Cannot Give More than What She Has and the History of “Tobacco Control” Will Absolve Me, by the same author ](Harm Reduction Journal)
An Open Letter against Plagiarism and Plagiarists [namely: Bertrand Dautzenberg (president OFT) and Jean-Yves Nau (Le Monde)] (published in peer-reviewed medical journal Tabaccologia)
Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences (Int. J. Environ. Res. Public Health)
A Global Prison ? [An interview with Kamal C. on world tobacco policy]. Run by Chris S. Velvet Glove, Iron Fist 2009 (8 Apr)
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An AUTOMATIC quick
translation of the original (French)
Review
on Narghile (Hookah, Shisha, “Waterpipe”)
CAUTION: it must be understood that this a machine generated
translation (NOT HUMAN at all, lightly enhanced) so we apologise in advance for
the many linguistic errors it contains. The English-speaking reader is kindly
asked to rephrase mentally what is not clear in the first instance.
__________________________
Kamal CHAOUACHI. Shisha,
hookah. Narghile au XXIème siècle [Shisha,
hookah. Narghile in the XXIst century.
An Overview of the Scientific Knowledge about it].
Le Courrier des Addictions 2004 (Oct) ; 6 (4) : 150-2.
www.vivactis-media.com/default/Som_Revue.asp?numrevue=17&numParution=1021
Since the middle of the years 1990, narghile
suddenly became an increasingly known object of the public others that Asian
and African. However, one had about it
only of fragmentary and often anecdotic information until our publication of
the first synthesis knowledge in 1997. Trained in socio-anthropology, the
postgraduate DIU degree of Tobaccology from Paris (1998) enabled us to
apprehend the pharmacological, behavioural aspects and pathology related to the
tobacco in general as well as the immense field of investigation opened by this
form of use (doctoral thesis 2000).
Today, the tobaccologists are sometimes asked about it. Also, this
article is particularly intended to them.
DESCRIPTION
In spite of its diverse shapes and materials,
4 principal elements make up narghile now universally known under the name of
"shisha" or "hookah":
the bowl with tobacco (in general of conical form), the stem (vertical
tube of 75 cm to 120 cm on average) for drawing down the smoke from the bowl to
the water, the water container (a kind of vessel with 500ml on average) and the
suction hose (1,50m on average). Embers (natural or commercial quick-lighting
charcoal) come to cap the tobacco-based mixture packed in the bowl.
In the case of the tobamel (cf infra), an
aluminium foil bored with several holes is interposed. Because of the depression induced by an
aspiration in the hose, smoke is drawn down along the stem and undergoes a forced
washing in the water. From there, it emerges on the surface of the liquid and
engages, through an internal conduit of the mast, in the long hose before
reaching the mouth of the smoker.
SMOKED PRODUCTS
Various preparations containing tobacco are
used. The tobamel, the most widely
spread, contains up to 70% of honey or molasses; from there its name (in arabic “mu'essel”=with honey). The
glycerin, as a moistener, constitutes also an essential ingredient as well as
the essences of flowers or fruits:
apple, cutter, rose, etc. The
yields of nicotine and tar announced on the packs often vary around the
zero... The tumbâk is made up mainly of
leaves of tobacco, washed and dried several times then packed in the bowl to be
heated directly by embers. With higher
content of nicotine than the tobamel (Hadidi 2004), its preliminary washing
should however contribute to decrease the rate of the alkaloid. The jurâk is an
intermediate product: thick, blackish
and not aromatised (cf Zahran 1982). As
regards the users, the tobamel is in general more "female", more
"young" and more "urban" than the tumbâk or the jurâk.
THE CRAZE
The reasons of the vogue are numerous. Inter alia:
tourists returning with one narghile in their suitcase, multiplication
of the neo-orientalist lounges (narghile bars), self-incandescent charcoal with
fast implementation; not irritated
nonsmokers (filtering of acrolein and acetaldehyde [ Huber 1991 ]); anti-tobacco campaigns; mode of use considered as healthier than the
cigarette; varied flavours... More subjectively, the term "social
smoking" (very specific: long time
of the meeting, shared pipe, bubbling of water, conversation, etc.) is systematically used.
HISTORY
The history of the object is surrounded by a
certain halo of mystery and its origin is not necessarily Indian as certain
authors affirm it. One can however fix
the appearance of a use social, either individual, narghile, on a large scale,
simultaneously with the appearance of the public coffee-houses and the adoption
of the tobacco, roughly speaking with the turning of 16th and 17th century.
Today, the most serious assumptions allot to him a South-African, Ethiopian
origin or Persian (Chaouachi 2000).
PIONEERS
40 years ago, Hoffmann measured the rate of
filtration of certain components of the smoke of a shisha with tumbâk: phenol 90%, 50% of nicotine and
benzo[a]pyrene of its particulate phase.
At the same time, Rakower, intrigued by the very weak prevalence of the
lung cancer among populations of users of the madâ'a (narghile with tumbâk),
measured the rates of filtration of the tar:
84mg for 10g of tobacco and 161mg without water. In the seventies, Salem, another pioneer,
led a number of impressive works on the gûza (Egyptian narghile of small size
functioning with tabamel/jurâk).
DISEASES
Perhaps this mode of use would reduce the
risks of lung cancer (Hoffman, Rakower, Salem 1983 and 90, Gupta Dheeraj 2001,
Tandon 1995, Lubin 1992, Hazelton 2001, Stirling 1979). Other pathologies like
oral, gastric cancer and of the bladder, the eczema of contact, tuberculosis or
aspergillosis, etc. (El-Hakim 1999,
Gunaid 1995, Bedwani 1997, Onder 2002, Munckhof 2003, Salem 1973, Shadi 1985,
Szyper-K. 2001) are not clearly
established because of a non-rigorous methodology (simultaneous use of other
products [e.g. qât, cigarettes, etc ], strongly neglected hygiene, statute and
career of the smokers not specified, etc).
The use of narghile could however induce a significant increase in the
oxydative stress in vivo (Wolfram 2003).
Let us announce here that the water of the container could filter a
variety of free radicals (Zaga 2003).
Lastly, even with a degree lower than that of the cigarette or bidi, the
smoke of the hookah would be genotoxic (but possible environmental factor) and
clastogenic (Yadav 2000).
Kiter showed that the effects of narghile
(tumbâk) on the pulmonary function would be less serious than those caused by
cigarette (FEV1 and higher FEV1/FVC).
In this same field, various studies tend to show that cigarette and
shisha would produce similar harmful effects on the ventilatory capacity
(Al-Fayez 1988). Whereas the cigarette
smoke would affect the small respiratory tracts rather, that of narghile would
have an effect on the large ways (Bakir 1991, Kiter). A high production of anion superoxyde (O2 _) in the neutrophiles,
observed in India by Sharma 1997, raises also the question of the diet
(antioxydants) of the committed volunteers.
Macaron noticed how heavy smokers using tumbâk
"titrate" (compensation) by obtaining out of narghile all the nicotine
they need (rates close to those of smokers of cigarettes). Shafagoj measured high rates of blood,
salivary and urinary nicotine and cotinine of heavy smokers of narghile with
tobamel (used in a rather intense way:
3 times per week) to whom an abstinence of 3 days and half was required
before the experiment. The urinary rate
of cotinine reported (249,79 +/- 54,78 µg/24 H) is to be compared with those
obtained by Macaron (700 to 33000 µg/l (6.080 +/- 1.810 µg/l)). The urinary nicotine rate is of (73,59 +/-
18,28 µg/24 H). Between the beginning
and the end of the session of narghile (45 min later), the average values of
blood nicotine pass from 1,11 to 60,31 ng/ml.
3 hours later, the blood cotinine passed from 0,79 to 51,95 ng/ml. The average values of salivary nicotine and
cotinine pass, respectively, of 1,05 to 624,74 ng/ml and 0,79 to 283,49
ng/ml.
A recent study finally approached certain
thermodynamic aspects (Shihadeh). The
conditions (tobamel, non-natural quick-lighting coal, 100 puffs of 0,3l, 3s all
30 S) really did not correspond to reality (irregularity of smokes, etc). The temperature of the tobamel, increasing,
would reach 120°C to the maximum at the end of the meeting of 50min. As for the smoke filtered by water, it is at
the ambient temperature. The case of
the tumbâk, heated directly with 600-650°C is very different (cf Rakower). As for nicotine, a whole session would
deliver to the smoker only the quantity obtained by 1 or 2 cigarettes. On the other hand, the quantities of tar
obtained are high: for example 242mg
(puffed out all 30s). Let us recall
here that Hoffman and Rakower had recorded a rate of filtration of the tar of
approximately 50%. However, because of
the low temperatures concerned, the condensates would be more the product of a
distillation than of a pyrolysis.
Wynder (1958) thus showed that the carcinogenic character of smoke
increases with the temperature, particularly starting from 800°C. See also
White (2001) in connection with the genetic changes. Heat "enables chemical reactions between the aldehyde
functions of sugars and the nitrogenous compounds, ammonia to start with, that
the tobacco manufacturers use to give various aromatic compounds, as those
which occur when one roasts meat. These
flavours explain why the American cigarettes, where the tobacco is soaked in
"sauces" containing molasses, little by little supplanted our
traditional dark tobacco "(M., quoted in Chaouachi 2000).
Lastly, the study of Shihadeh records very
high values for certain metals (Co, Pb, Have, Cr). Commercial coal used (unknown composition), the coating of the
bowl and the stem or the aluminium foil probably play a role. As for lead, the results are apparently
contradictory with those of a study of Salem (1990). In India, high levels of cadmium were recorded (Sukumar 1992) but
factors of pollution are perhaps in question.
CARBON MONOXIDE
Coal, the tobacco and its molasses, the size
of narghile contribute to the production of this gas. A rise in the carboxylemy seems acquired (Zahran 1985, Salem
1989). In Pakistan, Sajid showed that
the CO rate rises in reverse ratio of the dimensions of the 4 principal
elements of the device but also depends on the varieties of tobacco used. Thus, a rate equivalent to that of a simple
cigarette can sometimes be measured.
For expired CO, recent measurements (rather "heavy "smokers)
reveal a high rate: 14,2ppm (Shafagoj).
DEPENDENCE
Recreational, dependent? Which tools to use for this mode of use
(Chaouachi)? Passage of a collective
use to an individual practice (Maziak)?
Certain dependent individuals are able to refrain from smoking during
several days. As they cannot get their
usual tobamel or tumbâk, they generally do not have recourse, not only to the
other of the two products, but yet to the cigarettes. Dependence on tobacco and not on nicotine, with a strong
behavioral and even social variable ?
And would the importance of the flavours of the tabamel imply a
dependence similar to that of the coffee?
EPIDEMIOLOGY AND PREVENTION
In the Middle East, a quarter of the various
categories of the population, without distinction, including the pregnant women
(cf Nuwayhid 1998), indulge in narghile, in an recreational or regular
way. In the majority of the countries
of the Mediterranean basin, very concerned by the traditional use of the
object, more than 45% from the men and 15% of the women would be smokers of
cigarettes (Tessier 1999). Certainly, a
significant proportion of the smokers selected in the recently surveys were
simultaneous smokers of cigarettes, ex-users of these last or individuals
"having substituted" a dependence by another. As for prevention, the religion is sometimes
requested but without much success (Radwan 2003). Two recommendations seem significant here to us. The first is that it is necessary to deter
the cigarette smokers "to switch" to narghile (illusion due to
titration (compensation)). The second is that commercial coal
(self-quick-lighting) currently used, far from the areas of origin mainly (Asia
and Africa), should be avoided.
As for the cannabis, studies showed that
aqueous filtering filtered... the cannabinoïdes effectively (Savaki 1976,
Lazaratou 1980). Research is directed
towards a device which would make the economy of the coal and which would heat
the plant around 200°C instead of burning it (Gieringer 2004).
CONCLUSION
Although the social use of narghile has more
than 400 years of age, research in connection with it is late and this is why
there does not exist yet programs of prevention worthy of this name. Probably, for reasons more sociocultural
than pharmacological, the smoker of narghile seldom metamorphoses himself in a
smoker of cigarettes. Thus, the world
of narghile and that of the cigarette remain, a priori, strangers to each
other. Practically, there is a fact
that the researchers did not entirely assimilate yet; it is that it is
important to study exclusive smokers of narghile and to reject as far as
possible the simultaneous smokers of cigarettes, the ex-smokers of the latter
product or those "having substituted" the practice of narghile. This last type of smoker is more exposed to
the risks of dependence and absorption of quantities much more significant of
elements normally reduced by narghile. It is also important, taking into account
the high complexity of narghile, whose best point of view is at the fringes of
the medical and sociocultural fields, to avoid, as far as possible, the quick
comparisons with the cigarette. Lastly, because of the tobaccologic singularity
of its mechanisms but also of the very diverse points of view that it offers to
the researcher, narghile can, above all, help make enhance the comprehension of
the phenomenon of dependence on cigarette.
Chief References : (for details, contact
author at kamchaAgmail.com) :
- Chaouachi K., Le
narghile : analyse socio-anthropologique. Culture, convivialité, histoire
et tabacologie d’un mode d’usage populaire du tabac, thèse doct., Paris X,
420 pages.
-
Chaouachi K., Le Narghile: Anthropologie d’un mode d’usage de drogues
douces, Paris, L’Harmattan, 1997, 263 pages.
- Hadidi KA et
alii. Nicotine
content in tobacco used in hubble-bubble smoking. Saudi Med Journal 2004; vol.
25 (7): 912-917.
- Hoffman D. et alii. Comparison of the
yields of several selected components in the smoke from different tobacco
products. Journal of the National Cancer Institute. 1963;
31:627-635.
- Kiter G et alii. Water-pipe
smoking and pulmonary functions. Resp Med 2000; 94: 891-4.
- Macaron C et
alii. Urinary cotinine in narguila or
chicha tobacco smokers. J Med Liban 1997;45(1):19-20.
-
Maziak M et alii. Factors related to frequency of narghile
(waterpipe) use: the first insights on tobacco dependence in narghile users.
Drug and Alcohol Dependence. 2004 (in press).
- Rakower J et alii. Study of Narghile
Smoking in Relation to Cancer of the Lung. Br J Cancer. 1962 Mar; 16:1-6.
-
Salem ES: nombreuses publications dans The Egyptian Journal of Chest
Diseases and Tuberculosis.
- Shafagoj Y et alii. Hubble-Bubble
(Water Pipe) Smoking: Levels of Nicotine and Cotinine in Plasma, Saliva and
Urine. Int J Clin Pharmacol Ther. 2002a; 40(6):249-55.
- Sajid KM et alii. Carbon
monoxide fractions in cigarette and hookah. J Pak Med Assoc. 1993 Sep;
43(9):179-82.
- Shihadeh A. Investigation of mainstream smoke
aerosol of the argileh water pipe. Food and Chemical Toxicology 2003;
41: 143-152.
- Zahran et alii. Carboxyhaemoglobin concentrations in smokers of sheesha and
cigarettes in Saudia Arabia. BMJ 1985; 291:1768-70.