Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences. International Journal of Environmental Research and Public Health. 2009; 6(2):798-843.
“-[ADDENDUM 2 mar 2010] After the claims about the supposedly high hazards of hookah Environmental Tobacco smoke. have been clarified, findings from antismoking researchers funded by powerful lobbies have been published. However, they were actually based on methodological tricks”. For more details, go to relevant KNOL (piece of KNOwLedge).
[COPY, with permission from the author]
Seven Thousand Billions of Ultra Fine Smoke Particles
in a Single Hookah (Narghile, Shisha) Session
and Yet its Users are Still Alive…
[French: Sept mille milliards de particules ultra-fines pour une seule séance
de narguilé (chicha) et ses fumeurs sont toujours là, en vie…]
includes : “Shocking Unsubstantiated Neo-Orientalist Statement on Lung Function
Discrimination (Middle East vs. European Hookah Smokers)
Published in the ‘Tobacco Control’ Journal”
by Kamal C. (Paris, 01 Dec 2007)
What this paper adds:
Ø Banning of hookah smoking machines should become a top priority for public health;
Ø Forbiddance of ludicrous anthropometrical statements should become part of national edicts regarding smoke-free places;
Ø The collapse of the peer-review system in relation with hookah studies is confirmed;
1 Cigarette roughly Equals 3 (unshared) Hookahs
(regarding Ultra Fine Particles concentration and for a reference volume of 500 ml)
a reference volume of 500 ml)
1 Cigarette roughly Equals 13 (unshared) Hookahs (regarding Carbon Monoxide yields and for a reference volume of 500 ml)
a reference volume of 500 ml)
Ø Hookah has not proved, to date, to be MORE dangerous than cigarettes.
A “research paper” entitled “Ultrafine particle emissions from waterpipes”, authored by Drs MONN, KINDLER, MEILE and BRANDLI (Switzerland), was recently published in the “Tobacco Control” journal . It reports a new experience mainly based on a smoking machine supposed to reflect “real” hookah (narghile, shisha) smoking. To start with and despite all existing critiques on the subject, only 8 grams of tobamel/mu‘assel (the tobacco-molasses based mixture) were used in a 50 minute (machine) smoking “session” . This is a first serious methodological error. While the laboratory experience refers to exactly the same smoking product used in a similar system in Lebanon (Shihadeh et al.), the authors surprisingly acknowledge: “Some important differences in the breathing patterns of waterpipe smokers between smokers in the Middle East and in our study were found. In the study from Shidadeh et al the tidal volume of smokers was 0.53 litres, the duration was 2.6 seconds and the interval between breaths was 17 seconds.6 In our study the volume was 1 litre, the duration 5 seconds and the interval between breaths was 25 seconds (see table 1).”
Such a statement was published in the Tobacco Control journal and was supposedly “peer-reviewed” and screened by teams of world top experts. However, it is nothing but ludicrous pseudo-scientific anthropometrics. For a given product and a same configuration, all hookah users of the world smoke the same way. Consequently, the authors have presented not less than a mere artefact generated by the use of the smoking machines themselves. They eventually believed that their smoking machines were an image of real human hookah smoking… The fact that data collection through smoking topographies in Lebanon and Switzerland gave so striking differences means that the methodology is wrong. For many years now, I have been warning against the use of such artificial means which have already generated a great world confusion .
On the occasion of the “World No Tobacco Day” (2006), a book written by Bertrand DAUTZENBERG (President of French OFT) and Jean-Yves NAU (journalist from Le Monde) and containing the same “finding” was released in France. The related message was largely an shamelessly disseminated and echoed in the media of that country. Together with other numerous other errors, I showed that this book was the greatest fraud in the history of tobacco research, apart from its intellectual piracy aspects .
Of course, Dr MONNIN and his colleagues are neither directly responsible for using a smoking machine nor for inferring from its use anthropometrical nonsense reminiscent of other glorious 19th Century “scientific” theories (on human races and so on)... The AUB (the US-American University of Beirut) is certainly responsible for this situation.
CHALLLENGE. I challenge all ““waterpipe”” experts of Tobacco Control, Nicotine and Tobacco Research (including their teams of peer-reviewers), Globalink, WHO (World Health Organisation) TFI (Tobacco Free Initiative), WHO TobReg (Study Group for Tobacco Regulation) and all their followers anywhere in the world, to produce the least evidence that Middle Easterners’ and Europeans’ lungs react differently to hookah smoke stimuli. If they are unable to do so, then they owe an apology to all Middle Easterners of the world: from East to West. That they stain the credibility of public health or science is one thing. That they publish ludicrous pseudo-scientific statements on people is another one.
LIE. The new Swiss paper states: “Shihadeh et al assessed the chemical composition of waterpipe particles for the first time.” This is a blatant lie. This is the message ““waterpipe”” experts have been trying to hammer in people’s minds in order to make them accept the idea that smoking machines are the best way to do science in this field. I have also noted that in the Cochrane Review, all of Shihadeh’s five publications are cited . In fact, early decades before, researchers had analysed key elements of hookah smoke. Besides, many hookah users now know that particle emissions depend on many factors that will not be detailed now in this communiqué.
FINDINGS. On one hand, it has been given for granted in scientific journals, the biomedical press and the mass media that 1 hookah would equal 100 cigarettes, wouldn’t it? On the other, and as many hookah are aware of, a single cigarette often equals several hookahs on a toxicological level, doesn’t it ? Let us see now thanks to the figures provided in Monn et al.’ study. There would be 74.4 billions (109) of UFP (ultrafine particles the size of which ranges from 0.02 to 1µm) for one 1000 ml ““waterpipe””™ (machine) “breath” (i.e. a puff) and 9.24 billions of UFP¨for a single 45 ml cigarette “breath” (id.).
From the above, we infer that for a reference volume of 500 ml, a single cigarette actually delivers 9.24 x (500/45)=9.24 x 11.1 = 102.6 billions of UFP. For the same volume, a hookah actually delivers 74.4 x (500/1000)=37.2 billions of UFP. Noting that one machine-smoked cigarette produces about 500 ml, that is 11 puffs of 45 ml, we therefore conclude that 1 cigarette equals 102.6/37.2= 2.76 hookah
> 1 Cigarette roughly Equals 3
(unshared) Hookahs (regarding Ultra Fine Particles concentration and for a reference volume of 500 ml
a reference volume of 500 ml)
As for CO (Carbon Monoxide), we have: 1.79 mg for a 1000 ml hookah (machine) puff and 1.06 mg for a 45 ml cigarette puff. If we do the same calculation, then, for a common reference volume of 500 ml, a cigarette actually delivers 1.06 x (500/45)=1.06 x 11.1=11.76 mg of CO. For the same volume, a hookah actually delivers 1.79 x (500/1000)= 0.89 mg. Noting that one machine-smoked cigarette produces about 500 ml, that is 11 puffs of 45 ml, we therefore conclude that 1 cigarette equals 11.76/0.89= 13.21 hookah
> 1 Cigarette roughly Equals 13
(unshared) Hookahs (regarding Carbon Monoxide yields and for a reference volume of 500 ml
a reference volume of 500 ml)
Of course, this kind of equation may change, tremendously sometimes, according to the considered (toxic) substances. This is why I have never paid too much attention to comparisons that most often prove to be un-scientific. Only comparable things can be compared. I am not a fearmonger but a scientist interested in public health.
Also, I forgot to say that for a 100-puff “session”, the number of UFP would be:
74.4 billions x 100 = 7,440 billions.
>> Seven Thousand Billions of Ultra Fine smoke Particles in a Single Hookah (Narghile, Shisha) Session and Yet their Users are Still Alive…
By the way, what are these particles made of ? I will have the opportunity to address this question in a further communiqué.
AS A BEGINNING FOR A CONCLUSION
This study from Switzerland, the land of chocolate, was also announced in the media by Pascal DIETHELM (a member of the Governing Board of the French CNCT, the Comité National Contre le Tabagisme) and a group of organisations . Pascal DIETHELM has cited the erroneous WHO report on hookah smoking which disparagingly misrepresent families and life in the whole Arab world by officially stating that children smoke the hookah with their parents . However, the above reporter went as far as writing that 12 year old children and even kids under that age, are allowed to smoke the narghile in the very home of their parents because the latter would rather see them using the bubbling contraption instead of cigarettes... A contextual analysis of such propaganda revealed that this was mere Fallacist stuff for fear-arousing media because the referred to families are of immigrant origins . In this respect, the infamous though popular Sacred Narghile site awarded th author the rare Golden Stupidity Palm for his statement, recalled here: « Pire encore, de nombreux parents, en toute innocence, permettent à leurs enfants, parfois de très jeunes adolescents de 12 ans ou moins, de se réunir en groupe avec des amis dans le logement familial pour fumer le narguilé, alors qu'ils n'accepteraient pas que ceux-ci fument des cigarettes ».
I have heard that recently in France, two famous scholars have issued a call in which they warn against fatal trends in alcohol and tobacco policies. I found their analysis so interesting that I decided to copy it on a listing of personal communiqués I am preparing . Certainly, as they say, hell is paved with good intentions.
Finally, I would like to point out that I am not impressed by the recent ““waterpipe”” studies blitzkrieg. Bad study + bad study + … + bad study = mass bad studies, isn’t it ? I have called for collaboration for ages. As my first concern is public health, I have made several offers which were even lifelines in view of the catastrophic situation. The last one, about a Meta Peer Reviewer position with WHO can be found here.: http://kamcha.googlepages.com/home . In view of the asymmetric war imposed to me and the silly opposition between anti-hookah’s and pro’s, this is all I can do and the proposal is still open. Take it or leave it. If they want a One Hundred Years’ War, I will be standing behind the scientific barricades and they may be assured that I will not know Jeanne d’Arc’s fate. If several erroneous public health reports (including two from WHO) have been debunked, and if they want more intense exposure, much good may it do them. They are free.
Researcher and Consultant in Tobacco Control (Paris)
 Monn C, Kindler P, Meile A, Brandli O. Ultrafine particle emissions from waterpipes. Tob Control 2007;16: 390-3.
 Chaouachi K. The narghile (hookah, shisha, goza) epidemic and the need for clearing up confusion and solving problems related with model building of social situations. TheScientificWorldJOURNAL: TSW Holistic Health &Medicine 207 (7): 1691–6. DOI 10.1100/tsw.2007.255.
 Chaouachi K. Tout ce que vous ne pouviez pas savoir sur le livre de Bertrand DAUTZENBERG et Jean-Yves NAU : « Tout ce que vous ne savez pas sur la chicha ». Paris, 8 June 2007.
 Chaouachi K. Communiqué: The Cochrane 2007 Review Masquerade on ““Waterpipe”” Smoking Cessation (by Wasim MAZIAK, Kenneth WARD and Thomas EISSENBERG), its By-Products and the Suspect Unbalanced Focus on ““Waterpipe”” Smoking vs. Cigarette Smoking. Paris, 29 Oct 2007.
 Diethelm P. « Narguilé : attention, danger!» (May 2007) http://www.oxygeneve.ch/dossier.php?id=67 (accessed June 29, 2007). Campaign” prepared by: OxyRomandie ; CIPRET-Genève ; UICC ; Département de l'économie et de la santé de Genève and Organisation mondiale de la santé (World Health Organization)
 Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” entitled: “Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators”. Journal of Negative Results in Biomedicine 2006; 5:17.
 Chaouachi K. Communiqué (in collaboration with The Sacred Narghile site): La rage et l’orgueil contre... le narguilé. Paris, 29 June 2007. Available via the above the above site.
 Appel à réagir du 19 novembre 2007: Alcool, tabac. Gare au pavé de l'ours. Hygiénisme moral, puritanisme d'Etat, ou lobbies industriels ? Copy: http://narghilecommuniques.googlepages.com/Alcool_Tabac_Grands_Sages_Tabacologi.htm