Public health intervention for narghile (hookah, shisha) use requires a radical critique of the related “standardised” smoking machine
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Much has been written about the toxicity of narghile (hookah, shisha) smoke. However, it is seldom mentioned that narghile smoke is actually far less complex than that of cigarettes. In spite of being a much simpler object to research, there has been a world of avoidable and preventable confusion due, to a great extent, to the inappropriate use of the narghile smoking machine designed at the US-American University of Beirut that now is considered to be “standardised”. This machine has allowed the claims of high yields of tar, CO, PAH, heavy metals and, lastly, volatile aldehydes. Consequently, any public health intervention against narghile (hookah, shisha) use requires a long overdue critique of this machine on which a large amount of the peer-reviewed “waterpipe” literature uncritically relies. Public health policy makers should be aware of the unprecedented degree of confusion in this field.
The analysis is twofold. On one hand, the classical FTC (Federal Trade Commission) regime applied to cigarette testing (and behind the official figures printed on cigarette packs) is presented, whereby it is recalled that a 35-ml puff is drawn each minute for only a few minutes. On the other hand, a discussion follows about the relevancy of the narghile smoking machine based on averaging a complex human and social activity to a puff relentlessly drawn every 17 s over a full hour, with, marginally, the heating source (coal) in the same position over the smoking mixture (contrary to common practice). It is assumed that such stress-strain conditions result in abnormal perturbations in the chemical reactions at stake. The case of aldehyde generation is taken as an example.
The narghile smoking machine was modelled after the one for cigarettes, which not only is an inappropriate reference, but also is totally irrelevant for a kind of tobacco use that is different from all points of view. The narghile smoking machine and its underlying smoking topography represent a biased toxicological model of the related practice. Human-centered alternatives are presented.
Against the background of a public health epidemic, a recommended research avenue is to focus on biological measurements of human subjects (urinary carcinogens, chemical or biological markers) carried out in a natural environment in realistic conditions and coupled with a puff-by-puff smoke analysis.
KeywordsSmoking Tobacco Narghile Shisha Smoking machine Puffing behaviour
Conflict of interest
The author has no competing interests. He has never received financial or non-financial, direct or indirect, funding neither from pharmaceutical companies (nicotine ‘‘replacement’’ therapies and products) nor from the tobacco industry. For more details, see Chaouachi (2009) in Int. J. Environ. Res. Public Health; 6(2):798–843).
- Chaouachi K (2006) A critique of the WHO’s TobReg “Advisory Note” entitled: “Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators” (2005). Journal of Negative Results in Biomedicine 5:17 http://www.jnrbm.com/content/pdf/1477-5751-5-17.pdf CrossRefPubMedGoogle Scholar
- Chaouachi K (2007) 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 7:1691–1696Google Scholar
- Fromme H, Dietrich S, Heitmann D, Dressel H, Diemer J, Schulz T, Jörres RA, Berlin K, Völkel W (2009) Indoor air contamination during a waterpipe (narghile) smoking session. Food Chem Toxicol 2009 [Epub ahead of print] ( 10.1016/j.fct.2009.04.017)
- Guillerm R, Badré R, Vignon B (1961) Effet inhibiteurs de la fumée de tabac sur l’activité ciliaire de l’épithélium respiratoire et nature des composants responsables [Inhibitory effects of tobacco smoke on the respiratory epithelium ciliary activity]. Académie Nationale de Médecine:416–423Google Scholar
- Helsinki Declaration (2008) Ethical principles for medical research involving human subjects. 1964–2008 General Assemblies (http://www.wma.net/e/policy/b3.htm)
- Patent (2005) Narghile with simplified ignition. Appl. EP20050291196. Filed 3 June. Published 14 Dec.Google Scholar
- Philip Morris USA (1967) FTC to begin cigarette testing [Press Release, Aug 1)] http://www2.philipmorrisusa.com/en/product_facts/tar_nicotine/ftc_1967_press_release.asp
- Sajid KM, Chaouachi K, Mahmood R (2008) Hookah smoking and cancer. Carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduct J 24 May;5(19):http://www.harmreductionjournal.com/content/pdf/1477-7517-5-19.pdf
- Salem ES, Mesrega SM, Shallouf MA, Nosir MI (1990) Determination of lead levels in cigarette and goza smoking components with a special reference to its blood values in human smokers. The Egyptian Journal of Chest Diseases and Tuberculosis 37(2)Google Scholar
- WHO-EMRO (World Health Organisation - Eastern Mediterranean Regional Office) and ESPRI (Egyptian Smoking Prevention Research Institute) (2007) Shisha hazards profile “Tobacco Use in Shisha—Studies on Water-pipe Smoking in Egypt”. Cairo. ISBN: 978-92-9021-569-1. 84 pages. Prepared by senior editors: Mostafa K. Mohamed, Christopher A. Loffredo, Ebenezer Israel et alGoogle Scholar