Send letter to journal:
Re: Some Misconceptions in a Good Alert Paper

Dear Editor,

We wish to draw your attention to some misconceptions in the following study:

Rima AFIFI SOWEID. Lebanon: water pipe line to youth. Tobacco Control 2005;14:363-4.

>"In Lebanon, youth and women are the target of a marketing campaign featuring a new tobacco product for use with the more traditional water pipe."

The caption for the embedded picture is a an erroneous interpretation. Sociological semiology showed us in the fifties that if you want to sell a car (to men, of course), you have to depict it with a nice looking girl leaning on it. Once again, in the present case, the message is not directed to "youth and women" but to men in the first instance.

Then, the word "water pipe", in the title and elsewhere, is not appropriate. It is used only in a certain orientalist or neo-orientalist literature,(1) just like the sometimes disparaging "hubble-bubble" (2). If you enter a café in the Middle East or in Europe and North America nowadays, and order a "water pipe" or a "hubble-bubble", in most cases you will not be understood. So, let us use the words people use in the real human world we are interested in, as scientists serving the public health.

-"(N)arghile" is widely used in the Middle East: from Turkey to Iran via Lebanon, Syria, etc. -"Hookah" is quite common in Asia (India, Pakistan, etc.) and the English- speaking world. -"Shisha" fits first the North of Africa: countries such as Tunisia, Libya, Egypt and now Morocco but it is also common in the Arab-Persian Gulf region and now, thanks to the world hookah craze, in every part of the globe (3).

>"The water pipe is a traditional form of tobacco smoked in Arab countries, including Lebanon."

It is not. It has been used for centuries in Asia and Africa and not only in the Arab countries (4).

> "Recently, trends have shifted between tobacco types, and water pipe smoking is becoming the preference for young people and women specifically, ousting the once more popular cigarette."

We are afraid they have not. It is also becoming the preference for men too. It is not ousting the cigarette; on the contrary. People, in countries like Lebanon, smoke indistinctly hookahs and cigarettes (5). Tobaccologists are not that much interested in the dozens of millions of recreational hookah smokers around the word who have been smoking a hookah once a week or a month over the past centuries. What is of utmost concern to them is those dual smokers and those who have switched from cigarette (or bidi, etc.) smoking to narghile use. The body memory of their past career and their inhaling patterns are different. This is the real health concern we have to focus on (6)(7).

> "Ironically, with an eye on an ever "health conscious consumer", the new product comes in individually wrapped portions (hitherto in large bales) and the promise that it has not been touched by human hands."

We are sorry to say that it is not a "new product". Indian manufacturers, like Afzal, for instance, have been providing with these individually wrapped portions for a very long time now. Besides, this marketing concept, adopted and developed further by Western manufacturers, will be very soon available in the whole world.

Generally speaking, this article is interesting and, despite the above commented upon misconceptions, we cannot but share the author's concern regarding the existence of this kind of advertisement. Any advertisement for any substance should be prohibited as a rule.

Kamal Chaouachi, Paris Universities. Researcher in Socio-Anthropology and Tobaccology

REFERENCES

(1) CHAOUACHI Kamal. Culture matérielle et orientalisme. L'exemple d'une recherche socio-anthropologique sur le narguilé, Arabica (Paris III Sorbonne et EHESS), 2005. [Engl.: Material Culture and Orientalism. The Example of a Socio-Anthropological Research on Narghile]

(2) CHAOUACHI Kamal. Le narguilé. Anthropologie d'un mode d'usage de drogues douces [Engl.: An Anthropology of Narghile: its Use and Soft Drugs], Ed. L'Harmattan, 1997, 262 pages.

(3) CHAOUACHI Kamal. The Recent Development of Hookah Use in the World : a Serious Epidemic or just a Passing Fad ? The Need for a Socio- Anthropological and Medical Approach. IFSSH (International Forum for Social Sciences and Health), World Congress "Health Challenges of the Third Millenium". Istanbul, 21-26 Aug. 2005. Published by YEDITEPE University, Dept. of Anthropology, Aug. 2005, tome I, pp. 360-1.

(4) CHAOUACHI Kamal. Le narguilé : analyse socio-anthropologique. Culture, convivialité, histoire et tabacologie d'un mode d'usage populaire du tabac. Doctoral Thesis, Université Paris X (France), 420 pages. [Engl.: "Narghile (hookah): a Socio-Anthropological Analysis. Culture, Conviviality, History and Tobaccology of a Popular Tobacco Use Mode"].

(5) Baddoura R., Wehbeh-Chidiac C. Prevalence of tobacco use among the adult Lebanese population. July-Sept. 2001; 7 (4/5): 819-28. St-Joseph University, Beirut, Lebanon. Published by WHO/EMRO.

(6) CHAOUACHI Kamal. Presentazione del narghilè e del suo uso. Guida critica della letteratura scientifica sul narghilè (shisha, hookah, waterpipe). Dalle origini ai giorni nostri : necessità di un approccio interdisciplinare socio-antropologico, medico e farmacologico. Tabaccologia 2005; 1: 39-47. [Engl.: A critical review of scientific literature on narghile (Shisha, Hookah, Waterpipe) from its origins to date: the need for a comprehensive socio-anthropological, medical and pharmacological approach].

(7) CHAOUACHI Kamal. Shisha, hookah. Le narguilé au XXIe siècle. Bref état des connaissances scientifiques. [Eng.: Narghile, Hookah in the 21st Century: An Overview of the Scientific Knowledge]. Le Courrier des Addictions 2004 (Oct) ; 6 (4) : 150-2.

Send letter to journal:
Re: Hookah or water pipe ?

I certainly agree with most of the comments of Dr Kamal Chaouachi but the need to develop one generic name for the different types of this form of tobacco smoking is definite and we tend to prefer the term water- pipe smoking as it denotes the similarity that links all these forms and shapes and local names. Certainly these different names are associated with local geographical languages and idenified best in the repsective languages. The need to use a common generic name is recognized to avoid using three to five different names in every paper to make sure that the study covers these types. Water-pipe tobacco smoking is a good common name and reflects the major difference from direct tobacco smoking which is a lower temperature of burning as well as cooler smoke temperature. This is reflected in the composition of the smoke and characteristics of toxic and carcinogenic componenets as alluded to in some work from Lebanon by Alan Shihada cited in the original paper discussed here.

Mostafa K. Moahmed Professor of Community Medicine AinShams University Faculty of Medicine Abbassia , Cairo, Egypt

Principal investigator Egyptian Smoking Prevention Research institute ESPRI

Tel /fax Office 20-2-368-2774 / 368-6275/ 368-8400 Mobile 20-12-241-7933 email: ecgc@internetegypt.com