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Re: The Social Context of Individual and Collective Smoking: Similarities and Differences

Dear Editor,

Studying the social context of cigarette smoking was acknowledged as a pressing need in tobacco control. However, with new emerging health concerns like the growing use of the hookah (narghile) in the world, the social context, which bear similarities in both individual and collective smoking, also shows great differences that need to be reviewed. This letter introduces the reader to the specificities of collective smoking. It is based on a comprehensive and updated review of the related literature that includes several scientific books.

Recent efforts are geared towards the necessity of exploring further the complexity of the social context of smoking and its consequences on policy making. However, even if the background social theory is sometimes the same, the analysis in the case of individual smoking (cigarette) and collective smoking (hookah, narghile) is necessarily different in both cases and social scientists, as well as biomedical researchers, working in the field of tobacco control must be aware of similarities and differences.

For instance, a team of social scientists has recently published a study on the importance of the social context in tobacco control (1). An emphasis, placed so far on the disease or addiction model, would have resulted in negative consequences for the understanding of the human smoking behaviour. In this respect, this is particularly true in the case of fashionable hookah (narghile, shisha) smoking, our very field of research, where the social context is completely different from the one based on six dimensions: power relations, physicality (body in smoking), consumption patterns, social identity, desire and pleasure, place (1).

Apart from the peculiar traditional, historical and “exotic” aspects, we also have to deal with a collective (vs. individual) tobacco use mode with a particular staging of the “situation” with the meaning given to this last word by sociologist Ervin Goffman (2). In the USA, the interviewed hookah smokers themselves strongly insist in describing their practice as “social smoking” and, by coincidence, their peers in French- speaking countries use most of the time and spontaneously the word “conviviality”.

With all social scientists, we insist on the necessity of studying in depth the social representations related to smoking. In the case of narghile, we had to face a central one related to drug use so we decided to proceed as follows. We very early treated this question as a priority by publishing a core document on this aspect (3). This way, we avoided negative interferences with our further comprehensive approach of the other dimensions of hookah use in the world which are mainly related to tobacco use only (4).

Then, there is another set of social representations not to be found in the case of cigarette use: orientalism. On the one hand, this last concept is familiar for social scientists because the corresponding issue is considered as very serious in their field of work where a researcher like Edward Said (5) actually touched off an epistemological revolution. Unfortunately, on the other hand, biomedical researchers had no concrete clue for an evaluation of the relevance of such a concept in the field of tobacco control. So, we will limit here ourselves to cite a cogent publication on the subject (6) that develops further an earlier analysis (4).

As mentioned earlier, the central role of power relations, out of the six dimensions set out for any social context regarding cigarette smoking, was underscored (1). Notwithstanding, we wish to suggest an excellent relatively unknown study carried on in this respect where researchers actually showed how marginalized groups adopt unexpected strategies to adapt to a new situation posed by rises in tobacco prices. Just to mention one of them, they leave shorter butts which is unfortunately an extremely hazardous behaviour (7).

Then, once again, hookah smoking, as a collective practice, is different from cigarette use known to be individual. Both in traditional historical or modern social settings, the practice indistinctly covers the whole social spectrum. European travellers of the past centuries, to Asian and African traditional societies, were often startled by this sociological aspect and this was highlighted in their narrations (4). According to a famous anthropologist, the sultan would share his hookah with the street sweeper (8).

A second key dimension of the social context is physicality or the use of body in smoking (1). However, since a hookah is much bigger in size than a cigarette, the psycho-anthropological analysis differs in both cases with deep consequences on the physicality of smoking. Indeed, it is not only a question of how a cigarette is held by the smoker but how the body adapts to a device that can reach the size of a smoker sitting on a chair. The same Marcel Mauss, who actually created the “body techniques” (techniques du corps) concept, defined the latter as the ways and manners men, society by society, and in a traditional way, know how to use their body (9).

Excellent examples are given by the many orientalist paintings, where the narghile is omnipresent, but also in a recent article in the biomedical literature that features a young narghile female smoker lying by a swimming pool in Lebanon (10). The importance of the Maussian concept was further investigated and applied by other social scientists within the framework of what is now called “material culture” (6, 11).

Apart from the diverse dimensions of the social context, two main ideas should guide research work in the field of tobacco control. The first one is reflexivity defined as “maintaining a self critical attitude and questioning taken-for-granted assumptions regarding the (political) nature of our work and its (intended and unintended) effects, as well as the social distribution of these effects” (1).

Such an attitude will certainly have positive practical implications for policy makers and tobacco control activists. It may be seen as “novel”; however, it is familiar and natural for social scientists because this very interrogation is at the root of the anthropology discipline itself. Indeed, a scientist like Bourdieu was often considered as an anthropologist rather than a mere sociologist (4). In any case, this also shows the importance of collaboration between social and biomedical researchers.

The second important point is that the smokers’ voice would be rather absent from most of the studies. Indeed, this is one the first striking things any social scientist involved in tobacco control notice. In our early work on hookah smoking, we gave the transcripts of several unique face to face qualitative early interviews carried on in the Middle East (4). Such a literature reveals the many details to which some of our colleagues of the biomedical field did not pay the sufficient attention.

For instance, our findings were crucial in understanding the specificity, particularly pharmacological and behavioural, of the dependence process, completely different from that related to cigarette (12). On the daily life level, we can see that the so-called “hookah lounges” in the West already offer herbal fruit-flavoured tobacco-free smoking mixtures to their patrons. To close this chapter, we point out that our typology of the diverse tobacco-based smoking mixtures (tobamel, jurâk, tumbâk, etc.) was more than a mere ethnographic classification exercise (4, 13). For having ignored this point, the authors of recent and widely advertised studies, misled by a misnomer used by local scientists, actually mistook one type for another (14).

In conclusion, we invite our colleagues of both the social and biomedical sciences field to consider other forms of smoking and pay attention to the findings set out in this text. Some of them, like the hookah are gaining increased public health interest because of their dramatic development (15).

Kamal Chaouachi

REFERENCES

(1) POLAND B, FROHLICH K, HAINES RJ, MYKHALOVSKIY E, ROCK M. SPARKS R. The social context of smoking: the next frontier in tobacco control?. Tobacco Control 2006;15:59-63.

(2) GOFFMAN Erving (book). Les moments et leurs hommes. Seuil (Paris) 1988.

(3) CHAOUACHI Kamal (book). 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.

(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) SAID Edward (book), L’orientalisme: L’Orient créé par l’Occident (orig. Title : Orientalism, 1978), Seuil (Paris) 1980.

(6) CHAOUACHI Kamal. Culture matérielle et orientalisme. L’exemple d’une recherche socio-anthropologique sur le narguilé, Arabica (Paris III Sorbonne et EHESS), 2006. Published by Brill (The Netherlands) [Engl.: Material Culture and Orientalism. The Example of a Socio-Anthropological Research on Narghile], 32 pages. Soon available online at www.brill.nl

(7) MOLIMARD R, AMRIOUI F, MARTIN C, CARLES P. Poids des mégots et contraintes économiques [Eng. Weight of Cigarette Butts and Economic Constraints]. La Presse Médicale 1994 ; 23 : 824-6.

(8) LEVI-STRAUSS Claude (book). Tristes tropiques [Eng. Sad Tropics]. Plon (Paris) 1955.

(9) MAUSS Marcel (book). Sociologie et Anthropologie. Presses Universitaires de France (Paris) 1968.

(10) CHAOUACHI Kamal. eLetter to the Editor: Some Misconceptions in a Good Alert Paper. Tobacco Control (18 January 2006). A critical analysis of the following study: AFIFI-SOWEID Rima. Lebanon: water pipe line to youth. Tobacco Control 2005;14:363-4. http://tc.bmjjournals.com/cgi/eletters/14/6/363-a#479

(11) WARNIER Jean-Pierre (book). Construire la culture matérielle : l’homme qui pensait avec ses doigts. Presses Universitaires de France (Paris) 1999.

(12) 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.

(13) 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 (tabaccologia.org) 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]. A tetralogy on all aspects of hookah smoking (further issues on Pharmacology, Pathologies and Public Health). All issues available at www.tabaccologia.org and www.tabaccologia.org/archivio.htm)

(14) Among others: NATTO S, BALJOON M, BERGSTROM J. Tobacco Smoking and Periodontal Health in a Saudi Arabian Population. Journal of Periodontology 2005; 76 (11): 1919-26.

(15) 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.