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The tobacco health nexus? Health messages in narghile advertisements
  1. Joanna Khalil,
  2. Robin L Heath,
  3. Rima T Nakkash,
  4. Rema A Afifi
  1. Department of Health Behavior and Education, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  1. Correspondence to Dr Rema A Afifi, Department of Health Behavior and Education, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon; ra15{at}

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In many parts of the world, cigarettes are not the only form of tobacco smoked.1 2 In the eastern Mediterranean region, narghile (water pipe) is a more traditional form of tobacco consumption. The Lebanon Global Youth Tobacco Survey (GYTS), conducted among schoolchildren in 2005, indicated that 61% were current users of tobacco and 33.9% currently smoked narghile.3 Research on the narghile smoke constituents suggest it is as harmful—if not more harmful—than cigarettes.4 5 Recently, narghile smoking has become “big business” and a variety of marketing techniques are being used to emphasise the enjoyable facet of smoking while disregarding its detrimental health effects.

One interesting marketing technique has been the use of health messages to market narghile products. This makes the narghile look like a healthy behaviour, more acceptable and, thus, more attractive for many people. For example, in one advertisement for locally manufactured tobacco, the slogan “untouched by human hands” was used as an indicator of “the purity” of the product. In addition, the product was shown to be manufactured in state-of-the-art machines, indicating a product that is modern and meant to appeal to a new generation concerned with cleanliness and health.

Simultaneously, two advertisements for a type of charcoal used to light the narghile charcoal embers were advertised as being “natural” and made of “100% coconut shell”, smokeless, odourless and “free of chemicals.” One of these advertisements ends with the comment that not a single tree was cut down to produce the charcoal (fig 1). Narghile smoking is highlighted as safe and environmentally friendly. The brand name furthers this image by using the prefix “eco” thus conferring eco-friendly legitimacy on the image of narghile smoking.

Figure 1

Ad for type of charcoal used to light the narghile.

Although the above two examples specifically mention the health aspect of narghile, other messages are more tacit. For instance, in an advertisement for a brand of mo’assel, the fruit-flavoured narghile tobacco, what first hit your eye is the fresh watermelon, constituting the background of the ad (fig 2). Although the photograph of the narghile is shown on the left of the ad, the mouthwatering fruit is impossible to miss. This watermelon, and the other fruits that indicate the different available flavours, make narghile seem as healthy as the fruits. The fruit-flavoured mo’assel is implicated in the resurgence of smoking narghile.6 In addition, and to enhance this nexus, actual fruits are used to hold the water; so narghile is offered in watermelons and pineapples (fig 3).

Figure 2

Ad for fruit-flavoured narghile tobacco.

Figure 3

Narghile in the shape of a pineapple.

As suggested by the specific examples above, the myth of the narghile smoking being less harmful than cigarette smoking is being exploited by a new tobacco industry. This new spin on the image of the narghile, as associated with the Western green revolution and the implied healthy lifestyle, is consistent with the belief that narghile smoking is a safe alternative. In light of the current weak policy and regulatory framework for tobacco control in Lebanon,7 a serious commitment from health stakeholders and advocacy groups is mandatory to counter these false claims.



  • Funding This paper was supported by a generous grant from Research for International Tobacco Control, an IDRC secretariat.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.