| The Hookah (Shisha, Narghile, Goza) |
 |
A hookah (shisha, narghile, goza, etc.) is a kind of pipe
that filters tobacco smoke or, more and more often these
days, that produced by a heated tobacco (or no-tobacco)-molasses/fruits
based mixture. The corresponding practice has created,
through the past centuries, a whole culture based on
a peculiar form of sociability that young people in the
English-speaking world sometimes call “social smoking”.
Indeed, this conviviality (from Latin “convivialis”=
to share [a meal, etc.]) deeply stamped many societies
of Africa and Asia. This “bel objet” [nice
to look at artefact] is often seen as: a pretext for
conversation; a socially, religiously and sexually egalitarian,
playful, situationist and poetic symbol of time passing;
etc. Its origins go back far before the diffusion of
tobacco in the world (16th –17th). It has not posed
any particular medical problem for centuries. However,
it may today introduce new problems because some of its
inner anthropological characteristics have been actually
changing over the last 2 decades. For example, the nature
of the smoked products changed or switched: from raw
plain tobacco (tumbâk, tumbeki, tütün)
or jurâk (raw tobacco mixed with molasses [a sugar
by-product] and/or soaked fruits, oils…), used
within relatively standardised socio-cultural frameworks
towards Tobamel (Mu‘assel in Arabic [i.e. a honeyed
mixture]; “mel” means honey in Latin).
A- The tobamel is one of the chief reasons behind the world
upsurge that surprised the World Health Organisation to
the highest point [1][2]. This product is actually a “light” and
gooey version of the jurâk. It also contains glycerol
as a moistening agent and quite often flowers or fruits
essences (apple, strawberry, rose, etc.). Once it is packed
inside the bowl of the pipe, it must be covered by an aluminium
foil pierced with small holes, that will be topped in its
turn by one or several pieces of charcoal. The hot gases
of their combustion, and not that of tobacco (as in cigarettes),
will cause the “distillation” of some of its
components (flavours, nicotine, etc). Today the use of
opium or cannabis remain very limited.
B- Amazingly, the tobamel produces a non-irritating smoke,
much milder than that of a cigarette. This is because most
of the aldehydes (molecules that are quite aggressive to
the respiratory mucous membranes) are watered down. In
these conditions, the users can inhale such a smoke directly
into their lungs and, visibly, in great volumes. In spite
of this softening process, it could be as harmful as that
of a cigarette. In the case of a daily use, it could cause
respiratory diseases like the COPD (Chronic Obstructive
Pulmonary Disease) [3].
C- The tobamel (mu‘assel) is often used with a self-lighting
coal the chemical composition of which is still unknown.
Coal combustion produces carbon monoxide (CO), a hazardous
gas. Consequently, it is very important to efficiently
ventilate the rooms where a hookah smoking session is to
take place. Otherwise, as it often happens in Europe (where
narrow rooms may host several shishas and cigarettes simultaneously
lit), the intoxication risks are real. Common symptoms
are headaches, pulse acceleration and a muscular weakness.
This is because CO prevents oxygen from binding to the
red blood cells and inside the muscles.
D- The socio-cultural guard-rails (ritual, etiquette, etc)
dissolved to a large extent as a result of the transplantation
of the practice from its homelands to other continents.
Even basic hygiene (changing the water; stopping the smoking
session before the tobamel gets charred; cleaning the elements
of the paraphernalia; using a personal sterile nozzle;
etc) is not always observed.
Nicotine and Tobacco Dependence. Many cigarette smokers
actually “switch” to shisha use. However, as
water retains part of the nicotine, this could be a first
reason for of a weaker dependence (particularly in the
case of tobamel). However, it is now established that dependent
smokers can draw from the device all the nicotine their
body may need (“compensation”). If they have
time, they may become “chain smokers”. Otherwise,
they come back to cigarette smoking which is a more efficient
nicotine delivery tool. As hookah smokers would absorb
less nicotine than cigarette users, this might also mean
that this alkaloid is not the chief central substance involved
in the tobacco dependence process [4]. Indeed, hookah dependence,
when it appears, is very peculiar because the related behaviour
and environment are very special. Its sound study requires
the development of complex questionnaires, closer to the
one designed by Etter and colleagues than that, more “traditional”,
called the Fagerström Dependence Test [5].
Tar. Shisha smoking (including shisha with tobacco-free
tobamel) produces tar. However, it is likely very different
from that produced by cigarettes because of the great differences
in temperatures (hundred of degrees).
Diseases. Hookah smoking is a tobacco use mode which produces,
because of the coal, an important quantity of CO. Unlike
snuff or orally-taken tobacco (Swedish SNUS), it cannot
be presented as a valid medical alternative to cigarette
use. When smoked on occasions, its health effects could
be similar to those of the short “European” pipe
or the cigar. Used heavily (one or more pipes a day), it
is likely that a pathology comparable with that induced
by cigarettes could appear in the long term; in particular
bronchial and bladder cancers, infarction and arteritis.
Unfortunately, we tragically lack thorough and serious
studies -on the long term and focussing on exclusive narghile
users-, in order to be able to objectively evaluate the
corresponding risks. In the meantime, concern over the
diffusion of such a practice outside its original socio-cultural
environment is certainly logical. However, this issue must
be addressed with great tact, cleverness and the strictest
scientific rigour [6].
| |
Dr Kamal T. Chaouachi
Researcher and Consultant in Tobacco Control (Paris)
Author of: Tout savoir sur le narguilé. Société, culture,
histoire et santé [Eng.: Everything You Always Wanted to Know about Hookahs.
Society, Culture, Origins and Health Aspects]. Paris, Maisonneuve et Larose 2007,
256 pages, colour.
http://docs.google.com/View?docid=dgbz283m_19f97ts3
|
|
_________________________
References:
[1] Le rapport de l’OMS sur le narguilé :World
Health Organization (Tobacco Free Initiative): Advisory
Note. Waterpipe Tobacco Smoking: Health Effects, Research
Needs and Recommended Actions by Regulators. 2005. Retrieved
15 Dec. 2005 from http://www.who.int/tobacco/global_interaction/tobreg/en/
[2] Evaluation du rapport de l’OMS sur le narguilé:
Chaouachi K. A Critique of the WHO’s TobReg “Advisory
Note” entitled: “Waterpipe Tobacco Smoking:
Health Effects, Research Needs and Recommended Actions
by Regulators” [Fume du tabac au moyen du narguilé :
Effets sur la santé, besoins en recherche et actions
recommandées par les régulateurs](2005).
Journal of Negative Results in Biomedicine 2006 (17 Nov);
5:17.
http://www.jnrbm.com/content/5/1/17
[3] Waked M. Mémoire du Diplôme Inter-Universitaire
de Tabacologie. Paris (France), 2003. Faculté de
Médecine Paris-Sud, CHU Kremlin-Bicêtre (France).
[Eng.: Thesis for the Inter-University Degree in Tobaccology]
[4] Al-Mutairi SS, Shihab-Eldeen AA, Mojiminiyi OA, Anwar,
AA. Comparative analysis of the effects of hubble-bubble
(Sheesha) and cigarette smoking on respiratory and metabolic
parameters in hubble-bubble and cigarette smokers. Respirology
2006; 11: 449-55
[5] Etter JF. Evaluation de la dépendance au tabac
[Evaluating tobacco dependence]. Rev Med Suisse 2006 (Nov)
29;2(89):2744-8.
[6] Chaouachi K. The Medical Consequences of Narghile (Hookah,
Shisha) Use in the World [Fr: Les conséquences médicales
de l’usage du narguilé (chicha) à travers
le monde]. Revue d’Epidemiologie et de Sante Publique
(Epidemiology and Public Health) 2007;55(3):165-70.[Article
in English]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17446024&itool=pubmed_DocSum
See also:
© copyright K.C. 2006 and 2007 |
