Hookah Smoking Harmfulness : Correcting a Few Errors and Clarifying Some Points of Interest Kamal Chaouachi, DIU Tabacologie, Universite Paris XI (France) 20 January 2010 Dear Editor, NICOTINE. Aljarrah et al state that “scientific facts indicate that” when compared to cigarette smoking "hookah smoke also contains 36 times the amount of nicotine” . The authors cite for this purpose two papers from the US-American University of Beirut. In fact, this elevated figure is not that that for nicotine and it should be divided by at least 18. Indeed, there is a growing consensus among tobacco control researchers that one hookah session would not deliver more nicotine than one single cigarette. TEMPERATURES. There is also another error concerning the working temperatures. 900°C is a common figure for the temperature at the tip of a cigarette, not inside the hookah bowl as Aljarrah et al state. 450°C is the temperature of the glowing charcoal (of the quick self-lighting type). It should be noted that there is a thermal foil screen separating the heating source from the mixture so the temperature inside the bowl hardly goes in excess of 200°C. Furthermore, tobacco (or, more properly, the tobacco-molasses based mixture) does not burn in a hookah bowl but is simply heated. These points were clarified in a commentary about the WHO report cited by the authors . ORIGINS. The WHO report mentions the 16th century and not the previous one put forward by Aljarrah et al. In any case, the same above-mentioned commentary suggested, among others, a chief archaeological reference showing that water pipes were dug out in Eastern Africa two centuries before . GENDER USE. Aljarrah et al state that “late in the 19th century, hookah use started spreading among women in the Middle East". However, the use by women is as old as the invention of the device. A prestigious Syrian female lung specialist who has been studying this practice for two decades, clearly shows that women in this region “have been smoking narguileh water pipes for centuries”. SECOND-HAND SMOKE. This problem should not be exaggerated and the focus should remain on the hazards of active hookah smoke, i.e. the one inhaled by the smoker. Indeed, US researchers have early pointed out that “one of the only articulated benefits to this tobacco alternative is the minimal release of side-stream smoke, which would ultimately place by-standers at risk for ETS exposure” . GATEWAY HYPOTHESIS. This hypothesis (switching from hookah to cigarette use) is acceptable. However, one should not omit to mention negative results such as those from an important recent Australian survey involving a large sample. Its authors conclude that they “are not alarmed about potential switching as only one ex-CCP [Cigarette/Cigar/Pipe] smoker (out of 1,102 respondents) also reported smoking WT [Water pipe Tobacco] on a daily basis” . ________________ REFERENCES  Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tob Induc Dis. 2009 Dec 18;5(1):16. [Epub ahead of print] http://www.tobaccoinduceddiseases.com/content/5/1/16  Chaouachi K. A Critique of the WHO's TobReg "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. Journal of Negative Results in Biomedicine 2006 (17 Nov); 5:17. http://www.jnrbm.com/content/pdf/1477-5751-5-17.pdf  Van Der Merwe NJ: Cannabis Smoking in 13th-14th Century Ethiopia: Chemical Evidence. In World Anthropology: Cannabis and Culture. Edited by Vera Rubin: Mouton Publ. (The Hague); 1975: 77-80.  Mohammad Y, Kakah M, Mohammad Y. Chronic respiratory effect of narguileh smoking compared with cigarette smoking in women from the East Mediterranean region. Int J Chron Obstruct Pulmon Dis. 2008;3(3):405-14.  Deckers SK, Farley J, Heath J. Tobacco and its trendy alternatives: implications for pediatric nurses. Crit Care Nurs Clin North Am 2006 (Mar);18(1):95-104.  Carroll T, Poder N, Perusco A. Is concern about waterpipe tobacco smoking warranted? Aust N Z J Public Health. 2008 Apr;32(2):181-2. Competing interests no competing interests.