Is This Just Another Stupid Article Trying To Bash Hookahs?

[Teissenb]

Vague? I sent you a link to the *abstract*, which is a brief summary, usually 250 words or less, of a complete research paper. Have you read the paper (which is 9 pages long)? Here is an excerpt:

"To standardize the experiments, self-starting charcoal
disks manufactured by Three Kings Charcoal Co.
(Holland) sold widely in tobacco supply shops were
utilized, at a rate of one disk for each 100-puff smoking
session. The disks were held by a metal tong with the
radial axis of the disk in a vertical plane, and the bottom
side exposed for 5 s to the flame of a butane
cigarette lighter, and held for an additional 100 s in the
same position to ensure that the ignition agent had been
entirely consumed before placing the charcoal disk on
the argileh head (the reaction front visibly traverses the
entire length of the disk in roughly 45 s after lighting).
The first puff was initiated 15 s after the disk was placed
on the head. One disk, weighing 5.8 g, was used in each
smoking session, and its weight recorded before and
after each session.
Three 250-g packages of the locally most popular type
of mo'assel tobacco mixture (''Two Apples'' flavor,
manufactured by Adel El-Ibiary & Co., Egypt) were
mixed together, and large agglomerations and stems
removed (accounting for approx. 10% of the as-purchased
weight) so as to create a more homogeneous
mixture for the experiments. The mixture was parceled
into airtight packets of roughly 12 g each, and stored in
a sealed container at 20
C in the dark for the duration
of the study. For each smoking run, an individual
packet was unwrapped and 10 g of tobacco mixture was
loaded into the head, essentially filling it.
A small aluminium foil sheet (approx. 9 cm 9cm)
was used to cover the head, and was perforated
according to the 18-hole pattern shown in Fig. 2.
Rather than wrapping the foil tautly over the head,
enough slack was left to allow an approximately 2 mm
depression relative to the head rim to be formed in
order to help hold the coal disk in place during the
smoking session. It was found that when the foil was
wrapped tautly, it tended to form a ''drumhead'' that
vibrated at the bubbling frequency, particularly in the
second half of the smoking session, when the tobacco
under the foil had become stiff and its vibrationdamping
properties reduced. This caused the coal to
migrate, thereby necessitating periodic intervention
during the session to prevent it from marching entirely
off the head (it is quite usual for an argileh smoker to
adjust the coal during a smoking session). With the
depression, the need for intervention was greatly
reduced or eliminated altogether, though the bubbleinduced
vibration remained noticeable.
After each smoking run, the water in the bowl was
discarded, the bowl partially re-filled, shaken by hand
for several seconds, and discarded again. The bowl was
then re-filled with tap water to the water level indicator
line (corresponding to a volume of 785 ml). The head
was emptied, wiped dry with a paper towel, and repacked
with the prescribed 10 g of tobacco mixture. In
keeping with common practice at local restaurants and
coffee shops, there was no attempt to clean any of the
flow passages within the argileh between runs, though
some deposits in the body pipe were visible, with a
thickness of the order 0.1mm.
To further reduce variations between smoking sessions,
all flow interfaces—head/body, body/bowl, and
sidearm/hose—were externally sealed each smoking
session with one layer of electrical tape. In addition, the
body and water bowl were joined via a rubber sleeve
that was originally supplied with the argileh. The ceramic
head fit tightly into the body as supplied with no
rubber sleeve.
The apparatus used in this study was obtained from a
stock of in-use argilehs at a local popular restaurant
frequented by argileh smokers. Some 40 standard
smoking sessions were conducted in the lab prior to the
first set of nicotine and water determinations. It is
expected that aerosol deposition on the various argileh
flow surfaces is greater when the apparatus is new than
when it is well-seasoned, though this remains to be verified
experimentally. The dimensions of the argileh used
in the study are listed in Table 2.

Quoted from: Shihadeh A. 2003. Investigation of the mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol, 41: 143-152.

I think, if you would please read the paper, you will find many answers to your questions. With all due respect, until you read the *entire* paper, criticisms of it are simply not well-informed.

No one knows what is in the "nicotine free dry particulate matter" (which is the legal definition of "tar") that is in waterpipe smoke. Addressing questions like this takes time and a great deal of money. We are working on it.

I suspect, as you do, that lead does not occur in shisha tobacco (though I have not analyzed shisha tobacco for lead content, so I have no data to support my suspicion. I suspect that the lead occurs in the charcoal, and we are working to determine if this suspicion is supported by the data.

St Goody:

I posted two responses on that blog, one clarifying remarks attributed to me about cigarettes, the other addressing your statements about the science behind the article that was posted. I am reprinting that second response here:

"Also, the details St. Goody requests are available by reading the scientific articles on which the comments were based. You may need to go to a library to get the full text, but the relevant abstracts can be found here:

http://www.ncbi.nlm.nih.gov/pubmed/1245373...Pubmed_RVDocSum

and

http://www.ncbi.nlm.nih.gov/pubmed/1577800...Pubmed_RVDocSum

Both of these articles were reviewed by experts prior to publication, and both used state of the art methods that mimic, to the best of current knowledge, the way in which waterpipe users smoke (based on detailed observation of waterpipe users in Beirut, Lebanon). In short, this work is not casual, fly-by-night research by some amateur. It is high quality science. I am certain it can be improved, and we are working to improve on it. Nonetheless, it deserves to be read and understood before it is critiqued."

I mean no disrespect to you and I agree that the article could have referenced its sources more clearly. I do want to assure you that there is science behind the statements that were made, that this science can be defended, and that it most assuredly can be improved. We are working to identify what is in hookah smoke and what gets from the smoke into the users. Already it looks as though what is in the smoke is nicotine, "tar" that contains several well-known carcinogens, carbon monoxide, and a variety of heavy metals. Nicotine and CO have been measured in hookah smokers immediately after they smoke (the article refers to these studies as well, they were conducted in Jordon and you can find out more about them by using PubMed to search for "Shafagoj" the scientist that conducted the work). Now, we can quibble about the methods, and I'll grant you again that they can be improved. However, there is no argument that these smoke constituents, when inhaled, are dangerous to humans. Period. My goal is to inform people of the risks, and that is why I pursue this work. What you do with the information, whether you choose to believe it or act upon it -- I agree completely that these issues are for you and not me to determine.

I agree wholeheartedly that hookah smoking is hazardous to your health. However, I disagree strongly with the implied effects of hookah smoking.

Also, the information within the two links seems quite vague for a research paper. The statement "results using a common mo'assel tobacco mixture" does not tell you which brand, type, or flavor the shisha is. The comparison to the smoke in an entire hookah session using 1.5 coals and 171 puff
s to a single cigarrette is also highly flawed, as the amount of tobacco smoked in a session with 1.5 coals is much larger than what is in cigarrettes. The usage of the term "nicotine free dry particulate matter" does not state how much of the said particulate matter is toxic. I am not certain what kind of mo'assel was used for that experiment, but lead does not occur in shisha. That is most likely a result of the pipe that was used, which is another piece of information which is left out.

Once again, I must protest the use of unreferenced "experts" in any supposedly valid research paper. Anyone at all can claim to be an expert on a subject.

I think that the interpretation of the severity of the results needs serious rethinking, and that any scientific conclusion is not valid until it is repeatedly shown true. I also think that informing people of the risks and using misleading information to affect people's opinions are two completely different things.

I will post this response on the site as well in the hope of informing people of the risks of not investigating claims.


With respect and hope,
St. Goodypants

Edited February 14, 2008 by Teissenb

[gaia.plateau]

If smoked properly, there is no "nicotine free dry particulate matter" in waterpipe smoke. This occurs when a waterpipe is handled by a research assistant, instead of a hookah smoker, and heat is poorly managed. In normal circumstances, which is what any waterpipe study should be trying to replicate, the ma'assel is not burned and no particulate matter forms in the smoke. This is probably the single biggest problem with every waterpipe study to date.

I've read your article in full, and as you admit in the quoted text, it is not conclusive in any way as to either the physically addictive or physically detrimental properties of waterpipe smoking. This is why it is so academically and intellectually irresponsible of you to make claims about the "behaviour" of considering waterpipe smoking to be less harmful than cigarette smoking, and why it must be prevented.

No one knows what is in the "nicotine free dry particulate matter" (which is the legal definition of "tar") that is in waterpipe smoke. Addressing questions like this takes time and a great deal of money. We are working on it.

I suspect, as you do, that lead does not occur in shisha tobacco (though I have not analyzed shisha tobacco for lead content, so I have no data to support my suspicion. I suspect that the lead occurs in the charcoal, and we are working to determine if this suspicion is supported by the data.

Edited February 14, 2008 by gaia.plateau

[Teissenb]

With regard to nicotine free dry particulate matter, I must disagree. For your contention to be true, the smoke that emerges from a waterpipe, without any nicotine free dry particulate matter, would be nicotinized STEAM (with other non-particulate gasses like CO). You see, nicotine free dry particulate matter is whatever solids are left in the smoke when you remove the nicotine (hence "nicotine free") and you remove the water (hence, "dry"). You claim that there is no nicotine free dry particulate matter (NFDPM) in waterpipe smoke, so you are arguing that waterpipe smoke consists solely of nicotine and water (and other gasses like CO). Do you really believe this statement? If so, I fear continued discussion between us on this point will prove valueless.

By definition, almost *any* smoke contains NFDPM. Whatever particulates that aren't nicotine and aren't water is NFDPM. The question is *not* "Is there NFDPM in waterpipe smoke?" Of course there is. The question is "Is the NFDPM in waterpipe smoke harmful?". So far, judging by the contents that we know of, the answer is "Almost certainly, yes, at least with long-term, regular use." That is, we know that the NFDPM from a waterpipe contains polycyclic aromatic hydrocarbons, which are known potent carcinogens. We know that the NFDPM contains heavy metals, which, over the long-term, can cause disease and death. Does that mean every waterpipe smoker in the world will drop dead tomorrow from cancer or lead poisoning? No, of course not. Nor does it mean that we should ignore these facts about the carcinogen content or heavy metal content. As many folks on this forum have written, inhaling smoke is bad for you. Period. The question I hope to answer is "How bad?" I continue to hope that you and other waterpipe smokers will be interested in the answer.

You say you have read the article in full, and I hope we are talking about the same one -- the Shihadeh 2003 article from which I quoted above. In that article, detailed measures of the temperature of the tobacco were taken throughout the sessions (see Figure 3, page 147). If you would please look at Figure 3, you'll note that the center of the tobacco never reaches a temperature greater than 130 degrees C, and that was at the very end of the session. For the most part, the temperature of the center of the tobacco was within the range of 80 to 120 degrees C. What temperature is the tobacco you smoke during a smoking session? On what basis do you suggest that, in the Shihadeh 2003 experiments, the "heat is poorly managed" or that the ma'assel was burned?

I never said, in the quoted text or elsewhere, that waterpipe tobacco smoking is not physically addictive or physically detrimental. I said, in the quoted text, that we do not know what is in the NFDPM (and what I meant was ALL that is in the NFDPM, obviously we know a little bit, as I wrote above). With regard to addiction/dependence we do know, from a series of published scientific studies, that *some* waterpipe smokers are dependent (indeed, I have read statements to that effect on this forum). See, for example:

Maziak W, Ward KD, Eissenberg T. 2004. Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users. Drug Alcohol Depend, 76: 101-106.

Maziak W, Eissenberg T, Ward KD. 2005. Waterpipe use and dependence: implications for intervention development. Pharmacol Biochem Behav, 80: 173-179.

There is also evidence, albeit imperfect evidence, linking waterpipe tobacco smoking to health issues. This evidence has been reviewed several times, including:

Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. 2004. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tob Control, 13: 327-333.

and
http://www.ncbi.nlm.nih.gov/entrez/query.f...%22%5BAuthor%5DKnishkowy, B and Amitai, Y. 2005. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116(1): e113-9.


There is also ample evidence of CO and nicotine exposure in waterpipe smokers, including:

Zahran FM, Ardawi MSM, Al-Fayez SF. 1985. Carboxyhaemoglobin concentrations in smokers of sheesha and cigarettes in Saudi Arabia. BMJ 291:1768-70.

Shafagoj YA, Mohammed FI. 2002. Levels of maximum end-expiratory carbon monoxide and certain cardiovascular parameters following hubble-bubble smoking. Saudi Med J 23: 953-8.

Shafagoj YA, Mohammed FI, Hadidi KA. 2002. Hubble-bubble (water pipe) smoking: levels of nicotine and cotinine in plasma, saliva and urine. Int J Clin Pharmacol Ther 40: 249-55.

Neergard, J, Singh P, Job J, Montgomery S.http://www.ncbi.nlm.nih.gov/pubmed/1794361...Pubmed_RVDocSum Waterpipe smoking and nicotine exposure: a review of the current evidence. Nicotine Tob Res. 2007 Oct;9(10):987-94.

These and other studies suggest that waterpipe tobacco smoking is associated with many of the same toxins, and many of the same health risks, as cigarette smoking. I'm sorry if you think me irresponsible, but I think I am being honest when I say that we need to be aware of the very real risks.

Finally, with regard to preventing the behavior, I fear that my meaning may be misinterpreted. When I speak of preventing waterpipe use, I do *not* mean walking into your house and forcibly removing your waterpipe and tobacco. What I mean is, providing the facts about tobacco smoking to health conscious individuals so that they choose, based on those facts and their concern for their own health, to avoid tobacco use in the future. This goal is a long-term one and, in my mind, does *not* include bans or making tobacco use of any form illegal.

With respect,

Tom E.

PS: Please understand that I would love to post the full articles that I have cited above, but they are all copyrighted. Posting them here would violate the rules of the HookahForum.com as well as international copyright law. Some of the articles may be public access, and others you should be able to get by heading to a library at a university near you. I urge you to read them, in their entirety, and I think you will see that the folks writing them are quite knowledgeable. As for myself, I have smoked waterpipes in Syria, Lebanon, Germany, and, of course, here in the U.S. I have spent considerable time in waterpipe bars observing the method and the culture. I own three waterpipes myself. Please do not assume I do not know how to smoke them.

On preview, I see that there are some links to the ABSTRACT of some articles (don't know how that happened). Anyway, please be aware that these ABSTRACTS are brief summaries -- the articles are usually 2000-4000 words long, and will be much more informative.

If smoked properly, there is no "nicotine free dry particulate matter" in waterpipe smoke. This occurs when a waterpipe is handled by a research assistant, instead of a hookah smoker, and heat is poorly managed. In normal circumstances, which is what any waterpipe study should be trying to replicate, the ma'assel is not burned and no particulate matter forms in the smoke. This is probably the single biggest problem with every waterpipe study to date.

I've read your article in full, and as you admit in the quoted text, it is not conclusive in any way as to either the physically addictive or physically detrimental properties of waterpipe smoking. This is why it is so academically and intellectually irresponsible of you to make claims about the "behaviour" of considering waterpipe smoking to be less harmful than cigarette smoking, and why it must be prevented.

No one knows what is in the "nicotine free dry particulate matter" (which is the legal definition of "tar") that is in waterpipe smoke. Addressing questions like this takes time and a great deal of money. We are working on it.

I suspect, as you do, that lead does not occur in shisha tobacco (though I have not analyzed shisha tobacco for lead content, so I have no data to support my suspicion. I suspect that the lead occurs in the charcoal, and we are working to determine if this suspicion is supported by the data.

Edited February 15, 2008 by Teissenb

[ykol20]

I saw this video posted by another user and thought it was quite interesting http://youtube.com/watch?v=-DbFBu_I_lA

I have not had a chance to read the articles yet, I may if I am bored. The conclusion that the research comes to is something like "hookah smoke is equal to ##cigs in tar content" correct? That begs the question... Why do some hookah bars that operate the entire day without refilling the water in the pipes all have crystal clear water in the vases?

Not saying the research is bad research or anything, but obviously, from that video, there is something unaccounted for. (I honestly need to read the articles, so take this response with that in mind)

[St. Goodypants]

Much better, though your knowledge on the subject does not apply to the research being done or the results.

I've got one more question though:
Where are you getting "nicotinized steam"?

Thank you for clarifying
St. Goodypants


edit: Should this topic be moved to the serious discussion thread? Edited February 15, 2008 by St. Goodypants

[Bulldog_916]

Sir:

You may not be going into this venture with prevention of hookah smoking in mind, but that is what invariably all research of this caliber goes toward.

When people were informed of the dangers of cigarette smoking ON THE BOX, they still did it and the anti-tobacco lobby wasnt satisfied. They cooked up a story about second hand smoke and eventually got billboards advertising tobacco removed from within 1 mile of schools. Then there were no billboards advertising tobacco period. Then there were no commercials with tobacco products in them period. Then smoking sections of bars and restaurants were established to keep smoking patrons away from non-smoking patrons. Then they were removed and all smoking was banned inside bars and restaurants. Now it's being pushed back to 15 feet from all entrances. Now smoking inside SMOKING establishments is being banned. You cant eat or drink inside them. You arent allowed to smoke inside places that sell tobacco unless 80% of the revenue comes from selling tobacco. Sir, do you see where this is going? The same lobbies that have done all that about cigarette smoking are now focusing on hookahs and hookah tobacco because it has become popular with a younger crowd. People (like me) who wouldnt even think about picking up a cigarette are picking up hookah pipes. This concerns those very same anti-tobacco lobbies. Do you see where it will go? Pretty soon, there wont be lounges where you can smoke with your friends.

[Teissenb]

St. Goody:

My comment regarding nicotinized steam was a way of demonstrating the absurdity of the statement that there is no NFDPM in waterpipe smoke. I do not believe that the smoke that emerges from a waterpipe hose is nicotinized steam, but, if there were no NFDPM, that is largely what waterpipe smoke would be. I say this because tobacco smoke has been defined as containing 4 groups of constituents:

1) gasses like CO and NO
2) nicotine
3) water in vapor form (i.e., steam)
4) nicotine-free dry particulate matter (aka "tar").

If someone asserts that waterpipe smoke has no NFDPM or "tar", they are saying that waterpipe smoke must therefore only contain gasses like CO and NO, nicotine, and water. Hence, nicotinized steam. Again, I *DO NOT* assert this. It is merely the logical result of the statement that there is no NFDPM in waterpipe smoke. Of course there is NFDPM in waterpipe smoke -- the question is "How dangerous is waterpipe NFDPM?"

I am uncertain why you state that my "knowledge on the subject does not apply to the research being done or the results". In many cases, my colleagues and I are conducting the research and writing the results (I have co-authored over 15 peer-reviewed, scientific papers on waterpipe tobaccco smoking). In other cases, I work closely with the investigators doing the research and writing the results. Can you please help me understand what you meant?

Much better, though your knowledge on the subject does not apply to the research being done or the results.

I've got one more question though:
Where are you getting "nicotinized steam"?

Thank you for clarifying
St. Goodypants


edit: Should this topic be moved to the serious discussion thread?

[Boersnoes]

This is a rather interesting discussion…

I haven't read the articles but for the excerpts posted here on the forum.
Tomorrow I will have more time to read.
I for one, have never doubted the smoke of hookahs is any less toxic then cigarettes are.
Actually I believe the professional cigarette filters probably do a way better job then water does.
Although the water does smell/taste funky after even a single session (yes, I tried, don’t ask) I don’t believe it holds back all the tar (or NFDPM as it seems to be called). If this was the case, water-based filtering systems would already have existed for cigarettes.
I do feel that water pipes are less addictive then cigarettes though. I have never touched a single cigarette with the intend of smoking it in my entire life, but I do have lots of people in my social environment that do. They all wanted to quit at one time, because “it just tastes like it smells”, but sadly they all have given up fighting the addiction.
Whereas I don’t have any problem to have a 6 month winter hookah-stop every year - _without_ the nicotine patch/horrible pictures mambo jambo.

Further consideration has to be made though. Next to the health issues it would also be interesting to compare social behaviours between hookah users and cigarette smokers.
Have you ever seen a person sneak out during 7AM breakfast to have his/her morning hookah? Have you ever seen a person carry his hookah with a day’s worth of shisha to work?
Have you ever seen bits of used shisha lying around buss-stops, blocking water flow in the gutters? Do you have to throw your clothes in the washing machine every time you have smoked some shisha? Do your eyes tear on hookah-parties?

In my eyes, hookah is an sich at least (if not more) hazardous for your personal health. But because of the different social setting and less frequent use (in general context, there are always exceptions off course) I prefer a hookah smoker over a cigarette smoker any day.

That said, I do support Teissenb’s statements out of general curiosity. And I think along his line in terms of motivations, but I also see the point of Bulldog_916.
As of this year, there are tobacco seals required in Belgium for Shisha to (legally) cross the borders. This is, I fear, a first step along a road that will end in closing down hookah bars and pushing the hookah in even more dark corners.

This disinformation of people also helps in the fear for hookahs. Even today, most bar tenders don’t allow hookah’s to be lit anywhere near their establishments in Belgium because they fear the green stuff will be involved somehow. Even the argument that weed can be smelled from miles away doesn’t convince them because “they just don’t want any trouble”.

There! As for an inconclusive post, I think this one just raised the bar.
And I hope the last paragraph didn’t break the hookahforum’s rules, seen the context.

[St. Goodypants]

I didn't realize that you had participated in the tests. That's what I meant.

[Boersnoes]

Sorry for reviving an old post, but I'm just too curious.
Is there any news on this?

My father (a chemist) suggested that the metals could come from the head itself. The products used to colour the clay could very well contain them.
Clay that is used for storing food normally has to adhere very strict rules on what is mixed in it .
And I'm pretty sure hookah heads don't have to follow those rules...

[Canon]

im pretty sure they wouldnt use lead paint for our clay heads.

[Bulldog_916]

Even if they did, it doesnt get hot enough to vaporize lead or even get it into a state where vaporization is possible. There's lead in crystal and no one is out trying to ban fine crystal ware.

[Bushbr]

bet you 10 to 1 the health department PAYED him to put that loud of shisha juice in there.

I figure shisha juice tastes vile enough to be a good saying..... like hogwash, and all that