Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences
Identifieur interne : 000328 ( Pmc/Checkpoint ); précédent : 000327; suivant : 000329Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences
Auteurs : Kamal ChaouachiSource :
- International Journal of Environmental Research and Public Health [ 1661-7827 ] ; 2009.
Abstract
Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker’s respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.
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DOI: 10.3390/ijerph6020798
PubMed: 19440416
PubMed Central: 2672364
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A Critical Review of the Relevant Literature and the Public Health Consequences</title><author><name sortKey="Chaouachi, Kamal" sort="Chaouachi, Kamal" uniqKey="Chaouachi K" first="Kamal" last="Chaouachi">Kamal Chaouachi</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19440416</idno><idno type="pmc">2672364</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672364</idno><idno type="RBID">PMC:2672364</idno><idno type="doi">10.3390/ijerph6020798</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000520</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000520</idno><idno type="wicri:Area/Pmc/Curation">000519</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000519</idno><idno type="wicri:Area/Pmc/Checkpoint">000328</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000328</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences</title><author><name sortKey="Chaouachi, Kamal" sort="Chaouachi, Kamal" uniqKey="Chaouachi K" first="Kamal" last="Chaouachi">Kamal Chaouachi</name></author></analytic><series><title level="j">International Journal of Environmental Research and Public Health</title><idno type="ISSN">1661-7827</idno><idno type="eISSN">1660-4601</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker’s respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc xml:lang="EN" article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="publisher-id">101238455</journal-id><journal-title>International Journal of Environmental Research and Public Health</journal-title><issn pub-type="ppub">1661-7827</issn><issn pub-type="epub">1660-4601</issn><publisher><publisher-name>Molecular Diversity Preservation International (MDPI)</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19440416</article-id><article-id pub-id-type="pmc">2672364</article-id><article-id pub-id-type="doi">10.3390/ijerph6020798</article-id><article-id pub-id-type="publisher-id">ijerph-06-00798</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Chaouachi</surname><given-names>Kamal</given-names></name><xref ref-type="corresp" rid="C1"></xref></contrib></contrib-group><author-notes><corresp id="C1">DIU Tabacologie, Université Paris XI / Paris, France; E-Mail:
<email>kamcha@gmail.com</email>; Tel.: +33-1-49289860; Fax: +33-1-4238-0702</corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>23</day><month>2</month><year>2009</year></pub-date><volume>6</volume><issue>2</issue><fpage>798</fpage><lpage>843</lpage><history><date date-type="received"><day>4</day><month>1</month><year>2009</year></date><date date-type="accepted"><day>11</day><month>2</month><year>2009</year></date></history><copyright-statement>© 2009 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland.</copyright-statement><copyright-year>2009</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0"><p>This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/3.0/">http://creativecommons.org/licenses/by/3.0/</ext-link>).</p></license><abstract><p>Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker’s respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.</p></abstract><kwd-group><kwd>Hookah</kwd><kwd>shisha</kwd><kwd>narghile</kwd><kwd>tobacco</kwd><kwd>smoking</kwd><kwd>environmental tobacco smoke (ETS)</kwd><kwd>particles</kwd><kwd>public health</kwd></kwd-group></article-meta></front><floats-wrap><fig id="f1-ijerph-06-00798" position="float"><label>Figure 1.</label><caption><p>The hookah (narghile, shisha) operating procedure and the diverse smoke flows (Chaouachi, Cours du DIU de Tabacologie, Universite Paris XI).</p><p><bold>English terms (from left to right):</bold> TOBAMEL (moassel: tobacco-molasses based mixture) inside the bowl [for “Tabac (tabamel)...”]; BODY CONTAINING A VERTICAL STEM [for “Cheminée avec logement...”]; VALVE [for “Soupape”]; WATER VESSEL [for “Vase” and “Eau”]; FLEXIBLE SUCTION HOSE [for “Tuyau d’aspiration souple”]; OUPUT [for “Sortie”]; ALUMINIUM FOIL (punched with holes) [for “Disque d’aluminium perforé”]; GLOWING COAL [for “Charbon de bois allumé”].</p></caption><graphic xlink:href="ijerph-06-00798f1"></graphic></fig><fig id="f2-ijerph-06-00798" position="float"><label>Figure 2.</label><caption><p>Poster of the French INPES (Institut National pour la Prevention et l’Education a la Sante). This visual aid was used during the 2005 “World No Tobacco Day” campaign sponsored by the WHO. It shows a huge cloud of dense smoke (supposedly ETS) stemming from a hookah and featuring the spectrum of death.</p></caption><graphic xlink:href="ijerph-06-00798f2"></graphic></fig><fig id="f3-ijerph-06-00798" position="float"><label>Figure 3.</label><caption><p>Cover of the American Lung Association’s report on “waterpipe”. It shows a small-size hookah generating SSS on its own (American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. Feb 2007).</p></caption><graphic xlink:href="ijerph-06-00798f3"></graphic></fig><fig id="f4-ijerph-06-00798" position="float"><label>Figure 4.</label><caption><p>Main-Stream Smoke and Side-Stream Smoke in a burning cigarette (Thielen <italic>et al.</italic> [<xref ref-type="bibr" rid="b26-ijerph-06-00798">26</xref>]).</p></caption><graphic xlink:href="ijerph-06-00798f4"></graphic></fig><table-wrap id="t1-ijerph-06-00798" position="float"><label>Table 1.</label><caption><p>Concentration of particles (millions per mL [median Ø]) through the use of a smoking machine (from Becquemin <italic>et al.</italic> [<xref ref-type="bibr" rid="b93-ijerph-06-00798">93</xref>]).</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Concentration of particles
<break></break>(millions per mL [median Ø])</th><th align="center" rowspan="1" colspan="1">Cigarette</th><th align="center" rowspan="1" colspan="1">Narghile</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">MSS</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>3.14</bold> [0.27 μm]</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>3.55</bold> [0.34 μm]
<break></break>(before water bubbling)
<break></break><bold>1.20</bold> [0.27 μm]
<break></break>(after water bubbling)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SSS</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>19</bold> [0.09 μm]</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>2.91</bold> [0.11 μm]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">EMSS (machine)</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>2.26</bold>[0.30 μm]</td><td align="center" valign="top" rowspan="1" colspan="1"><bold>6.22</bold> [0.25 μm]</td></tr></tbody></table></table-wrap><table-wrap id="t2-ijerph-06-00798" position="float"><label>Table 2.</label><caption><p>Particles Filter Efficiency (from Bernstein/McCusker <italic>et al.</italic> [<xref ref-type="bibr" rid="b61-ijerph-06-00798">61</xref>,<xref ref-type="bibr" rid="b89-ijerph-06-00798">89</xref>]).</p></caption><table frame="box" rules="all"><thead><tr><th align="center" colspan="8" rowspan="1">Aerodynamic size and filter efficiency of smoke from commercial cigarettes</th></tr><tr><th align="left" rowspan="1" colspan="1">Cigarette</th><th align="center" rowspan="1" colspan="1">Filter type</th><th align="center" rowspan="1" colspan="1">FTC tar rating<sup>a</sup>(mg/cig)</th><th align="center" rowspan="1" colspan="1">MMAD (μm) with filter</th><th align="center" rowspan="1" colspan="1">MMAD (μm) without filter</th><th align="center" rowspan="1" colspan="1">Number/cm<sup>3</sup> with filter (10<sup>3</sup>)</th><th align="center" rowspan="1" colspan="1">Number/cm<sup>3</sup> without filter (10<sup>3</sup>)</th><th align="center" rowspan="1" colspan="1">Filter efficiency (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">IR2F</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">0.44</td><td align="center" rowspan="1" colspan="1">0.43</td><td align="center" rowspan="1" colspan="1">3.3</td><td align="center" rowspan="1" colspan="1">4.2</td><td align="center" rowspan="1" colspan="1">22</td></tr><tr><td align="left" rowspan="1" colspan="1">Marlboro</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">0.43</td><td align="center" rowspan="1" colspan="1">0.48</td><td align="center" rowspan="1" colspan="1">3.1</td><td align="center" rowspan="1" colspan="1">4.5</td><td align="center" rowspan="1" colspan="1">32</td></tr><tr><td align="left" rowspan="1" colspan="1">Tareyton</td><td align="left" rowspan="1" colspan="1">Cell. acetate + charcoal particles</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">0.50</td><td align="center" rowspan="1" colspan="1">0.47</td><td align="center" rowspan="1" colspan="1">1.6</td><td align="center" rowspan="1" colspan="1">4.0</td><td align="center" rowspan="1" colspan="1">60</td></tr><tr><td align="left" rowspan="1" colspan="1">Doral II</td><td align="left" rowspan="1" colspan="1">Cell. acetate + plastic baffles</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">0.50</td><td align="center" rowspan="1" colspan="1">0.48</td><td align="center" rowspan="1" colspan="1">1.9</td><td align="center" rowspan="1" colspan="1">4.4</td><td align="center" rowspan="1" colspan="1">57</td></tr><tr><td align="left" rowspan="1" colspan="1">Koolite</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">0.43</td><td align="center" rowspan="1" colspan="1">0.38</td><td align="center" rowspan="1" colspan="1">1.6</td><td align="center" rowspan="1" colspan="1">3.9</td><td align="center" rowspan="1" colspan="1">60</td></tr><tr><td align="left" rowspan="1" colspan="1">Merit</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">0.36</td><td align="center" rowspan="1" colspan="1">0.38</td><td align="center" rowspan="1" colspan="1">2.1</td><td align="center" rowspan="1" colspan="1">3.9</td><td align="center" rowspan="1" colspan="1">46</td></tr><tr><td align="left" rowspan="1" colspan="1">Vantage</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">0.47</td><td align="center" rowspan="1" colspan="1">0.48</td><td align="center" rowspan="1" colspan="1">2.7</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1">46</td></tr><tr><td align="left" rowspan="1" colspan="1">Cambridge</td><td align="left" rowspan="1" colspan="1">Cell. acetate</td><td align="center" rowspan="1" colspan="1"><1</td><td align="center" rowspan="1" colspan="1">0.53</td><td align="center" rowspan="1" colspan="1">0.51</td><td align="center" rowspan="1" colspan="1">0.25</td><td align="center" rowspan="1" colspan="1">4.67</td><td align="center" rowspan="1" colspan="1">96</td></tr><tr><td align="left" rowspan="1" colspan="1">Barclay</td><td align="left" rowspan="1" colspan="1">Cell. acetate + vent.holes</td><td align="center" rowspan="1" colspan="1"><1</td><td align="center" rowspan="1" colspan="1">0.56</td><td align="center" rowspan="1" colspan="1">0.36</td><td align="center" rowspan="1" colspan="1">0.57</td><td align="center" rowspan="1" colspan="1">5.9</td><td align="center" rowspan="1" colspan="1">91</td></tr><tr><td align="left" rowspan="1" colspan="1">Carlton</td><td align="left" rowspan="1" colspan="1">Cell. acetate + vent.holes</td><td align="center" rowspan="1" colspan="1"><1</td><td align="center" rowspan="1" colspan="1">0.43</td><td align="center" rowspan="1" colspan="1">0.36</td><td align="center" rowspan="1" colspan="1">0.33</td><td align="center" rowspan="1" colspan="1">5.3</td><td align="center" rowspan="1" colspan="1">94</td></tr><tr><td align="left" rowspan="1" colspan="1">Barclay</td><td align="left" rowspan="1" colspan="1">Vent.holes taped</td><td align="center" rowspan="1" colspan="1">–</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">4.90</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Carlton</td><td align="left" rowspan="1" colspan="1">Vent.holes taped</td><td align="center" rowspan="1" colspan="1">–</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2.37</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="tfn1-ijerph-06-00798"><p><bold>Abbreviations:</bold> Cell. acetate = cellulose acetate; Vent. Holes = ventilating holes.</p></fn><fn id="tfn2-ijerph-06-00798"><p><bold>Notes:</bold> From McCusker et al. (1983)</p></fn><fn id="tfn3-ijerph-06-00798"><p>a) Federal Trade Commission, Dec. 1979, Public Health Service, Office on Smoking and Health and National Cancer Institute, DHS Publication No. (PHS) 80-50135; cig, cigarette.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-ijerph-06-00798" position="float"><label>Table 3.</label><caption><p>Estimated dose ratio between active smoking (20 cig./day) and passive smoking (8 h/day) (Scherer et al. [<xref ref-type="bibr" rid="b100-ijerph-06-00798">100</xref>]).</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Tobacco smoke constituents</th><th align="center" rowspan="1" colspan="1">Smoking (S)(20cig/day)<sup>b</sup></th><th align="center" rowspan="1" colspan="1">Passive smoking (PS)(8h/day)<sup>c</sup></th><th align="center" rowspan="1" colspan="1"><bold>Dose ratio S/PS</bold></th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1"><bold>GASEOUS PHASE</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">CO (mg)</td><td align="center" rowspan="1" colspan="1">40–400</td><td align="center" rowspan="1" colspan="1">14.4–96</td><td align="center" rowspan="1" colspan="1">2.7–4.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Formaldehyde (mg)</td><td align="center" rowspan="1" colspan="1">0.4–1.8</td><td align="center" rowspan="1" colspan="1">0.08–0.4</td><td align="center" rowspan="1" colspan="1">4–5</td></tr><tr><td align="left" rowspan="1" colspan="1">Volatile nitrosamines (μg)</td><td align="center" rowspan="1" colspan="1">0.05–1.0</td><td align="center" rowspan="1" colspan="1">0.03–0.4</td><td align="center" rowspan="1" colspan="1">1.5–2.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Benzene (μg)</td><td align="center" rowspan="1" colspan="1">200–1200</td><td align="center" rowspan="1" colspan="1">40–400</td><td align="center" rowspan="1" colspan="1">3–5</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>PARTICULATE MATTER</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Particles (mg)</td><td align="center" rowspan="1" colspan="1">75–300</td><td align="center" rowspan="1" colspan="1">0.024–0.24</td><td align="center" rowspan="1" colspan="1">1250–3000</td></tr><tr><td align="left" rowspan="1" colspan="1">Nicotine (mg) <sup>d</sup></td><td align="center" rowspan="1" colspan="1">7.5–30</td><td align="center" rowspan="1" colspan="1">0.08–0.4</td><td align="center" rowspan="1" colspan="1">75–90</td></tr><tr><td align="left" rowspan="1" colspan="1">Benzo[a]pyrene (μg)</td><td align="center" rowspan="1" colspan="1">0.15–0.75</td><td align="center" rowspan="1" colspan="1">0.001–0.011</td><td align="center" rowspan="1" colspan="1">70–150</td></tr><tr><td align="left" rowspan="1" colspan="1">Cadmium (μg)</td><td align="center" rowspan="1" colspan="1">1.5</td><td align="center" rowspan="1" colspan="1">0.001–0.014</td><td align="center" rowspan="1" colspan="1">110–1500</td></tr><tr><td align="left" rowspan="1" colspan="1">Tobacco specific nitrosamines (μg)</td><td align="center" rowspan="1" colspan="1">4.5–45</td><td align="center" rowspan="1" colspan="1">0.002–0.010</td><td align="center" rowspan="1" colspan="1">2300–4500</td></tr></tbody></table><table-wrap-foot><fn id="tfn4-ijerph-06-00798"><p>a) Data are compiled from References 16, 19, 97, 38 (as printed in the original by Scherer <italic>et al.</italic>)</p></fn><fn id="tfn5-ijerph-06-00798"><p>b) Assumed deposition rate for particulate matter: 75% (14)</p></fn><fn id="tfn6-ijerph-06-00798"><p>c) Assumed breathing volume: 0.5 m<sup>3</sup>/h. Assumed deposition rate for particulate matter: 11% (13)</p></fn><fn id="tfn7-ijerph-06-00798"><p>d) Nicotine is particle-bound in MS and a gas phase constituent in ETS (7)</p></fn></table-wrap-foot></table-wrap><table-wrap id="t4-ijerph-06-00798" position="float"><label>Table 4.</label><caption><p>The 15 Reasons behind the World Upsurge in Hookah (Narghile, Shisha) Smoking. Originally published in the 4<sup>th</sup> part of the Tetralogy on Hookah and Health: Chaouachi K. <italic>Narghilé: un problema di Sanità Pubblica</italic> [<xref ref-type="bibr" rid="b6-ijerph-06-00798">6</xref>].</p></caption><table frame="box" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"><bold>The 15 Reasons behind the World Upsurge in Hookah (Narghile, Shisha) Smoking</bold></th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">OBECTIVE REASONS</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>1-Global Tourism and Migration Flows</bold><break></break>(back from Egypt, Tunisia, <bold>etc.</bold> with a hookah in the suitcase; hookah lounges in the West)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>2- A New Hassle-Free Lighting System</bold><break></break>(new easy to light charcoal)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>3-Relative Acceptance by Non-Smokers</bold><break></break>(notable smoke irritants filtered out)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>4-Unexepected Backlash Effect of Anti-Tobacco Campaigns</bold><break></break>(viewed as safer than cigarette smoking)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>5-Filtration of Some Noxious Substances</bold><break></break>(some carcinogens, among others, may be filtered out)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>6-A “Light” Dependence</bold><break></break>(seen as easy to quit)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>7-The Influence of Television (case of the Arab World)</bold><break></break>(Egyptian movies have featured hookah smokers for decades)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>8-The Rise of Individualism in Modern Societies</bold><break></break>(socialising needs and the search for new forms of sociability)</td></tr><tr><td align="center" rowspan="1" colspan="1">SUBJECTIVE REASONS</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>9-Conviviality</bold><break></break>(“social” smoking, sharing the hose (ludens), talking, long time passing)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>10-A Powerful Symbolism</bold><break></break>(dream, art, “mysticism”, “peace pipe”)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>11-A Transverse Social, Sexual, Religious and Inter-Generational Practice</bold><break></break>(social and cultural melting pot)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>12-Flavours</bold><break></break>(“tobamel” (mu’assel), a flavoured tobacco (or no-tobacco)-honey/molasses based mixture)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>13-The Cultural Status of Honey</bold><break></break>(Koran, <italic>The Bees</italic><bold>)</bold></td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>14-A Highly Sensory Experience</bold><break></break>(Five senses permanently stimulated)</td></tr><tr><td align="center" rowspan="1" colspan="1"><bold>15-“Rebellion” Values</bold><break></break>(an “anti-modern” concept of time passing in a global world. A social and cultural counter-product of the globalisation process of the Nineties)</td></tr></tbody></table><table-wrap-foot><fn id="tfn8-ijerph-06-00798"><p><ext-link ext-link-type="uri" xlink:href="http://www.tabaccologia.org/PDF/4_2006/7_42006.pdf">http://www.tabaccologia.org/PDF/4_2006/7_42006.pdf</ext-link></p></fn></table-wrap-foot></table-wrap></floats-wrap></pmc><affiliations><list></list><tree><noCountry><name sortKey="Chaouachi, Kamal" sort="Chaouachi, Kamal" uniqKey="Chaouachi K" first="Kamal" last="Chaouachi">Kamal Chaouachi</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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