The world is facing a very peculiar and complex tobacco epidemic and there is unfortunately a growing confusion among experts and health practitioners on how to cope with it [1].

Mokdad and Warren [2] gave a “rosy” picture of an alert paper which is regrettably not empty of misconceptions [3]. As for the literature review by Yunis et al. [4], also commented upon by Mokdad and Warren, I am afraid it lacks scientific rigour.

To start with, Yunis et al take one smoking product for the other. Tumbâk is said to be “a dark paste tobacco” whereas such a description is actually that of another product: jurâk [5].

Concerning the epidemiology of cancers related to narghile smoking, the references to Lubin et al. (1992), Dayal & Kinman (1983), Howe et al. (1980) are irrelevant. The first cited study dealt with a smoking device completely different from the Middle Eastern narghile and, above all, the conclusions reached by their authors do not support Yunis et al’ statement. Finally, the two other cited studies did not mention, at any point, narghile or water pipes of any sort.

As for “patterns, trends and predictors of tobacco use among men and women in Middle Eastern countries”, i.e., not necessarily through a narghile, Yunis et al also cite irrelevant studies; for instance Thompson & Fagerstrom (2006).

As for Fakhfakh et al (2002), I am afraid Tunisia is not a country of the Middle East.

Dr Kamal T. Chaouachi (KamchaAgmail.com) Researcher and Consultant in Tobacco Issue(Paris).

http://PublicationsList.org/kamal.chaouachi

_________ References:

[1] Chaouachi K (2007). Shisha confusion. British Dental Journal 203 (12):669-70. (22 Dec)

[2] Mokdad AH, Warren CW (2007). As if cigarettes were not enough, here comes narghile. Int J Public Health 52 (5):263-4.

[3] Chaouachi K (2006). E-Letter to the Editor: Some Misconceptions in a Good Alert Paper. Tobacco Control (18 Jan) http://tc.bmjjournals.com/cgi/eletters/14/6/3...

[4] Yunis K, Beydoun H, Nakad P, Khogali M, Shatila F, Tamim H (2007). Patterns and predictors of tobacco smoking cessation: a hospital-based study of pregnant women in Lebanon. Int J Public Health 52(4):223-32.

[5] Chaouachi K (2007). The Medical Consequences of Narghile (Hookah, Shisha) Use in the World. Revue d’Epidemiologie et de Sante Publique (Epidemiology and Public Health);55(3):165-70 [article in English].