Dear Editor,

I wish to thank Dr Hanna and her colleagues for this excellent study (1). I would like to share below a few comments.  We can read, under the “Social Acceptability” heading:

“Within the Bangladeshi community smoking was not acceptable as Islam forbids addiction to any substance. However, it was agreed that smoking was a habit for some Muslims, although much less acceptable in women than in men. Smoking using a hookah was uncommon in Scotland owing to the absence of strong sunlight for drying the tobacco. It was more acceptable to chew paan, which was common among women and men. It was thought that truthful answers to questions on smoking might be more likely if the questions were put by a doctor or by an independent researcher.”

First off, Islam does not “forbid” many things. It is an extremely tolerant religion; so tolerant that even Western tobacco control activists are often amazed to see how anti-tobacco campaigns are difficult to implement in the corresponding countries (2):

« Lâ ′ikrâha fî-d-dîn » (Let There Be No Compulsion in Religion) (Qur’ân: II, 255)

Concerning hookah (shisha, narghile) smoking, I think the questionnaire could have been enhanced at this point for two main reasons:

1-because of the tremendous recent development of hookah smoking in the world, already called an epidemic by some researchers;

2-the interviewees were probably thinking of the traditional raw tobacco usually prepared in their remote country. However, more and more people, in the United Kingdom and other countries of the world, now smoke a hookah with a ready-to-use tobacco or non-tobacco molasses based mixture called tobamel or “mu‘assel” (i.e. honeyed in Arabic)(3). In these conditions, their answer was expected and, I would add, naďve: no sun so no sun-cured tobacco…

This adapted questionnaire by Hanna and colleagues is, I insist, original and excellent and I have no doubt that “the methods and lessons are applicable internationally”. It is not biased as it actually happened with another one in Lebanon where the interviewees did not know that some questions related to the supposed established detrimental health effects of hookah smoking were, in fact, referring to a study based on a “waterpipe” smoking machine in a laboratory and powered by a type of charcoal (quick self-lighting) that  is not used in their country (4).

Kamal Chaouachi (kamchaAgmail.com)

______________

REFERENCES

(1) Hanna L, Hunt S, Bhopal RS. Cross-cultural adaptation of a tobacco questionnaire for Punjabi,Cantonese, Urdu and Sylheti speakers: qualitative research for better clinical practice, cessation services and research . Journal of Epidemiology and Community Health 2006;60:1034-1039.

(2) Chaouachi K: Le narguilé : analyse socio-anthropologique. Culture, convivialité, histoire et tabacologie d’un mode d’usage populaire du tabac. Doctoral thesis, Université Paris X (France). [Eng.: Narghile (hookah): a Socio-Anthropological Analysis. Culture, Conviviality, History and Tobaccology  of a Popular Tobacco Use Mode]. Published by ANRT (Lille), 420 pages.

(3) 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.

www.jnrbm.com/content/5/1/17 

(4) Chaaya M., Roueiheb Z.E., Chemaitelly H., Azar G., Nasr J. and Al-Sahab B. Argileh smoking among university students: A new tobacco epidemic. Nicotine & Tobacco Research. 2004 Jun; 6 (3):457-63.