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.Good, good, so that is a defence of Shish bars, now can we look at all bars please.
Interestingly the study also points out the falacious use of health statistics by the Scottish Government who had claimed that within a year of bringing in the smoking ban heart attacks had dropped significantly. Really?
However, it was also criticised. In particular, one researcher noted that “the drop in heart attacks is based on very few cases” and that “the reported difference could easily be due to chance or to some uncontrolled factor”. In 2008, and in a similar situation to that analysed in the Helena study, the Scottish government declared that the smoking ban enforced one year before in that country had also led to a dramatic fall in hospital admissions for acute coronary syndrome. However, "the latest figures suggest a rise of 7.8 per cent in the second year of the ban, cancelling out the earlier drop […] This seems to be backed up by hospital data from England and Wales, which have failed to show a significant reduction in incidence of acute coronary syndrome since these two countries followed Scotland and went 'smoke free' in 2007 .