Unhealthful News 97 – My favorite new tobacco statistics

I gave a plenary talk at the IHRA conference today.  Someone (who has enough data and understanding to make this judgment) told me that it was the best talk ever given on tobacco harm reduction.  I will post a link to whatever version of it I can on the THR blog sometime soon.

Just had to get that statistic out there.  On a more UN-worthy topic, apparently the Guardian is working on a story around the claim, by the always suspect (when it comes to tobacco) WHO, that hookah/sheesha smoking is 200 times more unhealthy than cigarettes.  It is kind of cheating to report on news that has not run yet, but I heard enough to make my point.  To use a word I learned from an Irish friend today, you would have to be totally crackers to believe this claim.  I am not even sure gunfire is 200 times as bad for you as cigarettes by any meaningful measure.  This would mean that hookah smoking is worse than that other popular local pass-time, civil wars.

What is most amusing is the observation that this is equivalent to saying that smoking cigarettes is 99.5% less hazardous than hookah smoking (s/o to Chris Snowdon for that observation).  So an obvious tremendously beneficial harm reduction intervention in Middle Eastern countries would be to get the guys here to substitute nice clean cigarettes for their awful hookahs.  According to WHO, the benefits in percentage terms might be better than those for substituting e-cigarettes or snus for smoking, and the absolute gain is 100 times as big.  That is really an impressive opportunity for harm reduction.

Incidentally, while I have not become an expert on their functioning and chemistry, it is pretty clear that hookahs are largely a heat-not-burn smoking method, which we generally believe to be substantially lower risk than full-on combustion (not low like smoke-free alternatives, but more different than differences from existing filters, “lights”, and other variants in cigarettes).  Maybe WHO just compared total mortality in the target population to European and American cigarette smokers. 

(For those missing the not-particularly-funny epidemiology joke:  If they just looked at differences in health and life expectancy to between hookah smokers – mostly in middle- and lower-income countries – and Western cigarette smokers, it would imply hookahs are a lot worse than they really are, because they would get blamed for all the other differences between the populations.  That is kind of a worst-case scenario version of that confounding thing I have written about before.)

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