Other considerations... Dan Bigg, Chicago Recovery Alliance 5 January 2012 While the dangers of tobacco abuse are well known I am left wondering if the reduced harm apparent from the Narghile smoking is created through its lower frequency of use, dose and social surroundings. The authors quote "one can not consider NS as a "safer" alternative to cigarettes when discussing the important issues of young age and female gender" is not entirely clear to me but seems to suggest a 'no use only' approach which misses the mark. Safer Hookah use seems possible in some ways mentioned here as well as with electronic ignition, well-ventilated rooms, reducing or stopping while pregnant, etc. As a long-time advocate for 'smoking or health' I have been there before but as a harm reductionist now I feel much of the safer health aspects of this form of tobacco consumption have been under-appreciated in this article. If Nafghile use leads to less harm it should be valued in this way for those who choose to smoke, or even as a model for safer drug ingestion of any kind. Great website about this issue is at http://www.sacrednarghile.com Competing interests I have never used Narghile or Hookah but do smoke a cigar or other non-cigarette tobacco product every few years.