Article

The global epidemic of waterpipe smoking

School of Public Health, University of Memphis, Syrian Center for Tobacco Studies, Browning Hall 112, 3820 DeSoto Avenue, Memphis, TN 38152-3340, United States.
Addictive behaviors (Impact Factor: 2.44). 09/2010; 36(1-2):1-5. DOI: 10.1016/j.addbeh.2010.08.030
Source: PubMed

ABSTRACT In the past decade waterpipe (WP) smoking (a.k.a. hookah, shisha, and narghile) has been steadily spreading among the youth around the world. The allure of this tobacco use method for the youth can stem from its pleasant smooth smoke, social ambience and the perception of reduced harm. The material in this review is based on detailed Medline search for articles appearing especially in the past two years that are of relevance to WP epidemiology, health and addictive effects, and WP-related tobacco control policies. It shows that WP smoking is continuing to spread among the youth worldwide, and perhaps represents the second global tobacco epidemic since the cigarette. Available evidence suggests that the prevalence of current (past month) WP smoking range from 6 to 34% among Middle Eastern adolescents, 5%-17% among American adolescents, and that WP use is increasing globally. Studies on the health effects of WP smoking are limited by methodological quality, as well as by the novelty of WP epidemic relative to the long latency of important smoking-related health outcomes. Still, research indicates substantial WP harmful effects similar to those of cigarettes, as well as to the potential of providing a bridge to cigarette smoking or relapse. Developing effective interventions to curb WP use among the youth requires a detailed understanding of how dependence develops in WP users, and how it is shaped by WP's unique features such as the following; the predominantly intermittent use with prolonged sessions, preparation time, accessibility, potent sensory cues, and convivial experience of group use. It also requires assessing effective policy options such as factual and visible health warnings on all its parts, as well as youth access and indoor smoking restrictions. WP smoking is currently showing all signs of a burgeoning global epidemic with serious implications for public health and tobacco control worldwide. Investment in research and policy initiatives to understand and curb WP use needs to become a public health priority.

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Available from: Wasim Maziak, Jan 28, 2014
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    • "As mentioned earlier, WPS is increasing rapidly all over the world. Maziak described it as " the first tobacco use method since the cigarette that is showing all signs of a burgeoning global epidemic " [7]. In the BREATHE COPD study that included more than 60,000 adults from 11 countries from Middle East and North Africa [9], 3.5% of individuals reported WP use with the highest rate being from Lebanon and Saudi Arabia. "
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    ABSTRACT: Water pipe smoking (WPS), an old method of tobacco smoking, is re-gaining widespread popularity all over the world and among various populations. Smoking machine studies have shown that the water pipe (WP) mainstream smoke (MSS) contains a wide array of chemical substances, many of which are highly toxic and carcinogenic for humans. The concentrations of some substances exceed those present in MSS of cigarettes. Despite being of low grade, current evidence indicates that WPS is associated with different adverse health effects, not only on the respiratory system but also on the cardiovascular, hematological, and reproductive systems, including pregnancy outcomes. In addition, association between WPS and malignancies, such as lung, oral and nasopharyngeal cancer, has been suggested in different studies and systematic reviews. Despite its long standing history, WPS research still harbors a lot of deficiencies. The magnitude of toxicants and carcinogen exposures, effects on human health, as well as the addiction and dependence potentials associated with WPS need to be studied in well-designed prospective trials. Unfortunately, many of the tobacco control and clean indoor policies have exempted water pipes. World-wide awareness among the public, smokers, and policymakers about the potential health effects of WPS is urgently required. Furthermore, stringent policies and laws that control and ban WPS in public places, similar to those applied on cigarettes smoking need to be implemented.
    Respiratory Medicine 09/2014; 108(9). DOI:10.1016/j.rmed.2014.07.014 · 2.92 Impact Factor
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    • "The global spread of waterpipe (WP) smoking among adolescents is widely documented (Centers for Disease Control and Prevention, 2013; Maziak, 2011; Mzayek et al., 2011; Primack et al., 2009; Parna et al., 2008; Maziak et al., 2004b; Maziak, 2014; Warren et al., 2009; Amrock et al., 2014). While the evidence is still preliminary, it suggests that WP smoking is as addictive and detrimental to health as cigarette smoking (Maziak et al., 2011; Rastam et al., 2011; Eissenberg and Shihadeh, 2009; Fromme et al., 2009; Al Rashidi et al., 2008). Prevalence of WP smoking is high among school children in other parts of the world and is increasing among adolescents in the US (Martinasek et al., 2011; Maziak and Mzayek, 2000; Mzayek et al., 2012; Weglicki et al., 2008; Barnett et al., 2013; Warren et al., 2009). "
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    ABSTRACT: Objective Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian schoolchildren. Methods A school-based cohort of all 7th grade students (N = 1,781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N = 1,243) Results During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: Odds Ratio 7.41; 95% Confidence Interval 4.05- 12.92 and girls: 8.48; 4.34-16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80-51.53 and girls: 11.49; 6.42-20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14- 4.64) or teachers (2.07; 1.12-3.84) who smoked and girls if they had friends (2.96; 1.59-5.54) who smoked Conclusion There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.
    Drug and Alcohol Dependence 09/2014; 142. DOI:10.1016/j.drugalcdep.2014.06.038 · 3.28 Impact Factor
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    • "For example, prevalence among university students in the United States ranges from 15% to 20% (Akl et al., 2011), and in Pakistan, it is as high as 33% (Jawaid et al., 2008). Described as a second tobacco epidemic following that caused by cigarettes (Maziak, 2011), reasons for its continuing growth are multifactorial but broadly rooted in an erroneous belief that hookah is safer than cigarettes (Akl, Jawad, Lam, Obeid, & Irani, 2013). "
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    ABSTRACT: To explore the differential effect of cessation interventions (behavioral support sessions with [BSS+] and without [BSS] bupropion) between hookah and cigarette smokers. We reanalyzed the data from a major cluster-randomized controlled trial, ASSIST (Action to Stop Smoking In Suspected Tuberculosis), which consisted of 3 conditions: (a) behavioral support sessions (BSS), (b) behavioral support sessions plus 7 weeks of bupropion therapy (BSS+), and (c) controls receiving usual care. The trial originally recruited 1,955 adult smokers with suspected tuberculosis from 33 health centers in Jhang and Sargodha districts of Pakistan, between 2010 and 2011. The primary endpoint was continuous 6-month smoking abstinence, determined by carbon monoxide levels. Subgroup-specific relative risks (RRs) of smoking abstinence were computed and tested for differential intervention effect using log binomial regression (generalized linear model) between 3 subgroups (cigarette-only: 1,255; mixed: 485; and hookah-only: 215). The test result for homogeneity of intervention effects between the smoking forms was statistically significant (p-value for BSS+: .04 and that for BSS: .02). Compared to the control, both interventions appeared to be effective among hookah smokers (RR: 2.5; 95% CI: 1.3-4.7 and RR: 2.2; 95% CI: 1.3-3.8, respectively) but to a lesser extent than among cigarette smokers (RR: 6.6; 95% CI: 4.6-9.6 and RR: 5.8; 95% CI: 4.0-8.5), respectively. The differential intervention effects on hookah and cigarette smokers were seen (a) because the behavioral support intervention was designed primarily for cigarette smokers; or (b) because of differences in demographic characteristics, behavioral, and sociocultural determinants; or (b) because of differences in nicotine dependency levels between the 2 groups.
    Nicotine & Tobacco Research 12/2013; 16(6). DOI:10.1093/ntr/ntt211 · 2.81 Impact Factor
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