Maziak WThe global epidemic of waterpipe smoking. Addict Behav 36: 1-5

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: 2.76). 09/2010; 36(1-2):1-5. DOI: 10.1016/j.addbeh.2010.08.030
Source: PubMed


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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    • "Whilst the Global Youth Tobacco Survey witnessed a net decrease in cigarette smoking amongst 13-15 year olds, an increase in other tobacco use was indicated, attributable mainly to WTS (Warren et al. 2009). The recent industrialisation of flavoured waterpipe tobacco, widespread social acceptance and globalisation are some of the reasons given for the rise in WTS (Maziak, 2011). "
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    ABSTRACT: Introduction Waterpipe tobacco smoking (WTS), known in the United Kingdom as shisha, is popular among adolescents worldwide. Some electronic cigarettes are marketed in the United Kingdom as 'electronic shisha' (e-shisha). This study aimed to understand how WTS users view e-shisha and whether it could be used as a harm-reduction or cessation aid. In-depth face-to-face interviews were conducted with 16 young adults recruited by snowball sampling in London, UK. Recurrent themes were derived iteratively through thematic analysis. WTS is a socially acceptable activity, carried out at home or in a café. Peer influence and flavour play a key role in its use. Participants were aware of some health risks of WTS, although many accepted this risk and reported a need for more health-related WTS information. Although participants were familiar with e-shisha, there was no evidence of its use as a harm-reduction or cessation product. E-shisha tasted different to flavoured waterpipe tobacco and removed the positive social attributes typically ascribed to WTS. Waterpipe users felt e-shisha may encourage non-users to initiate cigarettes or WTS. Opinions of reduced risk in using WTS may be due to the lack of available information, misconceptions and its easy accessibility. E-shisha does not appear to play a role in WTS harm reduction or cessation. On-going research efforts should test educational interventions addressing the adverse health impacts of WTS in this population group.
    Full-text · Article · Apr 2015 · Primary Health Care Research & Development
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    • "Shisha (also known as 'Hookah','Narghile' or 'Waterpipe') is one of the popular smoking devices after cigarettes. It is smoked in several South Asian and Midle East countries, but has gained popularity among a number of western countries as well (Cobb et al., 2010; Martinasek et al., 2011; Maziak, 2011; Akl et al., 2015). "
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    ABSTRACT: Shisha (also known as hookah, narghile or waterpipe) is a popular tobacco smoking device in South Asia and Middle East. Smoked shisha water, flavored (FSW) and non-flavored (NFSW) was analyzed for their environmental contamination potential using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Eighteen toxic elements were detected in the samples including arsenic, lead, cadmium, mercury and uranium. The levels of toxic elements were found to be higher in NFSW in comparison with FSW. Shisha tobacco, non-flavored (NFT) and flavored (FT), was also analyzed. Pattern of element levels in NFSW and FSW was similar with element levels in NFT and FT, respectively. Data indicate that the release of shisha water, either NSFW or FSW, into the environment may contribute to the accumulation of several toxic elements in soil and water. The present investigation provide a basis for further investigation of shisha water to assure whether regulatory measures are needed to handle this issue.
    Full-text · Article · Jan 2015 · Research Journal of Environmental Toxicology
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    • "In the eastern Mediterranean region, WTS is widespread among youth (Maziak, 2013, 2011; Nakkash et al., 2011). In Lebanon, for example, the prevalence of WTS exceeded that of cigarette smoking in 2003 (29.6% vs. 11.4%) "
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    ABSTRACT: In youth, both waterpipe tobacco smoking (WTS) and nonmedical use of prescription drugs (NMUPD) are globally growing concerns. This study assesses for the first time the lifetime and past-year associations between WTS and four classes of psychoactive prescription drugs. Cross-sectional data (2011) on 986 high school students attending public and private high schools in Beirut (Lebanon) was analyzed. Schools were selected using proportionate random cluster sampling from a comprehensive list of schools provided by the Ministry of Education. Almost half (46%) had tried WTS compared to 25% who had ever tried cigarettes. Lifetime prevalence estimates of NMUPD were: pain relievers (8.2%), sedatives/tranquilizers (5.6%), stimulants (3.5%), antidepressants (2.5%), and sleeping pills (2.3%). WTS was associated with increased odds of sedatives/tranquilizer use (OR=3.22, 95% CI: 1.25, 8.25), pain reliever use (OR=4.31, 95% CI: 2.02, 9.17), and sleeping medication use (OR=8.31, 95% CI: 2.37, 29.20), controlling for sex, age, school type, and other substance use. For cigarettes, the associations were consistently either weaker or non-existent, except with stimulant use (OR=5.29, 95% CI: 1.55, 18.05). While public health professionals have watched with caution the global prevalence of youth cigarette use-worldwide, an insidious alternative form of tobacco use has grown. Further research is needed to understand the unique risk factors and motives associated with WTS and how these relate to NMUPD in order to inform the development of effective intervention programs and policies that support youth positive health decisions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Drug and Alcohol Dependence
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