The global epidemiology of waterpipe smoking

Abstract

Objectives: In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally.

Data sources: Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used.

Study selection: The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking.

Data extraction: Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review.

Data synthesis: Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns.

Conclusions: Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.

Keywords: Global health; Media; Nicotine; Non-cigarette tobacco products; Public policy.

Figure 1

(A) Waterpipe device, (B) with presentation of its main parts.

Figure 2

Internet search patterns for waterpipe and e-cigarettes in four countries (US, UK, Canada and Australia).

Figure 3

Current other tobacco/waterpipe vs cigarette smoking among adolescents 13–15 year-olds in selected countries according to the most recent Global Youth Tobacco Survey (GYTS). *Specifically inquired about waterpipe smoking, otherwise it is represented by other tobacco use (mostly waterpipe in the Eastern Mediterranean region). †More than one survey, and the average of their prevalence measures is reported.

Figure 4

Gender-specific prevalence of current other tobacco/waterpipe smoking among adolescents (13–15 years-old) in selected countries according to the most recent Global Youth Tobacco Survey (GYTS). *Specifically inquired about waterpipe smoking, otherwise it is represented by other tobacco use (mostly waterpipe in the Eastern Mediterranean region). †More than one survey, and the average of their prevalence measures is reported.

Figure 5

Global prevalence of current waterpipe smoking among persons aged ≥15 years.

Figure 6

Time trends of waterpipe (WP) and cigarette (Cig) ever smoking among youth in the USA: (A) for overall age groups, (B) girls and (C) boys according to the National Youth Tobacco Survey, 2011–2012.

Figure 7

Waterpipe and cigarette smoking patterns among adults (18–65 years) in Syria.

Figure 8

Age-related waterpipe use patterns among college students in the USA.

Figure 9

Smoking behaviours among representative samples of individuals aged ≥40 years (total 62 086) in 10 countries in the Arab region, together with Pakistan.