Intended for healthcare professionals

Letters EU tobacco rules to deter young smokers

Impact of EU flavoured tobacco ban on waterpipe smoking

BMJ 2014; 348 doi: (Published 14 April 2014) Cite this as: BMJ 2014;348:g2698
  1. Mohammed Jawad, honorary clinical research fellow1,
  2. Christopher Millett, reader in public health1
  1. 1Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
  1. mohammed.jawad06{at}

We welcome the European Parliament’s decision to ban flavoured tobacco, among other measures, in a bid to curb smoking in young people.1 Importantly, however, this ban applies to cigarettes and roll-your-own tobacco only—disappointingly, waterpipe tobacco is omitted. Waterpipe smoking is an increasingly popular and equally harmful form of tobacco use among young people in Europe,2 and the tobacco used is almost exclusively flavoured. Waterpipes are typically smoked socially in bars or cafes, and England has witnessed a paradoxical 210% increase in such premises since the 2007 smoke-free law was introduced3—London alone has around 400.4

The unique appeal of waterpipe tobacco is its flavour, which includes a diverse range of fruits laced in molasses and is important in attracting new smokers. The decision not to include waterpipe smoking in this ban could greatly undermine tobacco control efforts, especially as targeting waterpipe smokers may reduce cigarette consumption in some settings.5

Where waterpipe smoking is not exempt from generic tobacco legislation, we seldom see guidance for the practical application of law to the waterpipe industry. For example, EU and UK legislation does not describe how health warning label requirements can be applied to the awkwardly sized waterpipe apparatus, which might be considered equivalent to a cigarette pack. As a result, these aspects of law are generally poorly enforced or not enforced at all.5

In contrast, a comprehensive EU ban on flavoured tobacco is a potential game changer for the waterpipe tobacco industry, as it effectively means a ban on waterpipe smoking where flavoured tobacco is used. We therefore call on legislative bodies to regulate waterpipe smoking on a par with cigarettes.


Cite this as: BMJ 2014;348:g2698


  • Competing interests: None declared.


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