Intended for healthcare professionals


Rise of waterpipe smoking

BMJ 2015; 350 doi: (Published 17 April 2015) Cite this as: BMJ 2015;350:h1991
  1. Wasim Maziak, professor and chair
  1. 1Department of Epidemiology, Florida International University, 11200 SW 8th Street Miami, FL 33139, USA
  2. 2Syrian Center for Tobacco Studies
  1. wmaziak{at}

A well developed global public health epidemic in need of a clear and comprehensive regulatory approach

When we started investigating the waterpipe more than a decade ago,1 we knew that we were facing something that could have serious effects on global health. We did not know whether this was a passing fad or the full spectrum of risks the waterpipe poses to individuals and society.

Considerable strides in understanding the public health impact of waterpipe smoking have been made since. At the same time, our worst predictions of an escalating global epidemic have been vindicated.2 Data from the Global Tobacco Surveillance System, including over 100 countries and repeated surveys since 1999, are clear. Time trends among 13-15 year olds show that while cigarette smoking has been either stable or declining globally, waterpipe smoking is on the rise in many countries and is replacing cigarettes as the most popular method of tobacco use among Middle Eastern youth.2 3 As the epidemic progresses, the waterpipe’s spread among adults globally is increasingly documented.4

The waterpipe, also known as shisha, hookah, and narghile, is a centuries old method of tobacco use that has its roots in Eastern societies. In its most common form, charcoal heated air is passed through a tobacco mixture to produce smoke, which is bubbled …

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