ObjectiveTobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities.Data sourcesGuided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched.Study selectionTwo reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation.Data extractionWe report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data synthesisEight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised.ConclusionsVLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

Well-designed trials of efficacy for preferred evidence-based strategies, particularly among middle-aged male Arabic-speaking smokers, appear warranted prior to policy development and implementation.

Waterpipe tobacco (WT) smoking is traditionally practised in the Orient.1 Waterpipe is known by many names, including narghila, nargila, shisha and goza.2 WT smoking involves burning the tobacco with embers or charcoal. The smoke is filtered through a bowl of water and then drawn through a rubber hose to a mouthpiece and inhaled through the mouth. 2The available research suggests that significant adverse health effects are associated with active and passive WT smoke; it is not a safe form of tobacco smoking.2-4 Researchers overseas have expressed concerns about the rising prevalence of WT smoking since the 1990s and erroneous consumer beliefs of relative safety compared with cigarette smoking. 2To our knowledge, we were the first to report the prevalence of WT smoking in an Australian population.5 A telephone survey of tobacco use among Arabic-speakers residing in south-west Sydney found 11.4% current prevalence (1% daily) of WT smoking. The data also indicated Arabic-speakers believed WT smoking was less harmful than cigarettes.To better understand the determinants of WT smoking and to identify at-risk groups, we further analysed this existing data 5 and focused on WT smoking and respondents' knowledge of its harms. We performed bivariate (cross-tabular) and multiple logistic regression analyses to explore the independent factors associated with WT smoking with WT smoking knowledge score, socio-economic and demographic characteristics. We found that current cigarette/cigar/pipe (CCP) smoking status, being aged 40-59, and having low to moderate WT smoking knowledge independently predicted WT smoking prevalence (Table 1). One-quarter of all current CCP smokers smoked WT at least occasionally, while only 7% of ex-CCP smokers and 7% of those who had never smoked CCP smoked WT at least occasionally. The most popular places to smoke WT reported by current WT smokers were at home (outdoors) 65%; at friends' and relatives' homes (outdoors) 50%; and at Arabic cafes (outdoors) 32%. Respondents who did not smoke WT were significantly more likely to agree with the statements 'smoking narghila/shisha (WT) is harmful to your health' (82% vs. 71%, p= ≤0.01) and that 'smoke inhaled from narghila/shisha (WT) contains harmful chemicals' (74% vs. 64%, p=≤0.05).We believe the main tobacco control priority for Arabicspeakers should remain focused on reducing cigarette smoking prevalence for several reasons. First, there is a low prevalence of WT smoking compared with CCP smoking prevalence (11.4% vs. 26%).5 Second, our analysis shows that CCP smoking status is the strongest predictor of WT smoking, with current CCP smokers being more than four times more likely to use waterpipe than non-CCP smokers. Finally, despite mistaken beliefs of the relative safety of WT compared with cigarette smoking, we are not alarmed about potential switching as only one ex-CCP smoker (out of 1,102 respondents) also reported smoking WT on a daily basis.Nevertheless, some specific strategies for WT smoking are still warranted as almost half of all WT smo...