Waterpipe smoking is a centuries-old method of inhaling tobacco after it has passed through a body of water. Cultural variations exist in its use; however, the West in particular has witnessed a surge in flavoured waterpipe tobacco use, known as moassel. This is typically shared among peers for 30-45 min, and is now the second most popular form of tobacco consumption after cigarettes in 20 out of 30 European countries. Contrary to the common belief that it is a safer method of tobacco intake than cigarettes, waterpipe tobacco smoke composition is known to contain significant quantities of harmful toxicants akin to cigarette smoke composition. Studies on the longterm health effects of waterpipe tobacco smoking, although of low quality in these early research stages, suggest significant morbidity and mortality is associated with its use. Cessation outcomes are promising although more work is needed to develop and test waterpipe-specific interventions. The waterpipe industry remains largely unregulated and threatens to undermine existing tobacco control policies. Government, policy makers and public health agents should consider waterpipe tobacco smoking as a growing public health concern that warrants attention, particularly in regions of high prevalence.Waterpipe tobacco smoking has been present for several centuries, likely originating in the Middle East or South Asia [1] (see also chapter 1). There are cultural variations in the names given to waterpipe smoking, such as narghile, shisha, qalyan and goza. Although several types of tobacco mixtures can be used in a waterpipe, the recent popularity surge in waterpipe tobacco smoking mainly uses moassel tobacco, which is a fruit-flavoured tobacco mixture laced in honey and treacle. Figure 1 depicts a typical waterpipe apparatus. The user manually packs tobacco in the head of the apparatus, which is covered by pierced aluminium foil and has burning coal placed above it. The coal heats the underlying tobacco, and when the user inhales on the hose, smoke travels through the apparatus and into a water bowl prior to entering the user's lungs. One waterpipe session can last anywhere between several minutes to several hours [2]; however, users usually smoke for at least 30-45 min at a time [3]. Waterpipes are usually shared with peers and smoking is considered a social activity [4]. Waterpipes are manufactured in different shapes and sizes, with slight cultural variations in the type of tobacco and charcoal used.
Prevalence of Waterpipe Tobacco SmokingThe prevalence of waterpipe tobacco smoking has surged dramatically in all continents since the late 1990s, despite plateauing or decreasing cigarette prevalence [5]. This is most likely due to increased immigration as well as the mass industrialisation of waterpipe tobacco, resulting in at least 100 million daily smokers [1]. In the US, nationally representative data show that waterpipe smoking is now among the more popular forms of tobacco consumption among young people and college students, where current use is estimated a...