Abstract
Waterpipe (WP) smoking has rapidly grown in popularity in the United States and other Western countries with the fastest uptake among younger individuals. This growth has been encouraged by the misperception that WP smoke is harmless or less harmful than cigarette smoke. To better understand how WP affects the health of young people, we conducted a narrative review of the literature focusing on the adverse health effects of WP smoking in adolescents and younger adults. We searched scientific literature databases including PubMed, MEDLINE, EMBASE, and ISI Web and selected papers that met the inclusion criteria. Sixty-three papers met the inclusion criteria and were selected for review. Data were abstracted from the selected papers into a standardized table. The evidence demonstrates that WP smoking can cause acute lung infection and injury, and carbon monoxide (CO) poisoning, in adolescents and young adults. It is also associated with adverse subclinical effects in this sub-population, including oral and systemic genotoxicity, lung function decline, and the alteration of vascular and hemodynamic functions. Limited evidence that is available indicates associations with psychological and neurological effects and asthma. No identified publications examined the association between WP use and type 2 diabetes, a condition that is associated with cigarette smoking among young people. WP smoking by younger individuals can result in their hospitalization due to systemic CO poisoning and acute lung disease, and induce subclinical adverse effects in the oral cavity, pulmonary system, and in circulation, that are involved in the pathogenesis of local and systemic chronic diseases.
Highlights
Referred to as hookah, shisha, narghile, and hubble-bubble[1], waterpipe (WP) smoking was traditionally associated with men in the Middle East[2]
Notwithstanding the weaknesses in the studies, results were consistent for the genotoxic effects of WP smoking which were observed to be more potent than cigarette smoking in a few studies
The plausibility of these effects, which are reported for cigarette smoking, is obvious as WP smoke contains many of the same toxic components of cigarette smoke, and many of these in much larger amounts
Summary
Referred to as hookah, shisha, narghile, and hubble-bubble[1], waterpipe (WP) smoking was traditionally associated with men in the Middle East[2]. Most of the global growth in the popularity of WP smoking has been among youth and young adults, few studies of its adverse health effects have been conducted among these age groups. DEVELOPMENTS Effects in the oral cavity The following effects of WP smoking have been studied in the oral cavity in young adults: physiological and biochemical changes in saliva[18,19]; inflammation and cytological effects including chromosomal aberrations in the oral mucosa[20,21,22,23,24,25,26]; oral infection and alteration of the oral microbiome[24,27]; and impairment of periodontal health[28,29,30] (Table 1). Cytometric alterations indicating premalignant and malignant lesions including changes in nuclear size and shape, and increase in the nuclear to cytoplasm ratio were observed in buccal, tongue and mouth floor mucosa cells of WP smokers compared to non-smoking controls. N=120 (60 WPS, 60 CS); 28±4 years for WPS, 27±3 years for CS; 100% male; Tunisia
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