Waterpipe Smoking Among Japanese Teens and Young Adults: an Emerging Public Health Concern.

FDA Encourages Reporting of Tobacco Product Adverse Experiences

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.

Water pipe tobacco smoking appears to be an increasing public health concern, with anecdotal reports of higher prevalence than cigarette smoking among young people in some high-income countries. We examined the prevalence and predictors of water pipe and cigarette smoking among students attending secondary schools in a deprived, ethnically diverse part of inner London. We conducted a 96-item, validated smoking habits questionnaire with 2,399 students from Years 8, 10, and 12/13 from 15 secondary schools in Brent, northwest London. Multilevel logistic regression models were used to examine predictors of current and ever cigarette and water pipe smoking. Current water pipe smoking prevalence was more than double that of cigarette smoking prevalence (7.6% vs. 3.4%, p < .001). One in 4 students had tried water pipe compared with 1 in 6 who had tried cigarette smoking (24.0% vs. 15.8%, p < .001). Significant predictors of ever water pipe use include being in a higher age group, South Asian or Middle Eastern ethnicity, and personal, family, or friends tobacco use. Significant predictors of ever cigarette use include being in a higher age group, White ethnicity, and personal, family, or friends tobacco use. Students attending schools with more water pipe cafes within 0.5 miles were more likely to be current water pipe users (AOR = 2.43, 95% CI = 1.33-4.42). Water pipe smoking may be more prevalent than cigarette smoking among young people in some high-income countries. Improved surveillance and dedicated tobacco control interventions are required to better understand the epidemiology of water pipe use and address its growing use.

Maternal tobacco use is a global public health problem. In the literature, the focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored dual use among pregnant women. We estimated the prevalence of current maternal tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of ten years (2007 to 2017), and examined the socio-demographic patterning of maternal tobacco use. A secondary analysis of Jordan DHS four data waves was conducted for women who reported to be pregnant at the time of the survey. Current cigarette and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only, waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and waterpipe, regardless of cigarette, were reported. The effect of independent variables on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression models assessed the adjusted effects of socio-demographic variables on cigarette smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted and a time-unadjusted logistic models were conducted. Over the last decade, the prevalence estimates of current cigarette-only smoking slightly decreased. The prevalence estimates of current waterpipe-only use exceeded those for cigarette-only after 2007 and showed a steady overall increase. Current dual use showed a continuous rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and 5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed an inverse relationship with cigarette and waterpipe smoking. Household wealth demonstrated a positive association with cigarette and waterpipe smoking. Tobacco use epidemic is expanding its roots among pregnant women in Jordan through not only waterpipe use but also dual cigarette-waterpipe smoking. Maternal and child services should consider tobacco counseling and cessation.

Widespread tobacco use, along with its induced diseases and subsequent deaths, comprise one of the biggest threats to public health in the world. Thus, we aimed to investigate the prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents. A total of 1524 adolescent students aged 14-18 years (764 boys and 760 girls) were randomly selected. The participants attended governmental, semi-governmental, and non-governmental schools in the city of Sanandaj, Iran in 2013. Data were collected using the "Sherer General Self-efficacy" and demographic questionnaire. Multivariate Logistic binary regresion analysis was conducted to determine the predictors. The prevalence rates of cigarette and water pipe smoking were 9.5% and 10.4%, respectively. About 3.7% of the adolescents used both cigarette and water pipe and 16% used at least one of these. Compared with girls, prevalence of both cigarette (13.1% vs. 6.4%) and water pipe (13.7% vs. 7.1%) smoking was higher among the boys. Male sex, father's education of secondary school, and use of water pipe were identified as cigarette smoking risk factors, while technical and commercial educational fields and attending non-governmental school were its protective factors. Risk factors of the use of water pipe were currently working, higher age and cigarette smoking, father's education of high school, father's occupation of employee and mother's education of a diploma degree, while higher self-efficacy and attending non-governmental school were its protective factors. The high prevalence of cigarette and water pipe smoking in adolescents continues to rise. Therefore, it is necessary to conduct further studies on effective factors on the onset and continuation of tobacco use.

Smoking tobacco preparations in a water pipe (hookah) is widespread in many places of the world and is perceived by many as relatively safe. We investigated biomarkers of toxicant exposure with water pipe compared with cigarette smoking. We conducted a crossover study to assess daily nicotine and carcinogen exposure with water pipe and cigarette smoking in 13 people who were experienced in using both products. When smoking an average of 3 water pipe sessions compared with smoking 11 cigarettes per day (cpd), water pipe use was associated with a significantly lower intake of nicotine, greater exposure to carbon monoxide (CO), and a different pattern of carcinogen exposure compared with cigarette smoking, with greater exposure to benzene, and high molecular weight polycyclic aromatic hydrocarbon (PAH), but less exposure to tobacco-specific nitrosamines, 1,3-butadiene, acrolein, acrylonitrile, propylene oxide, ethylene oxide, and low molecular weight PAHs. A different pattern of carcinogen exposure might result in a different cancer risk profile between cigarette and water pipe smoking. Of particular concern is the risk of leukemia related to high levels of benzene exposure with water pipe use. Smoking tobacco in water pipes has gained popularity in the United States and around the world. Many believe that water pipe smoking is not addictive and less harmful than cigarette smoking. We provide data on toxicant exposure that will help guide regulation and public education regarding water pipe health risk.

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Smoking tobacco preparations in a water pipe (hookah) is widespread in many places of the world and is perceived by many as relatively safe. We investigated biomarkers of toxicant exposure with water pipe compared with cigarette smoking.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; We conducted a crossover study to assess daily nicotine and carcinogen exposure with water pipe and cigarette smoking in 13 people who were experienced in using both products.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; When smoking an average of 3 water pipe sessions compared with smoking 11 cigarettes per day (cpd), water pipe use was associated with a significantly lower intake of nicotine, greater exposure to carbon monoxide (CO), and a different pattern of carcinogen exposure compared with cigarette smoking, with greater exposure to benzene, and high molecular weight polycyclic aromatic hydrocarbon (PAH), but less exposure to tobacco-specific nitrosamines, 1,3-butadiene, acrolein, acrylonitrile, propylene oxide, ethylene oxide, and low molecular weight PAHs.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; A different pattern of carcinogen exposure might result in a different cancer risk profile between cigarette and water pipe smoking. Of particular concern is the risk of leukemia related to high levels of benzene exposure with water pipe use.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Impact:&lt;/b&gt; Smoking tobacco in water pipes has gained popularity in the United States and around the world. Many believe that water pipe smoking is not addictive and less harmful than cigarette smoking. We provide data on toxicant exposure that will help guide regulation and public education regarding water pipe health risk. &lt;i&gt;Cancer Epidemiol Biomarkers Prev; 22(5); 765–72. ©2013 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Smoking tobacco preparations in a water pipe (hookah) is widespread in many places of the world and is perceived by many as relatively safe. We investigated biomarkers of toxicant exposure with water pipe compared with cigarette smoking.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; We conducted a crossover study to assess daily nicotine and carcinogen exposure with water pipe and cigarette smoking in 13 people who were experienced in using both products.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; When smoking an average of 3 water pipe sessions compared with smoking 11 cigarettes per day (cpd), water pipe use was associated with a significantly lower intake of nicotine, greater exposure to carbon monoxide (CO), and a different pattern of carcinogen exposure compared with cigarette smoking, with greater exposure to benzene, and high molecular weight polycyclic aromatic hydrocarbon (PAH), but less exposure to tobacco-specific nitrosamines, 1,3-butadiene, acrolein, acrylonitrile, propylene oxide, ethylene oxide, and low molecular weight PAHs.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; A different pattern of carcinogen exposure might result in a different cancer risk profile between cigarette and water pipe smoking. Of particular concern is the risk of leukemia related to high levels of benzene exposure with water pipe use.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Impact:&lt;/b&gt; Smoking tobacco in water pipes has gained popularity in the United States and around the world. Many believe that water pipe smoking is not addictive and less harmful than cigarette smoking. We provide data on toxicant exposure that will help guide regulation and public education regarding water pipe health risk. &lt;i&gt;Cancer Epidemiol Biomarkers Prev; 22(5); 765–72. ©2013 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

BackgroundMaternal tobacco use is a global public health problem. In the literature, the focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored dual use among pregnant women. We estimated the prevalence of current maternal tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of ten years (2007 to 2017), and examined the socio-demographic patterning of maternal tobacco use.MethodsA secondary analysis of Jordan DHS four data waves was conducted for women who reported to be pregnant at the time of the survey. Current cigarette and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only, waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and waterpipe, regardless of cigarette, were reported. The effect of independent variables on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression models assessed the adjusted effects of socio-demographic variables on cigarette smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted and a time-unadjusted logistic models were conducted.ResultsOver the last decade, the prevalence estimates of current cigarette-only smoking slightly decreased. The prevalence estimates of current waterpipe-only use exceeded those for cigarette-only after 2007 and showed a steady overall increase. Current dual use showed a continuous rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and 5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed an inverse relationship with cigarette and waterpipe smoking. Household wealth demonstrated a positive association with cigarette and waterpipe smoking.ConclusionsTobacco use epidemic is expanding its roots among pregnant women in Jordan through not only waterpipe use but also dual cigarette–waterpipe smoking. Maternal and child services should consider tobacco counseling and cessation.

Smoke and Mirrors: The Perils of Water-Pipe Smoking and Implications for Western Countries

At the beginning of the 21st century, waterpipe (shisha) smoking has become a new and global youth trend in tobacco consumption. Despite the fact that this type of tobacco use can also lead to serious health problems, there are only a few studies on this topic in Germany. The aim of this study was to determine the prevalence of waterpipe smoking among 12- to 17-year-old adolescents. Age- and sex-related differences were analyzed and, for the first time in Germany, the association between parental socioeconomic status and waterpipe use was examined. Data were obtained from the first follow-up of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1), which was conducted from 2009 to 2012. Waterpipe smoking was assessed among adolescents aged 12 to 17 years using three items (n = 4,543). We calculated prevalence rates and age-adjusted odds ratios (OR) with 95 % confidence intervals (95 % CI). Lifetime prevalence of waterpipe use was 28.9 % (95 % CI: 26.9-31.0). Approximately one fifth (20.6 %; 95 % CI: 18.8-22.6) of the adolescents reported waterpipe use in the past 12 months, one tenth (10.0 %; 95 % CI: 8.6-11.6) reported current use (at least once during the past 30 days). In both sexes, prevalence increased with age. Waterpipe smoking rates were significantly higher among boys than girls, while no significant differences were found regarding parental socioeconomic status. A considerable number of adolescents in Germany are at least occasional waterpipe (shisha) smokers. Because of waterpipe related health and addiction risks that are often underestimated by adolescents, specific health education and prevention measures are necessary.

BackgroundThe objective of this study was to systematically review the medical literature for the prevalence of waterpipe tobacco use among the general and specific populations.MethodsWe electronically searched MEDLINE, EMBASE, and the ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included cohort studies and cross sectional studies assessing the prevalence of use of waterpipe in either the general population or a specific population of interest. Two reviewers used a standardized and pilot tested form to collect data from each eligible study using a duplicate and independent screening process. We stratified the data analysis by country and by age group. The study was not restricted to a specific context.ResultsOf a total of 38 studies, only 4 were national surveys; the rest assessed specific populations. The highest prevalence of current waterpipe smoking was among school students across countries: the United States, especially among Arab Americans (12%-15%) the Arabic Gulf region (9%-16%), Estonia (21%), and Lebanon (25%). Similarly, the prevalence of current waterpipe smoking among university students was high in the Arabic Gulf region (6%), the United Kingdom (8%), the United States (10%), Syria (15%), Lebanon (28%), and Pakistan (33%). The prevalence of current waterpipe smoking among adults was the following: Pakistan (6%), Arabic Gulf region (4%-12%), Australia (11% in Arab speaking adults), Syria (9%-12%), and Lebanon (15%). Group waterpipe smoking was high in Lebanon (5%), and Egypt (11%-15%). In Lebanon, 5%-6% pregnant women reported smoking waterpipe during pregnancy. The studies were all cross-sectional and varied by how they reported waterpipe smoking.ConclusionWhile very few national surveys have been conducted, the prevalence of waterpipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries.

Background This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations. Methods PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10–24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982). Results A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10–24 years age group was noted to be 18.16% (95% CI, 18.03–18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34–6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers. Conclusion Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.

Background: Water pipe is a traditional method of tobacco use, which is epidemically spreading throughout Europe. There are scarce data about the use of water pipe and its relation to other addictive behaviors among young adults in Western countries. Objectives: It was our aim to identify the sociodemographic characteristics of water pipe users in Switzerland and to describe concurrent cigarette and cannabis smoking habits. Methods: Young adults aged 16-30 years were evaluated based on a 16-item standardized questionnaire on tobacco consumption and exhaled carbon monoxide. Current water pipe smoking was defined as water pipe use at least once within the last 4 weeks; regular water pipe smoking was defined as water pipe use at least once a week during the last 52 weeks. Results: Out of 353 volunteers, a total of 204 subjects (mean age 21 ± 3.5 years, 113 males) met the inclusion criteria for the study. A total of 78% (n = 160), 30.0% (n = 55) and 3.9% (n = 8) reported ever, current and regular water pipe smoking, respectively. Males smoked more often than females: 2.8 sessions/year (interquartile range 1.1-8) versus 2 sessions/year (interquartile range 0-4; p = 0.022). The major risk factor for ever smoking water pipe was cigarette smoking (odds ratio 6.22, 95% confidence interval 2.33-16.62), followed by cannabis consumption (odds ratio 1.44, 95% confidence interval 1.29-1.62). Ever water pipe smoking was more common among current cannabis users (100 vs. 0%; p < 0.0001) and related to higher exhaled carbon monoxide values (6.0 ± 9.0 vs. 2.1 ± 4.6 ppm; p < 0.001). Conclusion: Water pipe smoking is common among young adults and strongly associated with cigarette smoking and cannabis consumption.

Waterpipe smoking is becoming a global health crisis among youth. To identify the prevalence of waterpipe use among Iranian university students and to explore perceived reasons for use. A random sample of 1024 university students at two major universities in South Iran was enrolled in the study. A three-part questionnaire (baseline data, tobacco smoking status and perceived reasons for waterpipe use) was used. Students filled out the self-administered questionnaire in their classrooms. The prevalence of waterpipe smoking in the respondents' lifetime and in the last 30 days was 42.5% and 18.7%, respectively. The mean age at initiation of waterpipe smoking was 16.3 ± 3.2 years. Ever smoking was positively associated with age and male sex, whereas no association was found regarding marital status. The highest odds of lifetime waterpipe smoking were observed in students with close friends who smoked the waterpipe (5.94, 95%CI 4.26-8.30). The most important perceived reason for waterpipe smoking as stated by students was enjoyment (55.8%). Given the alarming prevalence of waterpipe smoking, preventive measures should be adopted among university students taking into account the influence of peers, siblings and parents in the lessening social tolerance of waterpipe smoking.