Waterpipe Tobacco Smoking Research Articles

Waterpipe tobacco smoking legislation and policy enactment: a global analysis

Objective(1) To review how current global tobacco control policies address regulation of waterpipe tobacco smoking (WTS). (2) To identify features associated with enactment and enforcement of WTS legislation.Data Sources(1) Legislations...

Assessing and Predicting Susceptibility to Waterpipe Tobacco Use Among College Students.

College youth susceptible to waterpipe tobacco smoking (WTS) represent an important target to intervene upon in order to prevent their uptake of this product. This study examined the performance of a 4-item susceptibility measure to WTS to predict future waterpipe use and correlates of susceptibility. A cohort of college students from 11 university campuses in North Carolina and Virginia completed an online survey in 2012 and again in 2013 that assessed WTS susceptibility and subsequent waterpipe use. Tobacco use, marijuana use, binge drinking, and sensation seeking were also assessed. Overall, 964 students who reported having never used waterpipe tobacco in 2012 completed the online surveys both years. Overall, about 27% of college youth were susceptible to WTS each year. Participants susceptible in 2012 were 2.5 times more likely to report having used waterpipe tobacco the subsequent year than non-susceptible participants after controlling for significant correlates of waterpipe use. Correlates of susceptibility were: being male, past 30 day cigarette smoking, use of other tobacco products, binge drinking and marijuana use, as well as higher sensation seeking. A 4-item WTS susceptibility measure predicts future WTS. This measure can be used to identify and intervene upon susceptible college youth to curb further exploration of WTS. Indeed, a nontrivial proportion of college students found susceptible go on to use waterpipe tobacco within a year.

Water pipe tobacco smoking in the United States: Findings from the National Adult Tobacco Survey

ObjectiveTo report prevalence and correlates of water pipe tobacco smoking (WTS) use among U.S. adults. MethodsData were from the 2009–2010 National Adult Tobacco Survey, a nationally representative sample of U.S. adults. Estimates of WTS ever and current use were reported overall, and by sex, age, race/ethnicity, educational attainment, annual household income, sexual orientation, and cigarette smoking status. State-level prevalence rates of WTS ever were reported using choropleth thematic maps for the overall population and by sex. ResultsThe national prevalence of WTS ever was 9.8% and 1.5% for current use. WTS ever was more prevalent among those who are male (13.4%), 18–24years old (28.4%) compared to older adults, non-Hispanic White (9.8%) compared to non-Hispanic Black, with some college education (12.4%) compared to no high school diploma, and reporting sexual minority status (21.1%) compared to heterosexuals. States with highest prevalence included DC (17.3%), NV (15.8%), and CA (15.5%). ConclusionWTS is now common among young adults in the US and high in regions where cigarette smoking prevalence is the lowest and smoke-free policies have a longer history. To reduce its use, WTS should be included in smoke-free regulations and state and federal regulators should consider policy development in other areas, including taxes, labeling, and distribution.

Double trouble: Exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents

BackgroundIn youth, both waterpipe tobacco smoking (WTS) and nonmedical use of prescription drugs (NMUPD) are globally growing concerns. This study assesses for the first time the lifetime and past-year associations between WTS and four classes of psychoactive prescription drugs. MethodsCross-sectional data (2011) on 986 high school students attending public and private high schools in Beirut (Lebanon) was analyzed. Schools were selected using proportionate random cluster sampling from a comprehensive list of schools provided by the Ministry of Education. ResultsAlmost half (46%) had tried WTS compared to 25% who had ever tried cigarettes. Lifetime prevalence estimates of NMUPD were: pain relievers (8.2%), sedatives/tranquilizers (5.6%), stimulants (3.5%), antidepressants (2.5%), and sleeping pills (2.3%). WTS was associated with increased odds of sedatives/tranquilizer use (OR=3.22, 95% CI: 1.25, 8.25), pain reliever use (OR=4.31, 95% CI: 2.02, 9.17), and sleeping medication use (OR=8.31, 95% CI: 2.37, 29.20), controlling for sex, age, school type, and other substance use. For cigarettes, the associations were consistently either weaker or non-existent, except with stimulant use (OR=5.29, 95% CI: 1.55, 18.05). ConclusionsWhile public health professionals have watched with caution the global prevalence of youth cigarette use–worldwide, an insidious alternative form of tobacco use has grown. Further research is needed to understand the unique risk factors and motives associated with WTS and how these relate to NMUPD in order to inform the development of effective intervention programs and policies that support youth positive health decisions.

Chinese Water-Pipe Smoking and the Risk of COPD

Studies show that the incidence of COPD has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. Chinese water-pipe tobacco smoking (commonly referred to as water-pipe smoking), which is thought to be less harmful under the assumption that no charcoal is used and water filters tobacco smoke, is popular in China. We investigated whether Chinese water-pipe use and exposure are associated with the risk of COPD. This multicenter, cross-sectional study enrolled 1,238 individuals from 10 towns in the Fuyuan area, Yunnan Province, China. A matched design was used to estimate the impact of active and passive exposure to Chinese water-pipe smoking on COPD risk; multivariate analyses adjusted for other risk factors. We also collected the water from Chinese water pipes to assess the mutagenicity of its major components and simulated Chinese water-pipe smoke exposure fine particulate 2.5 (PM2.5) by using the High Volume Air Sampler and individuals' sera to search for the potential protein biomarkers of COPD. The increased risk of COPD was profound for Chinese water-pipe smokers (adjusted OR, 10.61; 95% CI, 6.89-16.34), Chinese water-pipe passive smokers (adjusted OR, 5.50; 95% CI, 3.61-8.38), cigarette smokers (adjusted OR, 3.18; 95% CI, 2.06-4.91), and cigarette passive smokers (adjusted OR, 2.52; 95% CI, 1.62-3.91) compared with never-smoking control subjects. Chinese water-pipe use aggravates lungs with more PM2.5 compared with cigarettes. ChemR23 and tissue inhibitor of metalloproteinase-1 may be potential protein biomarkers of COPD. Chinese water-pipe smoking significantly increases the risk of COPD, including the risk to women who are exposed to the water-pipe smoke. Chinese Clinical Trial Registry; No.: ChiCTR-CCH-12002235; URL: www.chictr.org/cn/

Challenges to obtaining parental permission for child participation in a school-based waterpipe tobacco smoking prevention intervention in Qatar.

BackgroundInvolving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.MethodsA random sample of 40 schools in Doha, Qatar was selected for inclusion in the original intervention. Permission forms were distributed to parents for approval of their child’s participation. The permission forms requested that parents indicate their reasons for non-permission if they declined. These were categorized into themes. In order to understand reasons for non-permission, interviews with parents were conducted. Phone numbers of parents were requested from the school administration; 12 of the 40 schools (30%) agreed to provide the contact information. A random sample of 28 parents from 12 schools was interviewed to reach data saturation. Thematic analysis was used to analyze their responses.ResultsReasons for non-permission documented in both the forms and interviews included: poor timing; lack of interest; the child not wanting to participate; and the child living in a smoke-free environment. Interviews provided information on important topics to include in the consent forms, parents’ decision-making processes regarding their child’s participation, and considerations for communicating with parents. Many parents also indicated that this was the first time they had been asked to give an informed consent for their child’s participation in a study.ConclusionsResults indicate that more attention needs to be given to the informed parental consent process. Researchers should consider enhancing both the methods of communicating information as well the specific information provided. Before embarking on recruitment of children for studies, formative research on the parental consent process is suggested.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6939-15-70) contains supplementary material, which is available to authorized users.

Prevalence of tobacco smoking among health-care physicians in Bahrain.

BackgroundThere is a clear shift in smoking habits among the Middle Eastern population with a recent and alarming increase in the prevalence of waterpipe (shisha) smoking. This phenomenon has not yet been studied sufficiently across the physician population. Therefore, we set out to establish the smoking status of primary healthcare physicians in the kingdom of Bahrain.MethodsA self-administered questionnaire was distributed to a random sample of 175 out of the total 320 primary care physicians. Descriptive analysis was performed on all data and associations between variables were tested using Fishers Exact t test with statistical significance set as P-value < 0.05.ResultsOne hundred and fifty two physicians agreed to participate in the study. Sixty seven percent of physicians were females and the mean (SD) age was 45 (10) years. The majority of the physicians were married (93%) and of Bahraini nationality (76%). Ever-smokers were 11% of the population while current smokers corresponded to 8.6%. Waterpipe was the most common method of tobacco smoking followed by cigarettes. Among male physicians, the prevalence of current ‘waterpipe only’ smokers was 12%, followed by 4% and 2% corresponding to ‘cigarette only’ smokers and both, respectively. There were only three female smokers in the population, two ‘waterpipe only’ smokers and one cigar smoker. Of those who smoked waterpipe (n = 9; 6%), 33% smoked daily, 44% smoked weekly and 22% smoked at least once a month. Current smoking status was associated with male gender (P < 0.001) and showed a male to female smoking ratio of (10:1).ConclusionWaterpipe smoking rates exceeded cigarette smoking among the population of physicians in Bahrain. Prevalence of smoking remains unacceptably high among male physicians. Assessment of physicians’ knowledge of the harmful effects of waterpipe tobacco smoking is warranted to plan future interventions.

Effect of water pipe tobacco smoking on plasma high sensitivity C reactive protein level and endothelial function compared to cigarette smoking

Abstract Background Cigarette smoking is a well known risk factor for cardiovascular disease, however, little is known regarding water pipe (WP) smoking. High sensitivity C-reactive protein (hs-CRP) and flow mediated dilatation (FMD) are well recognized methods to assess cardiovascular risks. Objectives To study the effect of WP smoking on hs-CRP level and endothelial function compared to cigarette smoking. Methods The study included 77 male subjects (30 WP smokers, 30 cigarette smokers, and 17 controls). Hs-CRP level was measured using the ELISA technique and the threshold of high risk level was 3 mg/l. FMD was assessed in the brachial artery. Subjects with FMD Results Hs-CRP level was slightly higher in smokers than controls (2.21 ± 1.6 versus 1.73 ± 1.19 mg/l, P = 0.25). FMD was significantly lower in smokers (12 ± 6.66 versus 17.45 ± 11.29%, P = 0.016). There were no significant differences between WP smokers and cigarette smokers regarding hs-CRP level ( P = 0.19) and FMD ( P = 0.91). In an adjusted regression model, age ( P = 0.002) and cigarette smoking ( P = 0.046) were found to be significant predictors for high risk profile, whereas WP smoking did not have a predictive effect ( P = 0.91). Conclusions WP smokers and cigarette smokers had comparable degrees of inflammation and endothelial dysfunction. However, cigarette smoking was a stronger predictor for high risk profile.

Water pipe steam stones: familiarity and use among US young adults.

Water pipe tobacco smoking (WTS) is associated with substantial toxicant exposure. Water pipe steam stones (WSS) are marketed as a healthier alternative. The purpose of this study was to determine, in a nationally representative sample, young adults' familiarity with, perceptions regarding, and use of WSS. A survey about WTS was completed by 3,253 members of an online nonvolunteer access panel. Four items specifically addressed WSS. Of the 228 individuals who had heard of WSS, 17% (n = 41) reported using them. Use was associated with ever (adjusted odds ratio [AOR] = 7.7, 95% confidence interval [CI] = 2.7-21.8) and current (AOR = 16.1, 95% CI = 5.1-51.5) WTS. Compared with those who thought that WSS had about the same harm as WTS, those who thought that WSS was "a lot less harmful" to a person's health had substantially higher odds of having tried WSS (AOR = 6.8, 95% CI = 2.0-23.1). Approximately 1 in 6 young adults who have heard of WSS used them. WSS use is associated with the perception of reduced harm.

Waterpipes and electronic cigarettes: increasing prevalence and expanding science.

The prevalence of noncigarette tobacco product use is on the rise across the globe, especially for waterpipes (also known as hookah, narghile, and shisha) and electronic cigarettes (e-cigarettes). The scientific literature reveals that waterpipe tobacco smoking is associated with exposure to a variety of toxicants that can cause short- and long-term adverse health events. In contrast, there is far less evidence of health harms related to e-cigarette use, although the variety of products in this category makes it difficult to generalize. We searched the PubMed database for all publications on waterpipes and e-cigarettes from January 2000 to March 2014. The number of publications on waterpipes rose in a slow, linear pattern during this time, while the number of publications on e-cigarettes showed exponential growth. The different trends suggest there may be more interest in studying a novel nicotine product (the e-cigarette) over a traditional tobacco product (the waterpipe). We posit that, although the specific research needs for these products are different, public health would be served best by a more equitable research approach. Scientists should continue to devote attention to understanding the unknown long-term health effects of e-cigarettes and their potential to serve as harm reduction or smoking cessation tools while simultaneously investigating how to reduce waterpipe smoking given that it exposes users to toxicants known to cause harm to health. Recent regulatory action in the United States, which proposes to include waterpipes and e-cigarettes under some of the same regulations as tobacco cigarettes, makes such research particularly timely.

How popular is waterpipe tobacco smoking? Findings from internet search queries

ObjectivesWaterpipe tobacco smoking (WTS), a traditional tobacco consumption practice in the Middle East, is gaining popularity worldwide. Estimates of population-level interest in WTS over time are not documented. We assessed...

Reigniting tobacco ritual: waterpipe tobacco smoking establishment culture in the United States.

Waterpipe tobacco smoking (WTS) is an increasingly prevalent form of tobacco use in the United States. Its appeal may stem from its social, ritualistic, and aesthetic nature. Our aim in this study was to understand WTS as a social ritual with the goal of informing prevention efforts. We conducted a covert observational study consisting of 38 observation sessions in 11 WTS establishments in 3 U.S. cities. Data collection was based on an established conceptual framework describing ritualistic elements of tobacco use. Iterative codebook development and qualitative thematic synthesis were used to analyze data. Atmospheres ranged from quiet coffee shop to boisterous bar party environments. While some children and older adults were present, the majority of clientele were young adults. Men and women were evenly represented. However, there were 19 occurrences of a male smoking by himself, but no women smoked alone. The vast majority (94%) of the clientele were actively smoking waterpipes. All 83 observed groups manifested at least 1 of the ritual elements of our conceptual framework, while 41 of the 83 observed groups (49%) demonstrated all 4 ritual elements. Despite its heterogeneity, WTS is often characterized by 1 or more established elements of a tobacco-related social ritual. It may be valuable for clinical and public health interventions to acknowledge and address the ritualistic elements and social function of WTS.

Promotion of waterpipe tobacco use, its variants and accessories in young adult newspapers: a content analysis of message portrayal.

The objective of our study was to identify waterpipe tobacco smoking advertisements and those that promoted a range of products and accessories used to smoke waterpipe tobacco. The content of these advertisements was analyzed to understand the messages portrayed about waterpipe tobacco smoking in young adult (aged 18-30) newspapers. The study methods include monitoring of six newspapers targeting young adults from four major cities in the Southeastern United States over a 6-month period. A total of 87 advertisements were found; 73.5% (64) were distinct and content analyzed. The study results showed that of the advertisements analyzed, 25% advertised waterpipe tobacco smoking, 54.7% featured waterpipe tobacco smoking and other tobacco use, 14.1% featured non-tobacco waterpipe variants (i.e. vaporizers), and 6.3% featured waterpipe apparatus accessories (e.g. charcoal, hoses). The sociability (34%) and sensuality (29.7%) of waterpipe smoking were promoted themes. Alternative to cigarette use messages (3.1%), and harm-reduction messages (17.1%) emphasized that smoking waterpipe tobacco using the featured accessory or waterpipe variant was a healthier experience than cigarette smoking. The study concluded that the messages that promoted waterpipe tobacco smoking to young adults are parallel to those used to promote cigarette use. Tobacco control professionals should continue to monitor young adult newspapers as a source of waterpipe-related advertising.

Nicotine and carcinogen exposure after water pipe smoking in hookah bars.

Water pipe tobacco smoking is spreading globally and is increasingly becoming popular in the United States, particularly among young people. Although many perceive water pipe smoking to be relatively safe, clinical experimental studies indicate significant exposures to tobacco smoke carcinogens following water pipe use. We investigated biomarkers of nicotine intake and carcinogen exposure from water pipe smoking in the naturalistic setting of hookah bars. Fifty-five experienced water pipe users were studied before and after smoking water pipe in their customary way in a hookah bar. Urine samples were analyzed for nicotine, cotinine, the tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and mercapturic acid metabolites of volatile organic compounds (VOC). We found an average 73-fold increase in nicotine, 4-fold increase in cotinine, 2-fold increase in NNAL, and 14% to 91% increase in VOC mercapturic acid metabolites immediately following water pipe smoking. We saw moderate to high correlations between changes in tobacco-specific biomarkers (nicotine, cotinine, and NNAL) and several mercapturic acid metabolites of VOCs. Water pipe smoking in a hookah bar is associated with significant nicotine intake and carcinogen exposure. Given the significant intake of nicotine and carcinogens, chronic water pipe use could place users at increased risk of cancer and other chronic diseases. Cancer Epidemiol Biomarkers Prev; 23(6); 1055-66. ©2014 AACR.

Pilot Study of Waterpipe Tobacco Smoking Among US Muslim College Students

Waterpipe smoking is common among the young in Muslim-majority countries despite recent Islamic rulings on tobacco. US Muslim college students, especially immigrants, may be at high risk for smoking, but information is lacking. In this pilot study, respondent-driven sampling was used to sample 156 Muslim college students. Waterpipe smoking was common (44.3%). Leading motivations to smoke were social and perceived low tobacco harm. Independent risk factors among the Muslim students were perception that friends and other students smoked, and ever drank alcohol. Personal belief that waterpipe smoking is prohibited in Islam was not significant. This pilot suggests that Muslim students are at high risk for waterpipe smoking and more definitive studies are needed.

Experimentation with and knowledge regarding water-pipe tobacco smoking among medical students at a major university in Brazil

OBJECTIVE: Water-pipe tobacco smoking is becoming increasingly more common among young people. The objective of this study was to estimate the prevalence of the use of water pipes and other forms of tobacco use, including cigarette smoking, among medical students, as well as to examine the attitudes, beliefs, and knowledge of those students regarding this issue. METHODS: We administered a questionnaire to students enrolled in the University of São Paulo School of Medicine, in São Paulo, Brazil. The respondents were evaluated in their third and sixth years of medical school, between 2008 and 2013. Comparisons were drawn between the two years. RESULTS: We evaluated 586 completed questionnaires. Overall, the prevalence of current cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively. All respondents believed that health professionals should advise patients to quit smoking. However, few of the medical students who smoked received physician advice to quit. Experimentation with other forms of tobacco use was more common among males (p<0.0001). Despite their knowledge of its harmful effects, students experimented with water-pipe tobacco smoking in high proportions (47.32% and 46.75% of the third- and sixth-year students, respectively). CONCLUSIONS: The prevalence of experimentation with water-pipe tobacco smoking and other forms of tobacco use is high among aspiring physicians. Our findings highlight the need for better preventive education programs at medical schools, not only to protect the health of aspiring physicians but also to help them meet the challenge posed by this new epidemic.

Laboratory and Clinical Acute Effects of Active and Passive Indoor Group Water-Pipe (Narghile) Smoking

Indoor group water-pipe tobacco smoking, commonly referred to as water-pipe smoking (WPS), especially in coffee shops, has gained worldwide popularity. We performed a comprehensive laboratory and clinical evaluation of the acute effects of active and passive indoor group WPS. This comparative study evaluated pre- and post-30-min active and passive indoor group WPS. The outcome parameters were carboxyhemoglobin (COHb), nicotine, and cotinine levels; CBC count; and cardiorespiratory parameters. Exhaled breath condensate (EBC) cytokines and endothelial function (using the EndoPat device [Itamar Medical Ltd]) were measured only in active smokers. Statistical methods used were Student t test, Wilcoxon signed rank test, Fisher exact test, analysis of variance, and Newman-Keuls post hoc test where relevant. Sixty-two volunteers aged 24.9±6.2 years were included; 47 were active smokers, and 15 were passive smokers. COHb level increased postactive WPS (active smokers, 2.0%±2.9% vs 17.6%±8.8%; P<.00001); six subjects (12.7%) had a >25% increase, and two subjects (4.2%) had a >40% increase. Plasma nicotine level increased postactive WPS (active smokers, 1.2±4.3 ng/mL vs 18.8±13.9 ng/mL; P<.0001); plasma cotinine and urinary nicotine and cotinine levels also increased significantly. EBC IL-4, IL-5, IL-10, IL-17, and γ-interferon decreased significantly with postactive smoking; endothelial function did not change. WPS was associated with adverse cardiorespiratory changes. In passive smokers, COHb level increased (0.8%±0.25% vs 1.2%±0.8%, respectively, P=.003) as did respiratory rate. One session of active indoor group WPS resulted in significant increases in COHb and serum nicotine levels (eightfold and 18-fold, respectively) and was associated with adverse cardiorespiratory health effects. The minor effects found in passive smokers suggest that they too may be affected adversely by exposure to WPS. The results call for action to limit the continuing global spread of WPS in coffee shops. ClinicalTrials.gov; No.: NCT1237548; URL: www.clinicaltrials.gov.

Legislation Enforcement of the Waterpipe Tobacco Industry: A Qualitative Analysis of the London Experience

Waterpipe tobacco smoking (WTS) is prevalent worldwide and is legislatively enforceable under many countries' existing tobacco laws. Globally, however, the waterpipe tobacco industry anecdotally appears poorly controlled. This study aimed to gather intelligence from local government (known as local authority [LA]) staff in London, United Kingdom, about their WTS enforcement experiences. In-depth telephone interviews were conducted among 26 LA staff from 14 London boroughs, exploring industry characteristics and tobacco legislation compliance. Recurrent themes were analyzed and derived deductively. Approximately 400 waterpipe premises operate across London, benefiting from high profit margins. LA staff are resource strained, limiting their surveillance of waterpipe premises, some of which are associated with an underground culture. Noise and nuisance are key features of waterpipe premises. Most waterpipe premises were generally noncompliant with most aspects of existing tobacco legislation, mainly due to disproportionately low fines and unclear legislation enforcement guidance. Successful methods for enforcing legislation included a synchronized, multiagency approach; however, this was inconsistently implemented across boroughs. Many LA staff believe licensing waterpipe premises will improve surveillance and control the industry's proliferation. The waterpipe tobacco industry is unregulated and places a significant burden on many LAs in London, mainly due to lack of resources. These problems may also occur in other large cities worldwide. Existing tobacco legislation should be amended to accommodate WTS, including consideration of licensing the industry. More research is needed to gain a full understanding of the waterpipe tobacco industry and its impact on other global cities.

The LWDS-10J: Reliability and Validity of the Lebanon Waterpipe Dependence Scale Among University Students in Jordan

While the Lebanon Waterpipe Dependence Scale (LWDS-11) has shown promise in assessing dependence on waterpipe tobacco smoking (WTS) in Lebanon among adult users, it would be valuable to identify WTS addiction earlier and to explore reliability and validity of these items in other populations. In 2010-2012, we conducted a multiyear survey of 5,853 students from 4 Jordanian universities. We measured WTS, sociodemographic data, and the LWDS-11 items. We conducted exploratory factor analysis with half of the sample and confirmed the resulting model using confirmatory factor analysis with the other half. We examined construct validity with regression models assessing associations between the modified scale and 5 constructs conceptually expected to be associated with dependence. WTS rates were 35% in the past 30 days and 56% ever. Principal-components analysis of LWDS items in the first half of the sample yielded 10 items representing 3 factors labeled physical dependence, relaxation/pleasure, and social aspects. Cronbach's α was .77 for the total scale and was .75, .70, and .67 for each individual subscale. Confirmatory factor analysis in a structural equation modeling framework confirmed good fit (root mean squared error of approximation = 0.068, and comparative fit index = 0.937). Dependence according to the resulting scale (LWDS-10J) was strongly associated with each of the 5 expected constructs, whether the dependent variable was treated as categorical or continuous. The LWDS-11 items exhibited a different factor structure in our sample. However, the modified scale (LWDS-10J) showed promising reliability and construct validity in this population.

Bibliometric analysis of scientific publications on waterpipe (narghile, shisha, hookah) tobacco smoking during the period 2003-2012.

BackgroundWaterpipe tobacco smoking has spread worldwide. However, the evaluation of scientific output in the field of waterpipe tobacco smoking has not been studied yet. The main objectives of this study were to analyze worldwide research output in the waterpipe tobacco smoking field, and to examine the authorship pattern and the citations retrieved from the Scopus database for over a decade.MethodsData from January 1, 2003 through December 31, 2012 were searched for documents with specific words regarding waterpipe tobacco smoking as “keywords” in the title. Scientific output was evaluated based on a methodology developed and used in other bibliometric studies: (a) total and trends of contributions in waterpipe tobacco smoking research between 2003 and 2012; (b) authorship patterns and research productivity; (c) collaboration patterns; (d) the citations received by the publications; and (e) areas of interest of the published papers.ResultsWorldwide there were 334 publications that met the criteria during the study period. The largest number of publications in waterpipe tobacco smoking were from the United States of America (USA) (33.5%), followed by Lebanon (15.3%), and France (10.5%). The total number of citations at the time of data analysis (October 18, 2013) was 4,352, with an average of 13 citations per document and a median (interquartile range) of 4.0 (1.0–16.0). The h-index of the retrieved documents was 34. The highest h-index by country was 27 for the USA, followed by 20 for Syrian Arab Republic and Lebanon.ConclusionsThe present data reveal a promising rise and a good start for research activity in the field of waterpipe tobacco smoking. More effort is needed to bridge the gap in waterpipe smoking-based research and to promote better evaluation of waterpipe smoking, risks, health effects, or control services worldwide.