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The story has been told many times: waterpipe, a centuries-old tobacco use method in which smoke is passed through water before being inhaled, probably originated on the Indian subcontinent and southeast Asia. Over the years, it spread and became popular in the Middle East. During most of the 20th century, it seemed that waterpipe's heyday had passed, in favour of easy-to-use types of tobacco such as cigarettes. Its use was not even registered in the expanding body of global tobacco surveillance systems. The medical and public health literatures made little note of it: Rakower and Fatal's1 examination of lung cancer mortality rates by ethnic groups in Jerusalem that differed in their use of waterpipe, appearing in the British Journal of Cancer, was the first notice of waterpipe in Medline in 1962, and almost 20 years were to pass before any additional studies were to appear. But things suddenly changed in the 1990s: upticks in use were observed in the Middle East, especially among teenagers and young adults. This was mostly fuelled by the invention of flavoured and easier-to-use tobacco, a growing café culture in the Middle East, and expanding internet availability and globalisation. As a result, waterpipe use has snowballed globally at the start of the 21st century.
Tobacco Control published the first review of waterpipe's global spread and health effects in 2004,2 noting the scant but steadily increasing research base, and the potential for waterpipe to upend successes in global tobacco control. A decade later, that forecast has come true. In this supplement, Maziak et al3 note that the “global evolution of this smoking habit has exceeded worst predictions.” In several Middle Eastern nations, the waterpipe has quickly replaced cigarettes as the most popular method of tobacco use among youth, and in several other parts of …
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