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- Lung function
- air pollution
- smoking caused disease
- smoking topography
- second hand smoke
- global health
Regional trends indicate that tobacco waterpipe (TWP) smoking is common in the Eastern Mediterranean Region (EMR) and is increasing in global popularity.1–4 EMR TWP smokers use a commercially manufactured pipe (figure 1A)5 that is loaded with tobacco and sold in pre-weighed packages of 50 g or more. The EMR TWP user inhales a combination of tobacco and charcoal smoke after it has passed through water. Despite the mistaken belief that the water bath of the EMR TWP filters out harmful and/or addictive components,3 ,6–8 recent data indicates that EMR TWP smokers are exposed to biologically harmful levels of nicotine, tar, metals, volatile aldehydes, polycyclic aromatic hydrocarbons, volatile organic compounds and expired carbon monoxide (CO).9
In the Western Pacific Region, the Asian tobacco water pipe (ATWP, figure 1B) is a homemade pipe that consists of a tube (made of …
Funding This study was supported by grant R03 TWOO7345-01 from Fogarty/NIH (PI: Pramil Singh).
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics review and approval was obtained by the Institutional Review Board of Loma Linda University and the Ethics Committee on Research, Ministry of Health, Vientiane Capital, Laos PDR.
Provenance and peer review Not commissioned; externally peer reviewed.