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The global epidemiology of waterpipe smoking
  1. Wasim Maziak1,2,
  2. Ziyad Ben Taleb1,
  3. Raed Bahelah1,3,
  4. Farahnaz Islam4,
  5. Rana Jaber1,
  6. Rehab Auf1,
  7. Ramzi G Salloum5
  1. 1Department of Epidemiology, Florida International University, Miami, Florida, USA
  2. 2Syrian Center for Tobacco Studies, Aleppo, Syria
  3. 3Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
  4. 4Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  5. 5Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  1. Correspondence to Dr Wasim Maziak, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Syrian Center for Tobacco Studies, 11200 SW 8TH ST, Miami, FL 33199, USA; wmaziak{at}


Objectives In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally.

Data sources Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used.

Study selection The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking.

Data extraction Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review.

Data synthesis Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns.

Conclusions Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.

  • Public policy
  • Nicotine
  • Non-cigarette tobacco products
  • Global health
  • Media

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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