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Consensus statement on assessment of waterpipe smoking in epidemiological studies
  1. Wasim Maziak1,2,
  2. Ziyad Ben Taleb3,
  3. Mohammed Jawad4,
  4. Rima Afifi5,
  5. Rima Nakkash5,
  6. Elie A Akl6,7,
  7. Kenneth D Ward2,8,
  8. Ramzi G Salloum9,
  9. Tracey E Barnett10,
  10. Brian A Primack11,
  11. Scott Sherman12,
  12. Caroline O Cobb13,
  13. Erin L Sutfin14,
  14. Thomas Eissenberg2,13,
  15. Expert Panel on Waterpipe Assessment in Epidemiological Studies
    1. 1Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
    2. 2Syrian Center for Tobacco Studies, Aleppo, Syria
    3. 3Department of Epidemiology, Florida International University, Miami, Florida, USA
    4. 4Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
    5. 5Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
    6. 6Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
    7. 7Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    8. 8Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
    9. 9Department of Health Outcomes and Policy, and Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, Florida, USA
    10. 10Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
    11. 11Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    12. 12Departments of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York University, New York, New York, USA
    13. 13Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
    14. 14Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
    1. Correspondence to Dr Wasim Maziak, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8TH ST, Miami, FL 33199, USA; wmaziak{at}


    Numerous epidemiological accounts suggest that waterpipe smoking (aka hookah, shisha, narghile) has become a global phenomenon, especially among youth. The alarming spread of waterpipe and accumulating evidence of its addictive and harmful effects represent a new threat in the global fight to limit tobacco-related morbidity and mortality. In response to waterpipe's alarming trends, major public health and tobacco control organisations have started or are considering systematic collection of data about waterpipe smoking to monitor its trends and assess its harmful effects in different societies. Such plans require coordination and agreement on epidemiological measurement tools that reflect the uniqueness of this tobacco use method, and at the same time allow comparison of waterpipe trends across time and place, and with other tobacco use methods. We started a decade ago our work to develop standardised measures and definitions for the assessment of waterpipe smoking in epidemiological studies. In this communication, we try to expand and update these assessment tools in light of our increased knowledge and understanding of waterpipe use patterns, its context and marketing, as well as the need for evidence-guided policies and regulations to curb its spread. We have assembled for this purpose a group of leading waterpipe researchers worldwide, and worked through an iterative process to develop the suggested instruments and definitions based on what we know currently about the waterpipe epidemic. While the suggested measures are by no means comprehensive, we hope that they can provide the building blocks for standard and comparable surveillance of waterpipe smoking globally.

    • Surveillance and monitoring
    • Non-cigarette tobacco products
    • Public policy

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