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Hookah (a.k.a waterpipe) tobacco smoking is rooted in the middle eastern cultures and is rising in popularity among young people worldwide.1 This high popularity is attributed mainly to the introduction of tobacco flavouring, a growing cafe culture, the spread of social media and the absence of strong hookah-specific regulatory/policy frameworks.1–3 A recent review of legislation in 62 countries demonstrated that the majority do not address hookah regulation, relying instead on generic tobacco/smoking definitions to cover all tobacco products.2 One hookah smoking session exposes users to larger smoke volumes and higher levels of tobacco toxicants such as tar, carbon monoxide and nicotine compared with one cigarette.4 Tobacco control efforts aimed at regulating hookah smoking are often met with calls to ‘respect a traditional cultural practice’ and to be sensitive to this ancient middle eastern practice. …
Contributors MEK, AR, PG and ZBT contributed to the design and wrote the manuscript. All authors of the manuscript approved the final version for submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement There are no data in this work
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