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Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling
  1. Dima Bteddini1,
  2. Rima T Nakkash2,3,
  3. Ali Chalak4,
  4. Mohammed Jawad5,
  5. Yousef Khader6,
  6. Niveen M E Abu-Rmeileh7,
  7. Aya Mostafa8,
  8. Ruba Abla2,
  9. Sameera Awawda7,
  10. Ramzi G Salloum1,2
  1. 1 Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
  2. 2 Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
  3. 3 Department of Global and Community Health, George Mason University College of Health and Human Services, Fairfax, Virginia, USA
  4. 4 Department of Agriculture, American University of Beirut, Beirut, Lebanon
  5. 5 Public Health Policy Evaluation Unit, Imperial College London, London, UK
  6. 6 Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
  7. 7 Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
  8. 8 Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
  1. Correspondence to Dr Ramzi G Salloum, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; rsalloum{at}


Economic evaluation of tobacco control policies is common in high-income settings and mainly focuses on cigarette smoking. Evidence suggests that increasing the excise tax of tobacco products is a consistently effective tool for reducing tobacco use and is an efficient mechanism for increasing government revenues. However, less research has been conducted in low/middle-income countries where other tobacco forms are common. This paper presents insights from our work on the economics of waterpipe tobacco smoking conducted in the Eastern Mediterranean Region where waterpipe smoking originated and is highly prevalent. The specific areas related to economics of waterpipe smoking considered herein are: price elasticity, taxation, government revenue, expenditure and healthcare costs. This paper aims to provide practical guidance for researchers investigating the economics of waterpipe tobacco with potential implications for other novel tobacco products. We present lessons learnt across five thematic areas: data, demand, taxes, equity and health modelling. We also highlight knowledge gaps to be addressed in future research. Research implications include designing comprehensive assessment tools that investigate heterogeneity in waterpipe smoking patterns; accounting for cross-price elasticity of demand with other tobacco products; exploring the change in waterpipe tobacco smoking in response to a tax increase and analysing the equity impact of waterpipe tobacco control interventions.

  • non-cigarette tobacco products
  • economics
  • price
  • taxation
  • low/middle income country

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  • Twitter @Dima_Bteddini, @rimanakkash, @AliChalak3, @mojawad606

  • Contributors RGS, RTN, AC and MJ conceptualised the study. DB and RGS wrote the first draft. All authors contributed to successive drafts and approved the final manuscript.

  • Funding The research presented in this paper was funded by a grant from the International Development Research Centre (grant number 108821).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.