Consensus statement on assessment of waterpipe smoking in epidemiological studies

Abstract

Numerous epidemiological accounts suggest that waterpipe smoking (a.k.a. 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 organizations 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 standardized 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.

Hazards of cigarettes, smokeless tobacco and waterpipe in a Middle Eastern Population: a Cohort Study of 50 000 individuals from Iran

“…One problem that complicates studying waterpipe is the fact that its use is most often intermittent, and many measures of intensity and dependence devised for cigarettes (past month smoking, former vs current use, etc) cannot capture its variation 19 48. On the other hand, lifetime cumulative exposure to waterpipe has been collected in a few studies, including a report by Sibai et al 49 showing a threefold increased risk of severe coronary stenosis associated with 40 waterpipe-years or more use.…”

Comparison of a preferred versus non-preferred waterpipe tobacco flavour: subjective experience, smoking behaviour and toxicant exposure

“…Potential participants were screened for eligibility via telephone using the following eligibility criteria: (1) intended to smoke WP in the next 6 months, (2) were current WP smokers as indicated by smoking WP ≥1 time in the past month,32 (3) were ≥18 years old, (4) spoke and understood English, (5) denied current or past chronic health issues (eg, cystic fibrosis, chronic obstructive pulmonary disease, asthma, lung or heart disease) and (6) were not currently pregnant or breastfeeding or had plans of becoming pregnant or beginning breastfeeding at any point during the study. All participants completed written informed consent procedures.…”

Now is the time to advocate for interventions designed specifically to prevent and control waterpipe tobacco smoking

“…In addition, establishing surveillance systems for WTS, or adding specific items on WTS to available surveillance systems including the Global Tobacco Surveillance System (GTSS; USDHHS, 1999) is necessary to monitor use and track the (hopefully) decreasing epidemic. In line with this recommendation, recently, an update to the recommendations for standardizing the measurement of waterpipe use has been suggested (Maziak et al, 2016; see also Maziak et al, 2005). …”