Is concern about waterpipe tobacco smoking warranted?

Abstract

Waterpipe tobacco (WT) smoking is traditionally practised in the Orient.1 Waterpipe is known by many names, including narghila, nargila, shisha and goza.2 WT smoking involves burning the tobacco with embers or charcoal. The smoke is filtered through a bowl of water and then drawn through a rubber hose to a mouthpiece and inhaled through the mouth. 2The available research suggests that significant adverse health effects are associated with active and passive WT smoke; it is not a safe form of tobacco smoking.2-4 Researchers overseas have expressed concerns about the rising prevalence of WT smoking since the 1990s and erroneous consumer beliefs of relative safety compared with cigarette smoking. 2To our knowledge, we were the first to report the prevalence of WT smoking in an Australian population.5 A telephone survey of tobacco use among Arabic-speakers residing in south-west Sydney found 11.4% current prevalence (1% daily) of WT smoking. The data also indicated Arabic-speakers believed WT smoking was less harmful than cigarettes.To better understand the determinants of WT smoking and to identify at-risk groups, we further analysed this existing data 5 and focused on WT smoking and respondents' knowledge of its harms. We performed bivariate (cross-tabular) and multiple logistic regression analyses to explore the independent factors associated with WT smoking with WT smoking knowledge score, socio-economic and demographic characteristics. We found that current cigarette/cigar/pipe (CCP) smoking status, being aged 40-59, and having low to moderate WT smoking knowledge independently predicted WT smoking prevalence (Table 1). One-quarter of all current CCP smokers smoked WT at least occasionally, while only 7% of ex-CCP smokers and 7% of those who had never smoked CCP smoked WT at least occasionally. The most popular places to smoke WT reported by current WT smokers were at home (outdoors) 65%; at friends' and relatives' homes (outdoors) 50%; and at Arabic cafes (outdoors) 32%. Respondents who did not smoke WT were significantly more likely to agree with the statements 'smoking narghila/shisha (WT) is harmful to your health' (82% vs. 71%, p= ≤0.01) and that 'smoke inhaled from narghila/shisha (WT) contains harmful chemicals' (74% vs. 64%, p=≤0.05).We believe the main tobacco control priority for Arabicspeakers should remain focused on reducing cigarette smoking prevalence for several reasons. First, there is a low prevalence of WT smoking compared with CCP smoking prevalence (11.4% vs. 26%).5 Second, our analysis shows that CCP smoking status is the strongest predictor of WT smoking, with current CCP smokers being more than four times more likely to use waterpipe than non-CCP smokers. Finally, despite mistaken beliefs of the relative safety of WT compared with cigarette smoking, we are not alarmed about potential switching as only one ex-CCP smoker (out of 1,102 respondents) also reported smoking WT on a daily basis.Nevertheless, some specific strategies for WT smoking are still warranted as almost half of all WT smo...

The global epidemic of waterpipe smoking

“…In Canada, the 2006 Canadian Tobacco Use Monitoring Survey shows that 8% of youth aged 15–24 years had ever used the WP (Canadian Tobacco Use Monitoring Survey (CTUMS), 2006). The available evidence from Australia comes from a telephone survey conducted in 2004 and involved 1,102 Arabic-speaking residents in south-west Sydney, where current WP smoking was reported by 11.4% of participants (Carroll et al, 2008). …”

The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review

“…Recent studies have reported relatively high prevalence rates of waterpipe tobacco smoking in Middle Eastern countries,[10] but also in western countries such as the United States,[2,11] the United Kingdom,[12] and Australia[13]. In 2005, the World Health Organization (WHO) issued an advisory note calling for a better understanding of national and global trends of waterpipe tobacco smoking[14].…”

Association of waterpipe smoking and road traffic crashes

“…Other reports from the United States[21,22], United Kingdom[23], Estonia[24], Australia[25], Ukraine[26], Germany[27], Brazil[28], Canada[29], and Korea[30] also substantiate the evidence for this global public health threat. Generally speaking, the burden seems to be huge and increasing due to smoking-related harms, unrealistic risk perception and socio-cultural acceptability [5,31,32]. …”