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Tob Control. 2017 May;26(3):338-343. doi: 10.1136/tobaccocontrol-2016-052958. Epub 2016 May 10.

Consensus statement on assessment of waterpipe smoking in epidemiological studies.

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Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.
Syrian Center for Tobacco Studies, Aleppo, Syria.
Department of Epidemiology, Florida International University, Miami, Florida, USA.
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Department of Health Outcomes and Policy, and Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.
Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Departments of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York University, New York, New York, USA.
Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.


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.


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

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