BUFFALO, N.Y. - Students in schools and universities in the U.S.
and around the world are using waterpipes to smoke tobacco at
"alarmingly high" rates, according to a study published this month
by University at Buffalo researchers.
Published in Biomedical Health Central Public Health, the paper
is the first systematic review of the prevalence of waterpipe
smoking across countries, age groups and genders. It is available
Systematic reviews are conducted through an exhaustive and
systematic search for, assessment, and analysis of, all relevant,
peer-reviewed research ever published on a particular subject.
"Waterpipe smoking is a real epidemic in the world and it's
picking up in the U.S. too," says Elie Akl, MD, PhD, lead author
and associate professor of medicine, family medicine and social and
preventive medicine at the University at Buffalo's School of
Medicine and Biomedical Sciences and School of Public Health and
Health Professions. Akl also holds a part-time appointment in the
Department of Clinical Epidemiology and Biostatistics at McMaster
The UB review identified 38 relevant studies conducted in the
U.S., the United Kingdom, Australia and Estonia, as well as
countries in the Arab Gulf, including Lebanon, Pakistan, Egypt,
Syria, Bahrain, Kuwait, Oman, Qatar, the United Arab Emirates and
Yemen. Target populations of the studies were middle or high school
students as young as 13 years of age, university students, adults
and pregnant women.
While the paper reveals the highest rates of waterpipe smoking
in Middle Eastern and Asian countries, where the practice has a
centuries-long tradition, the researchers also found that it is
increasing in the U.S. and other western countries.
"The surveys included in this review found an alarming
prevalence of waterpipe smoking among middle and high school
students in the U.S.," Akl says. "It was especially true of
Arab-American students, who reported waterpipe usage ranging from
12 to 15 per cent."
The surveys included also revealed that current waterpipe
smoking among adults is at 6 percent in Pakistan, 4-12 percent in
the Arabic Gulf region, at 11 percent in Australia among
Arab-speaking adults and 15 percent in Lebanon. Group waterpipe
smoking was high in Lebanon, at 5 percent, and in Egypt ranging
between 11 and 15 percent. In Lebanon, between 5 and 6 percent of
pregnant women also reported waterpipe smoking during
The UB review also found that approximately 10 percent of
university students in the U.S. reported waterpipe smoking.
This is Akl's fourth publication on waterpipe smoking. A study
he published last year in Chest Journal found that, contrary to
popular perceptions, its deleterious effects on pulmonary function
are very similar to those of cigarettes. (Listen to the Chest
Journal podcast with Dr. Akl about that paper at http://chestjournal.chestpubs.org/content/139/4/764/suppl/DC1)
Akl says that the current findings should be a wake-up call to
public health agencies that should directly address waterpipe
smoking in their tobacco-control strategies.
"Awareness campaigns need to take into account that waterpipe
smoking is increasing, especially among youth, and that it may be a
gateway to cigarette use in adulthood," he says.
"The problem is that some people are advocating the hookahs, or
waterpipes, as safer than cigarettes," he explains. "It's perceived
as less addictive. And because in the hookah, the smoke comes
through a column of water, which is supposed to filter the smoke,
it's been seen as safer than cigarettes and other forms of tobacco
But a study by Akl and others published in the International
Journal of Epidemiology has found that waterpipe tobacco smoking is
significantly associated with lung cancer, respiratory illness, low
birth-weight and periodontal disease.
"Waterpipe smoking is seen as a more social, more sophisticated,
more fashionable way of smoking tobacco," he says, noting that
hookah bars are now opening up in cities throughout the U.S. and
western countries as well as in the Middle East.
"This review reveals a need for a better understanding of the
epidemiology of this new epidemic, especially concerning how
waterpipe smoking may lead to cigarette smoking, so that public
health agencies can best address these behaviors, particularly
among youth," says Akl.
The research was co-authored by Sameer K. Gunukula, MD, Sohaib
Aleem, MD, Philippe Abou Jaoude, MD and Roland Honeine, MD, all of
the UB Department of Medicine, Rawad Obeid of Wayne State
University and Jihad Irani of the University of Balamand in
The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New
York system and its largest and most comprehensive campus. UB's
more than 28,000 students pursue their academic interests through
more than 300 undergraduate, graduate and professional degree
programs. Founded in 1846, the University at Buffalo is a member of
the Association of American Universities.