Preventing and controlling water pipe smoking: a systematic review of management interventions
BMC Public Health volume 21, Article number: 344 (2021)
Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide.
A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories.
After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels.
The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.
Tobacco smoking is one of the main preventable causes of diseases and deaths claiming the lives of 7.2 million annually around the world [1, 2]. Although cigarette smoking is the dominant form of tobacco use in many countries, Water Pipe Smoking (WPS) with other names such as hookah, shisha, narghile, arghile. Goza, oriented pipe, hubble bubble, Mada’s and glaze base, accounts for a significant and growing share of tobacco use globally [3, 4]. In addition, WPS is a culture-based (there are some other types of tobacco smoking behavior) method of tobacco use  and its history goes back to 500 years ago in Middle East, North Africa and Asia. However, it has experienced a worldwide re-emergence since 1990  and is regaining popularity among different groups of populations, especially in school and university students [7, 8]. Although WPS is most prevalent in Asia (specifically the Middle East region) and Africa, it has now been changed to a rapidly emerging problem in other continents such as Europe, North, and South America [9, 10]. In recent years, there has been 6–34% increase in tobacco use among 13–15 year olds, most of whom attribute to WPS [10, 11]. In European regions such as Latvia and Czech Republic 22.7 and Estonia 21.9% of people smoke water pipe, while in the Eastern Mediterranean region, the prevalence of WPS is 39.0 and 31.0% of boys and girls, respectively . In average, Lebanon has the highest reported rate (37%) in this regard [12, 13]. In the United States, more than 30% of university students of both genders and 23% of high school students have experienced WPS [14, 15]. Similarly, WPS is also prevalent among highly educated groups. Nearly 20% of health professionals in Jordan and 11% of medical students in London smoked WP [16, 17]. Based on a report, 29.5% of physicians also experience WPS in Pakistan .
It has been shown that WPS’ smoking rate can be more addictive compared to that of the cigarette. It also contains more toxic and carcinogenic substances [19, 20] with deleterious effects on the respiratory and cardiovascular systems, as well as oral cavity and teeth . Furthermore, it has a huge negative impact on health costs and the gross domestic product of the countries. For example, the direct and indirect cost of smoking-related diseases is up to $300 billion in the United States annually [22, 23].
Considering the extension of WP businesses, some groups support its expansion . In recent years, the number of WP cafes has increased over many countries. As an example, there are nearly 400 WP cafes in London .
Using deceptive advertising, many cafes and restaurants offer WP services along with their orthodox services in order to earn more profit and lure more customers. Moreover, several factors contribute to attracting children and adolescents to WP cafes that leads to an increase in new cases of WPS [26,27,28]. These factors include the provision of flavored tobacco products or psychotropic WP, the proximity of WP cafe to the public settings such as educational or residential settings, sports clubs, and residential areas, tempting decoration, the provision of study places for students, live music, a variety of games and gambling, and the possibility of watching live movie and sport matches [6, 25, 29, 30].
All this shows that WPS has been turning to a public health crisis. WP business has remained largely unregulated and uncontrolled, which may result in the increasing prevalence of WPS . Moreover, WPS is one of the main factors that can lead to failure in tobacco control . Despite the concerns about WPS outcomes and nearly three decades of using control measures, the prevalence of WPS has increased over the world. Due to the unique nature of WP (multi-components), little is known about the prevention and control of WPS . Thus, special actions and interventions might be required to prevent and control WP tobacco use . Over the recent decade, there has been growing interest among researchers and policymakers regarding addressing the gaps in knowledge about interventions that can be useful in controlling and preventing WPS. Accordingly, this study aimed to identify the management interventions in international and national levels for preventing and controlling water pipe smoking.
A systematic literature review was conducted. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guideline  was used for performing and reporting the review.
Primary studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included.
WP consumers or people who are likely to be WP consumers in the near future.
Activities, programs, or strategies at the management level aiming at preventing and controlling WP use.
A categorized array of themes presenting a comprehensive picture of management interventions which are targeting WPS prevention and control.
PubMed, ISI Web of Science, Embase, Scopus, Science Direct, and Ovid were searched for published records from beginning 1990 to August 2018. Further, the first 10 pages of Google Scholar function, World Health Organization (WHO) and World Bank websites were also searched for relevant studies. Additional file 1 provides the terms and search strategy in PubMed.
Studies were excluded if their focus were on various forms of tobacco use and not just WP use or if they did not distinguish WPS from other forms of tobacco use.
According to the type of the included studies, the critical appraisal checklists of the Joanna Briggs Institute  were used for quality appraisal. The Joanna Briggs Institute (JBI) is an international, membership based research and development organization within the Faculty of Health Sciences at the University of Adelaide. JBI Critical appraisal tools have been developed by the JBI and collaborators and approved by the JBI Scientific Committee following extensive peer review. These tools were preliminary for use in systematic reviews. Based on a scoring approach (number of “yes” answers divided by all questions), included studies were categorized to high, moderate, or low quality.
The data extraction parameters included author, year, country, study design and setting, type of study, participants, the level and type of interventions, study duration, sample size, and main outcomes.
Management interventions which influenced controlling and preventing WPS were retrieved and categorized through content analysis method. The interventions were identified and categorized by two researchers (L. D. & J.B) using the following process.
Reading the selected records;
Identifying and extracting the related interventions after calibration to ensure consistency and accuracy;
Grouping the identified interventions into categories and sub-categories based on their conceptual similarity;
Solving disagreements between researchers by discussions. Whenever disagreement persisted the third author was approached. In some cases, the identified interventions were placed in more than one category;
Confirming categories and subcategories.
The searching process resulted in 4353 studies with 2125(48.81%) of these being repetitions. Out of 2228 screened articles (after removing the duplicates), 38 articles were selected through on the title& abstract screening process. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram was used to show the number of records in each phase (Fig. 1).
The included studies were of moderate-to-high quality. The characteristics of included studies are provided in Table 1.
The selected studies were published between 1990 and 2018 and focused on 19 different countries including the United States (13.15%) [6, 29, 30, 35, 36], the United Kingdom (7.89%) [25, 37, 38], Germany (5.26%) [12, 39], Iran (5.26%) [40, 41], Egypt [42, 43] (5.26%), Malaysia (2.63%) , India (2.63%) , Dutch(2.63%) , Pakistan (2.63%) , Qatar (2.63%) , Jordan(2.63%) , Lebanon(2.63%) , Syria(2.63%) , Turkey(2.63%) , Bahrain  (2.63%), Israel(2.63%) , the United Arab Emirates (2.63%) , Saudi Arabia (2.63%), and Switzerland(2.63%) . Additionally, the type of study design included cross-sectional (31.57%), quasi-experimental (15.78%), and qualitative types (23.68%).
Seventy eight management interventions were identified. After combining interventions with similar concepts into one category, the total number of exclusive interventions condensed to twenty seven.
In the next step, the interventions were assigned to four main subcategories including preventive interventions (18.51%) [12, 35, 40, 44, 46, 48, 54, 56] and control interventions (29.62%) [25, 30, 37, 45, 57, 58], as well as interventions at the international (25.92%) [6, 29, 39, 43, 44, 51, 53, 59, 60] and national (25.92%) [10, 16, 25, 30, 46, 49, 51, 57, 61, 62] levels. The details of the included interventions are presented in Table 2.
In this study, the management interventions affecting the prevention and control of WPS worldwide were identified through a systematic literature review. In this regard, 27 interventions were experienced in the world for WSP control that was categorized into four main themes and four sub-themes.
Preventive interventions refer to measures that their focus is on abatement of WPS consumption. Some studies suggested that more evidence and investigations are needed to prevent and control WPS [33, 38, 65, 66]. Lopez et al. found that evidence related to WPS control is very rare, and more investigations and studies are required in this respect . Some other studies were related to the current interventions for the prevention and control of WPS that were incompatible with the various needs of the new generations of adolescents. They are poly-users, occasional and social users, and have fast access to new products via the web [5, 44, 67].
To prevent WPS, most studies focused on school-based educational interventions . In many countries, for first time smoking occures in school students and adolescents , and students are considered as the current water pipe smokers [12, 41, 46, 48, 54, 55, 70, 71]. For example, the rapidly growing prevalence of experiencing WPS among younger age groups in Lebanon, is going to be considered as an epidemic phenomena [72, 73]. The younger generations have always been lured by fancy advertisements in the media. There have easy access to water pipe bars and are under the illusion and medical myth that the passage of smoke through the water in water-pipes “purifies” the smoke of all harmful elements .
NidalEshah et al. (2017) showed that more than 70% of smokers begin WPS in adolescence . In fact, in many countries, young and adolescents’ easy access to café which are providing water pipe facilitates, make them prone to try WPS out . Studies conducted by Aboaziza (2015), Stamm-Balderjahn (2012), and Tugay (2012) revealed that many adolescents become dependent after the first use of WP, which makes the quitting process extremely hard and the educational programs less effective [12, 19, 76]. Thus, access restriction regulations in the time of licensing and controlling their services can be considered as potential intervention.
Control interventions are activities that try to reduce WPS consumption. The lack of WPS control interventions among students has been reported. Harvey and Phan Thu, P (2016) confirmed that health care professionals have a key role in WPS prevention and control [10, 77]. In a study conducted by Moyer VJP (2013), health care professionals were found to be helping adolescents to change their behavior . On the other hand, Kumar et al.(2015) reported that the prevalence of WPS among health care professionals, especially medical and nursing students , can act as a positive vision to WP and cause low motivation to cooperate in WPS control programs [80, 81].
Public education about high-risk behaviors such as WPS was another experienced intervention. Social media, the Internet and mass media are the main factors in promoting or preventing WPS among adolescents.
In recent years, WPS has become a common social behavior and recreation and it is a catering item in many familiar parties. Social acceptance and being an essential part of the family, peer, and public gatherings and café and restaurant culture are highly influential factors contributing to the growth and its popularity. Therefore, exploring the general public’s knowledge and attitude toward WPS is useful in designing and formulating appropriate interventions in controlling WPS . Further, communication and dissemination strategies to facilitate the use of health-related evidence regarding the WPS alongside the role of community health workers, especially in the resource-poor and underprivileged areas of the society and agencies involved in raising public awareness on this issue are essential to be considered [82, 83].
Enactment and implementation of legislatives and policies in international level
According to the study findings, the WHO Framework Convention on Tobacco Control (FCTC) is a global treaty enacting the actions to control all tobacco products . However, controlling cigarettes and WP-specific actions has received less attention among national policies, and it just has been applied in some studies [85, 86]. It has been shown that using the proposed actions by the FCTC to manage WPS can lead to progress in its prevention and control .
Despite the WHO FCTC Article  on the taxation of all tobacco products, WP products are still tax-exempt. Although, some studies reported the effectiveness of taxation in reducing tobacco smoking [48, 49, 86], cheap or expensive prices may not be effective in WPS [48, 88]. Several studies suggested that executive authorities have main roles in controlling WPS and should be supported by legislative enforcers and policymakers [25, 30, 89].
According to different studies, the lack of proper interventions in WP industry, including packaging, labeling, advertising, fruit-flavored and sweet tobacco, settings, and diversified services can lead to a failure in WPS control programs [6, 29, 30, 43, 44, 59, 60]. Other studies represented that there is a strong relationship between fruit-flavored and sweet WP tobacco products and the expansion of WP use and act as the main barrier for WPS control [90, 91]. Therefore, measures to ban these additives proposed to be considered [6, 92, 93]. Furthermore, previous evidence shows that proper warning labels accompanied by a clear and intelligible packaging can be more effective in controlling WPS [25, 43, 51, 94, 95].
Enactment and implementation of legislatives and policies in national level
Although there are extensive WPS restrictive rules in countries , the lack of coordination between the involved organizations and the lack of executive support have led to their inefficiency . Community involvement and advocacy were found among the strongest WPS prevention measures [97, 98]. Moreover, community representatives, local and identical groups, and local community centers advocacy had shown some extend of efficacy as management interventions .
Some researchers believe that smoking related harms could not be completely prevented. Therefor harm reduction strategies were proposed in studies . Although, those strategies might be interesting for cigarette, they do not necessarily applicable for hookah . Recently, three harm reduction components (quick-light charcoal, electric heating and bubble diffuser quick-light charcoal and bubble diffuser) have been examined , however such strategies are not yet agreed upon and needs some more evidences .
Strengths and limitations of the study
Although this study was not aimed to evaluate interventions and provide some information about their efficacy, summarizing the intervention effects across themes would be valuable. However, we could not find well-defined interventional studies using a common evaluation means. Additionally, most found interventions were complex interventions with a variety of components making the synthesis of intervention effects more challenging.
In general, our findings indicated WPS related social and health crisis have not come into attention in high levels of decision making. The current enforced legislations are old, unclear, and incompatible with the needs of the adolescents and are not backed by rigorous evidence. In addition, the WP industry is rapidly expanding without monitoring and controlling measures. Informing and empowering adolescents for those who have not yet experienced smoking is a sensible intervention in this regard. Besides, empowering and involving health students and professionals in WPS control programs can lead to promising results in preventing and controlling WPS. It seems that there is a paucity of evidence regarding strategies on controlling and preventing WTS, thus further research in the society is warranted in this respect.
Availability of data and materials
All of the included papers are available in PubMed, ISI Web of Science, Embase, Scopus, Science Direct, and Ovid databases.
Water Pipe Smoking
Gross Domestic Product
World Health Organization
Framework Convention on Tobacco Control
Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1659–724.
Organization WH. WHO report on the global tobacco epidemic 2017: Monitoring tobacco use and prevention policies 2017.
Organization WH. Control and prevention of waterpipe tobacco products report. Geneva: World Health Organization; 2016.
Meeting WSGoTPR, Organization WH. WHO study group on tobacco product regulation: report on the scientific basis of tobacco product regulation: third report of a WHO study group: World Health Organization; 2009.
Horn K, Pearson JL, Villanti AC. Polytobacco use and the “customization generation”-new perspectives for tobacco control. J Drug Educ. 2016;46(3–4):51–63.
Salloum RG, Maziak W, Hammond D, Nakkash R, Islam F, Cheng X, et al. Eliciting preferences for waterpipe tobacco smoking using a discrete choice experiment: implications for product regulation. BMJ Open. 2015;5(9):e009497.
Primack BA, Shensa A, Kim KH, Carroll MV, Hoban MT, Leino EV, et al. Waterpipe smoking among U.S. university students. Nicotine Tobacco Res. 2013;15(1):29–35.
Barnett TE, Curbow BA, Weitz JR, Johnson TM, Smith-Simone SY. Water pipe tobacco smoking among middle and high school students. Am J Public Health. 2009;99(11):2014–9.
Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health. 2011;11(1):244.
Harvey J, Chadi N. Strategies to promote smoking cessation among adolescents. Paediatr Child Health. 2016;21(4):201–8.
Pandey P. Rising popularity of “tobacco-free” hookah among youth: A burgeoning public health challenge for India! International Journal of Noncommunicable Diseases. 2017;2(2):30.
Jawad M, Lee JT, Millett C. Waterpipe tobacco smoking prevalence and correlates in 25 eastern Mediterranean and eastern European countries: cross-sectional analysis of the global youth tobacco survey. Nicotine Tob Res. 2015;18(4):395–402.
Stamm-Balderjahn S, Groneberg DA, Kusma B, Jagota A, Schonfeld N. Smoking prevention in school students: positive effects of a hospital-based intervention. Dtsch Arztebl Int. 2012;109(44):746–52.
Arrazola RA, Singh T, Corey CG, Husten CG, Neff LJ, Apelberg BJ, et al. Tobacco use among middle and high school students—United States, 2011–2014. MMWR Morb Mortal Wkly Rep. 2015;64(14):381.
Barnett TE, Tomar SL, Lorenzo FE, Forrest JR, Porter L, Gurka MJ. Hookah use among Florida high school students, 2011-2014. Am J Prev Med. 2017;52(2):220–3.
Shishani K, Nawafleh H, Jarrah S, Froelicher ES. Smoking patterns among Jordanian health professionals: a study about the impediments to tobacco control in Jordan. Eur J Cardiovasc Nurs. 2011;10(4):221–7.
Jawad M, Wilson A, Lee JT, Jawad S, Hamilton FL, Millett C. Prevalence and predictors of water pipe and cigarette smoking among secondary school students in London. Nicotine Tobacco Res. 2013;15(12):2069–75.
Kumar A, Baig S, Raif A. Comparison of knowledge attitude and practice of shisha use among medical students and pharmacy students. Eur Respir J. 2015;46.
Aboaziza E, Eissenberg T. Waterpipe tobacco smoking: what is the evidence that it supports nicotine/tobacco dependence? Tob Control. 2015;24(Suppl 1):i44–53.
Bou Fakhreddine HM, Kanj AN, Kanj NA. The growing epidemic of water pipe smoking: health effects and future needs. Respir Med. 2014;108(9):1241–53.
Waziry R, Jawad M, Ballout RA, Al Akel M, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol. 2017;46(1):32–43.
Rezaei S, Sari AA, Arab M, Majdzadeh R, Poorasl AM. Economic burden of smoking: a systematic review of direct and indirect costs. Med J Islam Repub Iran. 2016;30:397.
Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual healthcare spending attributable to cigarette smoking: an update. Am J Prev Med. 2015;48(3):326–33.
Buice ME. Smoke signals: an analysis of policies to reduce hookah use among adolescents in Washington state; 2015.
Jawad M. Legislation enforcement of the waterpipe tobacco industry: a qualitative analysis of the London experience. Nicotine & tobacco research. 2014;16(7):1000–8.
Martinasek MP, McDermott RJ, Martini L. Waterpipe (hookah) tobacco smoking among youth. Curr Probl Pediatr Adolesc Health Care. 2011;41(2):34–57.
Hammal F, Wild TC, Nykiforuk C, Abdullahi K, Mussie D, Finegan BA. Waterpipe (hookah) smoking among youth and women in Canada is new, not traditional. Nicotine and Tobacco Research. 2016;18(5):757–62.
McKelvey K, Attonito J, Madhivanan P, Jaber R, Yi Q, Mzayek F, et al. Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis. Drug Alcohol Depend. 2014;142:307–13.
Joudrey PJ, Jasie KA, Pykalo L, Singer T, Woodin MB, Sherman S. The operation, products and promotion of waterpipe businesses in new York City, Abu Dhabi and Dubai. East Mediterr Health J. 2016;22(4):237–43.
Kassem NOF, Jackson SR, Boman-Davis M, Kassem NO, Liles S, Daffa RM, et al. Hookah smoking and facilitators/barriers to lounge use among students at a US university. Am J Health Behav. 2015;39(6):832–48.
Maziak W, Taleb ZB, Bahelah R, Islam F, Jaber R, Auf R, et al. The global epidemiology of waterpipe smoking. Tob Control. 2015;24:i3–i12.
Maziak W. The global epidemic of waterpipe smoking. Addict Behav. 2011;36(1–2):1–5.
Lopez AA, Eissenberg T, Jaafar M, Afifi R. Now is the time to advocate for interventions designed specifically to prevent and control waterpipe tobacco smoking. Addict Behav. 2017;66:41–7.
Institute JB. Critical Appraisal tools for use in JBI Systematic Reviews. Checklist for Prevalence Studies Available online: http://joannabriggs.org/research/critical-appraisal-tools.html (accessed on 12 Dec 2019). 2017.
Lipkus IMPD, Eissenberg TPD, Schwartz-Bloom RDPD, Prokhorov AVMDPD, Levy JPD. Affecting perceptions of harm and addiction among college Waterpipe tobacco smokers. Nicotine Tob Res. 2011;13(7):599–610.
Leavens ELS, Meier E, Tackett AP, Miller MB, Tahirkheli NN, Brett EI, et al. The impact of a brief cessation induction intervention for waterpipe tobacco smoking: a pilot randomized clinical trial. Addict Behav. 2018;78:94–100.
Lock K, Adams E, Pilkington P, Duckett K, Gilmore A, Marston C. Evaluating social and behavioural impacts of English smoke-free legislation in different ethnic and age groups: implications for reducing smoking-related health inequalities. Tobacco control. 2010;tc. 2009:032318.
O'Neill N, Dogar O, Jawad M, Kanaan M, Siddiqi K. Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique (ntw297, 2016). Nicotine & Tobacco Research. 2017;19(9):1123-.
Jawad M, Darzi A, Lotfi T, Nakkash R, Hawkins B, Akl EA. Waterpipe product packaging and labelling at the 3rd international hookah fair; does it comply with article 11 of the framework convention on tobacco control? J Public Health Policy. 2017;38(3):303–13.
Mahoozi S, Heidari M, Shahbazi S, Naseh L. Influence of training about carcinogenic effects of hookah smoking on the awareness, attitude, and performance of women. Asian Pac J Cancer Prev. 2017;18(7):1967–71.
Momenabadi V, Kaveh MH, Hashemi SY. Effect of educational intervention on intention of university students’ disuse of hookah smoking: BASNEF model. J Subst Abus. 2017:1–6.
Mohlman MK, Boulos DNK, Setouhy ME, Radwan G, Makambi K, Jillson I, et al. A randomized, controlled community-wide intervention to reduce environmental tobacco smoke exposure. Nicotine and Tobacco Research. 2013;15(8):1372–81.
Mostafa A, Mohammed HT, Hussein WM, Elhabiby M, Safwat W, Labib S, et al. Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? Tob Control: A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses; 2018.
Mohd Zin F, Hillaluddin AH, Mustaffa J. Adolescents' perceptions regarding effective tobacco use prevention strategies for their younger counterparts: a qualitative study in Malaysia. Asian Pac J Cancer Prev. 2016;17(12):5113–9.
Deshpande A, Kudtarkar P, Dhaware D, Chowgule R. Study of secondhand smoke levels pre and post implementation of the comprehensive smoking ban in Mumbai. Indian J Community Med. 2010;35(3):409–13.
Rozema AD, Hiemstra M, Mathijssen JJP, Jansen MWJ, van Oers H. Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up. Int J Environ Res Public Health. 2018;15:2.
Anjum Q, Ahmed F, Ashfaq T. Knowledge, attitude and perception of water pipe smoking (shisha) among adolescents aged 14-19 years. JPMA The Journal of the Pakistan Medical Association. 2008;58(6):312.
Jaam M, Al-Marridi W, Fares H, Izham M, Kheir N, Awaisu A. Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey. Public Health Action. 2016;6(1):38–43.
Salti N, Chaaban J, Nakkash R, Alaouie H. The effect of taxation on tobacco consumption and public revenues in Lebanon. Tobacco control. 2013:tobaccocontrol-2012-050703.
Asfar T, Al Ali R, Rastam S, Maziak W, Ward KD. Behavioral cessation treatment of waterpipe smoking: the first pilot randomized controlled trial. Addict Behav. 2014;39(6):1066–74.
Erdöl C, Ergüder T, Morton J, Palipudi K, Gupta P, Asma S. Waterpipe tobacco smoking in Turkey: policy implications and trends from the global adult tobacco survey (GATS). Int J Environ Res Public Health. 2015;12(12):15559–66.
Hamadeh RR, Ahmed J, Al-Kawari M, Bucheeri S. Quit tobacco clinics in Bahrain: Smoking cessation rates and patient satisfaction. Tobacco Induced Diseases. 2017;15:1.
Essa-Hadad J, Linn S, Rafaeli S. A web-based program to increase knowledge and reduce cigarette and nargila smoking among Arab university students in Israel: mixed-methods study to test acceptability. J Med Internet Res. 2015;17(2):e39.
Ali Quadri MF, Saleh SM, Alsanosy R, Abdelwahab SI, Tobaigy FM, Maryoud M, et al. Effectiveness of an intervention program on knowledge of oral cancer among the youth of Jazan, Saudi Arabia. Asian Pac J Cancer Prev. 2014;15(5):1913–8.
Tomaszek S, Schuurmans MM, Schneiter D, Weder W, Hillinger S. Smoking prevention intervention with school classes at a university hospital by thoracic surgeon und pulmonologist. Cancer Research. 2014;74:19.
Riggs NR, Pentz MA. Inhibitory control and the onset of combustible cigarette, e-cigarette, and hookah use in early adolescence: the moderating role of socioeconomic status. Child Neuropsychol. 2016;22(6):679–91.
Freiberg M. Options for state and local governments to regulate non-cigarette tobacco products. Ann Health Law. 2012;21(2):407-45.
Highet G, Ritchie D, Platt S, Amos A, Hargreaves K, Martin C, et al. The re-shaping of the life-world: male British Bangladeshi smokers and the English smoke-free legislation. Ethn Health. 2011;16(6):519–33.
Islam F, Salloum RG, Nakkash R, Maziak W, Thrasher JF. Effectiveness of health warnings for waterpipe tobacco smoking among college students. Int J Public Health. 2016;61(6):709–15.
Grant A, O'Mahoney H. Portrayal of waterpipe (shisha, hookah, nargile) smoking on twitter: a qualitative exploration. Public Health. 2016;140:128–35.
Kowitt SD, Goldstein AO, Schmidt AM, Hall MG, Brewer NT. Attitudes toward FDA Regulation of newly deemed tobacco products. Tob Regul Sci. 2017;3(4):504–15.
VanDevanter N, Katigbak C, Naegle M, Zhou S, Sherman S, Weitzman M. Nursing education to reduce use of tobacco and alternative tobacco products: change is imperative. J Am Psychiatr Nurses Assoc. 2017;23(6):414–21.
Sepetdjian E, Abdul Halim R, Salman R, Jaroudi E, Shihadeh A, Saliba NA. Phenolic compounds in particles of mainstream waterpipe smoke. Nicotine & tobacco research. 2013;15(6):1107–12.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Jawad M, El Kadi L, Mugharbil S, Nakkash R. Waterpipe tobacco smoking legislation and policy enactment: a global analysis. Tob Control. 2015;24(Suppl 1):i60–i5.
Consortium TCL. Regulatory Options for Hookahs and Water Pipes. Tobacco Control Legal Consortium, Washington, DC, http://publichealthlawcenter.org/sites/default/files/pdf/tclc-fs-regulatory-options-hookahs-2013.pdf. 2013.
Kingsbury JH, Parks MJ, Amato MS, Boyle RG. Deniers and admitters: examining smoker identities in a changing tobacco landscape. Nicotine & tobacco Res. 2016;18(11):2130–7.
Villanti AC, Pearson JL, Cantrell J, Vallone DM, Rath JM. Patterns of combustible tobacco use in U.S. young adults and potential response to graphic cigarette health warning labels. Addict Behav. 2015;42:119–25.
Crone M, Reijneveld S, Willemsen M, Van Leerdam F, Spruijt R, Sing RH. Prevention of smoking in adolescents with lower education: a school based intervention study. J Epidemiol Community Health. 2003;57(9):675–80.
Smith DM, Bansal-Travers M, Huang JD, Barker D, Hyland AJ, Chaloupka F. Association between use of flavoured tobacco products and quit behaviours: findings from a cross-sectional survey of US adult tobacco users. Tobacco Control. 2016;25:ii73–80.
Little MA, Talcott GW, Bursac Z, Linde BD, Pagano LA, Messler EC, et al. Efficacy of a brief tobacco intervention for tobacco and nicotine containing product use in the US air force. Nicotine & tobacco Res. 2016;18(5):1142–9.
Jawad M, Charide R, Waziry R, Darzi A, Ballout RA, Akl EA. The prevalence and trends of waterpipe tobacco smoking: a systematic review. PLoS One. 2018;13(2):e0192191.
Farah R, Haddad C, Sacre H, Hallit S, Salameh P. Knowledge and attitude toward waterpipe smoking: scale validation and correlates in the Lebanese adult population. Environ Sci Pollut Res Int. 2020.
Yadav S, G. R. Waterpipe Tobacco Smoking: A Mini-review. J Translational Int Med 2018;6:173–175.
Nidal Eshah NF, Froelicher ES. Understanding hookah smoking behaviors among non current cigarettes smokers: implications for prevention programs. Eur J Prev Cardiol. 2017;24(1):S129.
Tugay BU, Ilhan B, Çatak T. Kabakc¸i T, Koc¸ H, Tugay N. what do the adolescents think about smoking and ban strategies in Turkey? Eur Respir J. 2012;40.
Phan Thu P, Ngo Quy C, Vu Van G, Pham Le Q. Evaluate the demands for smoking cessation services of smokers at the outpatient departement of Bach Mai Hospital. Respirology. 2016;21:69.
Moyer VA. Primary care interventions to prevent tobacco use in children and adolescents: US preventive services task force recommendation statement. Ann Intern Med. 2013;159(8):552–7.
Arshad A, Matharoo J, Arshad E, Sadhra SS, Norton-Wangford R, Jawad M. Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review. BMC Public Health. 2019;19(1):439.
Kumar A, Ghazal S, Malik M, Rizvi N, Ismail S. Knowledge attitudes and practices of shisha smoking among medical practitioners in Karachi. Pakistan Journal of Smoking Cessation. 2015;10(1):44–9.
Mughal F, Rashid A, Jawad M. Tobacco and electronic cigarette products: awareness, cessation attitudes, and behaviours among general practitioners. Prim Health Care Res Dev. 2018:1–5.
Yadav S, Rawal G. Healthcare information for all-Is it achievable. Int J Sci Res Rev. 2015;4:101–5.
Yadav S. G. R. role of integrating community health workers in achieving healthcare information for all. Int J Sci Res Rev. 2015;4:106–10.
World HEalth Organization framework convention on tobacco control. WHO Regional Office for South-East Asia: WHO; 2004.
Advisory note: waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators. Regulation WSGoTP. 2005.
Zaatari GS, Bazzi A. Impact of the WHO FCTC on non-cigarette tobacco products. Tob Control. 2019;28(Suppl 2):s104–12. https://doi.org/10.1136/tobaccocontrol-2018-054346 Epub 2018 Jul 31.
World Health Organization. WHO Framework Convention on Tobacco Control. 2003.Available in: https://apps.who.int/iris/bitstream/handle/10665/42811/9241591013.pdf?sequence=1, Access date: 1 Nov 2020.
Maziak W, Nakkash R, Bahelah R, Husseini A, Fanous N, Eissenberg T. Tobacco in the Arab world: old and new epidemics amidst policy paralysis. Health Policy Plan. 2014;29(6):784–94.
Morris DS, Fiala SC, Pawlak R. Opportunities for policy interventions to reduce youth hookah smoking in the United States. Prev Chronic Dis. 2012;9:E165.
Regulation TP. Waterpipe tobacco smoking: health effects. Research Needs and Recommended Actions by Regulators.
Ben Taleb Z, Breland A, Bahelah R, Kalan ME, Vargas-Rivera M, Jaber R, et al. Flavored versus nonflavored waterpipe tobacco: a comparison of toxicant exposure, puff topography, subjective experiences, and harm perceptions. Nicotine and Tobacco Research. 2019;21(9):1213–9.
Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, Rose SW, et al. Flavored tobacco product use in youth and adults: findings from the first wave of the PATH study (2013–2014). Am J Prev Med. 2017;53(2):139–51.
Smith-Simone S, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples. Nicotine & tobacco research. 2008;10(2):393–8.
Roskin J, Aveyard P. Canadian and English students' beliefs about waterpipe smoking: a qualitative study. BMC Public Health. 2009;9:10.
Jawad M, Bakir A, Ali M, Grant A. Impact of waterpipe tobacco pack health warnings on waterpipe smoking attitudes: a qualitative analysis among regular users in London. Biomed Res Int. 2015;2015.
Jawad M, Jawad S, Waziry RK, Ballout RA, Akl EA. Interventions for waterpipe tobacco smoking prevention and cessation: a systematic review. Sci Rep. 2016;25872.
Gezer T, Dagli E, Yildiz F, Elbek O. Analysis of tobacco control in Turkey through political mapping. Eur Respir J. 2016;48.
Khayatzadeh-Mahani A, Breton E, Ruckert A, Labonte R. Banning shisha smoking in public places in Iran: an advocacy coalition framework perspective on policy process and change. Health Policy Plan. 2017;32(6):835–46.
Danaei M, Jabbarinejad-Kermani A, Mohebbi E, Momeni M. Waterpipe tobacco smoking prevalence and associated factors in the southeast of Iran. Addiction & health. 2017;9(2):72.
Dawson A, Verweij M. No smoke without fire: harm reduction, E-cigarettes and the smoking endgame. Public Health Ethics. 2017;10(1):1–4.
Chaouachi K. Harm reduction techniques for hookah (shisha, narghile, "water pipe") smoking of tobacco based products. Med Hypotheses. 2009;73(4):623–4.
C Brinkman M, Kim H, S. SB, M Adetona A, M Gordon S, I Clark P. Evidence of compensation among waterpipe smokers using harm reduction components. BMJ,. 2018;29(1).
This study is part of MSc. thesis in School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. The authors express their gratitude to Tabriz University of Medical Sciences for supporting this study.
The research has not received any financial grant from any organization or funding agency.
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This study reviewed and approved by Tabriz University of medical Sciences research ethical committee. Ethical code: IR.TBZMED.REC.1397.115.
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Babaie, J., Ahmadi, A., Abdollahi, G. et al. Preventing and controlling water pipe smoking: a systematic review of management interventions. BMC Public Health 21, 344 (2021). https://doi.org/10.1186/s12889-021-10306-w
- Management interventions
- water pipe
- Tobacco control