22, 24 Thus, compared to a cigarette, which involves inhalation of approximately 500–600 ml of smoke (ie, 10–13 puffs of about 50 ml, on average 25, 26), a single waterpipe use episode involves inhalation of approximately 90,000 ml of smoke. As seen in Table 1, data collected from actual waterpipe tobacco smokers in natural settings show that a waterpipe use episode typically involves almost 200 puffs, with an average puff volume exceeding 500 ml. 18 Recent technical innovations 22– 24 confirm this duration and also provide a more detailed analysis of waterpipe tobacco smoking episodes. Relative to a single cigarette, completed in about 5 minutes, 21 a single waterpipe use episode typically lasts for about 1 hour. 20Ī Waterpipe Prepared for Tobacco Smoking, Including Perforated Foil Separating the Charcoal from the Tobacco That Has Been Placed in the Head 19 Waterpipe charcoal products range from traditional earthen kiln charcoal to quick-lighting products that are particularly common in the United States. Maassel comes in many flavors, including fruit and candy, and it produces an aromatic smoke that may be particularly appealing to youth. 18 The most popular type of waterpipe tobacco is called maassel (also known as shisha tobacco), a wet mixture of tobacco, sweetener, and flavorings. The smoker inhales through the hose, thus drawing air over the burning charcoal, heating the tobacco, and producing smoke that travels through the body of the waterpipe, the water, and the hose to the user. The bowl is partially filled with water and the head is filled with moistened tobacco upon which a lit piece of charcoal is placed (tobacco and charcoal are often separated by perforated aluminum foil). Our goals include increasing awareness, stimulating research, influencing policy, and developing effective prevention and treatment interventions.What Are Waterpipes and How Are They Used to Smoke Tobacco?Īlthough composition details may differ by culture, tobacco waterpipes most often seen in the United States have a fired-clay head, metal body, glass or acrylic water bowl, and leather or plastic hose ( Figure 1). Thus, this review addresses this emerging tobacco use method in the United States by highlighting current data regarding its prevalence and potential health effects, as well as the knowledge, beliefs, and attitudes associated with, and potentially fueling, the spread of this tobacco use method. 15– 17 All of these issues are relevant to the United States, where waterpipe tobacco smoking appears to be increasing in popularity. 13, 14 In addition, waterpipe tobacco smoking may be, for some individuals, a precursor to cigarette smoking. Contrary to popular belief that waterpipe tobacco smoking is less lethal than cigarette smoking, 9, 11 emerging research indicates that both involve comparable health risks 3, 4, 12 including nicotine/tobacco dependence.

Although known by many different names (eg, hookah, narghile, shisha), the term waterpipe has been used for the last 2 decades in the English language scientific literature 6– 10 to refer to any of a variety of instruments that involve passing tobacco smoke through water before inhalation.

Waterpipe tobacco smoking is a centuries-old tobacco use method with an ambiguous origin 5 and links to the countries of southwest Asia and north Africa. 2 This success is threatened by alternative methods of tobacco use, including waterpipe tobacco smoking. 1 In the United States, tobacco smoking remains the leading preventable cause of death, even as considerable success has been achieved in curbing the tobacco epidemic over the past 20 years. Tobacco use causes many of the world’s leading lethal ailments, including cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.

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