The waterpipe: An emerging global risk for cancer

Abstract

Tobacco smoking continues to be the leading preventable cause of morbidity and mortality worldwide. Each year more than 5 million smokers die prematurely because of their habit wreaking havoc on the welfare of families and communities worldwide. While cigarettes remain the main tobacco killer worldwide, for many youth tobacco use and addiction is maintained by means other than cigarettes. In particular, over the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become increasingly popular among youth in the Middle East, and is rapidly spreading globally. Available evidence suggests that waterpipe smoking is associated with many of the known risks of tobacco smoking, particularly cancer. Despite these worrisome signs, policies and interventions to address this emerging public health problem have been lagging behind. In this short review I discuss briefly the evidence generated mostly in the past decade about the global spread of waterpipe smoking and its cancer risk potential.

Introduction

Tobacco smoking continues to be the leading preventable cause of morbidity and mortality worldwide. Each year more than million smokers die prematurely because of their habit wreaking havoc on the welfare of families and communities worldwide. Most of the brunt of the tobacco epidemic is currently borne by developing countries, and this is likely to worsen unless an effective and comprehensive response is materialized [1]. While cigarettes remain the main tobacco killer worldwide, for many youth tobacco use and addiction is maintained by means other than cigarettes. In particular, over the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become increasingly widespread among youth in the Middle East, and is rapidly spreading elsewhere [2]. Many factors are suggested as the main drives behind the re-emergence of this ancient tobacco use method including; the introduction of manufacture sweetened-flavored waterpipe tobacco (a.k.a. Maassel), the harm-reduced perception of waterpipe smoking, and the communication revolution brought about by the internet [2].

The waterpipe, known in many cultures under different shapes and names (e.g., hookah, shisha, narghile), is a centuries-old tobacco use method that has traditionally been associated with eastern societies. Evidence from around the world is accumulating to signify the emergence of waterpipe smoking as a global threat to public health [3], [4], [5], [6], [7], [8]. In the waterpipe, charcoal-heated air passes through a perforated aluminum foil separating the charcoal from the flavored tobacco to become smoke that cools as it bubbles through the water on its way to the smoker (Fig. 1). This last feature; i.e. the passage of smoke through water, underlies much of the widespread misperception about waterpipe's “reduced” harm and addictiveness [9]. Available evidence however, suggests that waterpipe smoking is associated with smoking-related diseases [10]. Despite these worrisome signs of fast spread and potential health risks, policies and interventions to address this emerging public health problem have been lagging behind. In this short review I discuss briefly the evidence generated mostly in the past decade about the global spread of waterpipe smoking and its cancer risk potential.