title: The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review.
abstract: BACKGROUND
  The objective of this study was to systematically review the medical literature for the prevalence of waterpipe tobacco use among the general and specific populations.
  
  
  METHODS
  We electronically searched MEDLINE, EMBASE, and the ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included cohort studies and cross sectional studies assessing the prevalence of use of waterpipe in either the general population or a specific population of interest. Two reviewers used a standardized and pilot tested form to collect data from each eligible study using a duplicate and independent screening process. We stratified the data analysis by country and by age group. The study was not restricted to a specific context.
  
  
  RESULTS
  Of a total of 38 studies, only 4 were national surveys; the rest assessed specific populations. The highest prevalence of current waterpipe smoking was among school students across countries: the United States, especially among Arab Americans (12%-15%) the Arabic Gulf region (9%-16%), Estonia (21%), and Lebanon (25%). Similarly, the prevalence of current waterpipe smoking among university students was high in the Arabic Gulf region (6%), the United Kingdom (8%), the United States (10%), Syria (15%), Lebanon (28%), and Pakistan (33%). The prevalence of current waterpipe smoking among adults was the following: Pakistan (6%), Arabic Gulf region (4%-12%), Australia (11% in Arab speaking adults), Syria (9%-12%), and Lebanon (15%). Group waterpipe smoking was high in Lebanon (5%), and Egypt (11%-15%). In Lebanon, 5%-6% pregnant women reported smoking waterpipe during pregnancy. The studies were all cross-sectional and varied by how they reported waterpipe smoking.
  
  
  CONCLUSIONS
  While very few national surveys have been conducted, the prevalence of waterpipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries.
authors.affiliation: Department of Medicine, State University of New York at Buffalo, NY, USA. elieakl@buffalo.edu
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Gunukula
authors.forename: Sohaib
authors.initials: S
authors.lastname: Aleem
authors.forename: Rawad
authors.initials: R
authors.lastname: Obeid
authors.forename: Philippe Abou
authors.initials: PA
authors.lastname: Jaoude
authors.forename: Roland
authors.initials: R
authors.lastname: Honeine
authors.forename: Jihad
authors.initials: J
authors.lastname: Irani
mesh_terms: D000293:Adolescent; D000328:Adult; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water