title: Waterpipe smoking: not necessarily less hazardous than cigarette smoking : Possible consequences for (cardiovascular) disease.
abstract: BACKGROUND
  Cigarette smoking has declined over the last years in modern countries. On the contrary, waterpipe smoking has increased, especially among young people visiting waterpipe bars. Unfortunately, most waterpipe smokers seem to know little about the possible cardiovascular and other health consequences of waterpipe smoking.
  
  
  OBJECTIVE
  To describe by narrative literature review the known adverse consequences for the human body caused by smoking the waterpipe compared with the consequences of smoking normal cigarettes. Also, to get a picture of public awareness of these consequences as deducted from the literature and a small new survey in the Netherlands.
  
  
  CONCLUSIONS
  Tobacco smoking is associated with serious adverse (cardiovascular) health effects, and there is no evidence that these effects are less serious if a waterpipe is used. The increasing use together with the limited amount of awareness and attention for the possible health consequences of smoking the waterpipe is worrisome. Especially considering the increasing acceptance and use of the waterpipe among the youth. Therefore we recommend more systematic research into the possible health hazards of waterpipe smoking. In the meantime education campaigns and materials are needed to raise public awareness on the possible health risks of waterpipe use.
authors.affiliation: Medical Faculty, Free University, Amsterdam, the Netherlands, jelmerbjukema@outlook.com.
authors.forename: J B
authors.initials: JB
authors.lastname: Jukema
authors.forename: D E
authors.initials: DE
authors.lastname: Bagnasco
authors.forename: R A
authors.initials: RA
authors.lastname: Jukema