title: The global epidemiology of waterpipe smoking.
abstract: OBJECTIVE
  In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally.
  
  
  METHODS
  Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used.
  
  
  METHODS
  The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking.
  
  
  METHODS
  Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review.
  
  
  RESULTS
  Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns.
  
  
  CONCLUSIONS
  Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.
authors.affiliation: Department of Epidemiology, Florida International University, Miami, Florida, USA Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
authors.affiliation: Department of Epidemiology, Florida International University, Miami, Florida, USA.
authors.forename: Ziyad Ben
authors.initials: ZB
authors.lastname: Taleb
authors.affiliation: Department of Epidemiology, Florida International University, Miami, Florida, USA Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen.
authors.forename: Raed
authors.initials: R
authors.lastname: Bahelah
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Islam
authors.affiliation: Department of Epidemiology, Florida International University, Miami, Florida, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Jaber
authors.affiliation: Department of Epidemiology, Florida International University, Miami, Florida, USA.
authors.forename: Rehab
authors.initials: R
authors.lastname: Auf
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
mesh_terms: D014943:Global Health / Q000706:statistics & numerical data / Q000639:trends; D015438:Health Behavior; D006801:Humans; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology* / Q000639:trends; D000074606:Smoking Prevention; D014867:Water
chemical_list: D014867:Water
keywords: Global health; Media; Nicotine; Non-cigarette tobacco products; Public policy