title: The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally.
abstract: OBJECTIVE
  The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review.
  
  
  METHODS
  The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms.
  
  
  METHODS
  Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10-29 years.
  
  
  METHODS
  Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results.
  
  
  RESULTS
  The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels.
  
  
  CONCLUSIONS
  The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.
authors.affiliation: Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: E A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: School of Public Health, University of Memphis, Memphis, Tennessee, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Ward
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: D
authors.initials: D
authors.lastname: Bteddini
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: R
authors.initials: R
authors.lastname: Khaliel
authors.affiliation: School of Public Health, University of Memphis, Memphis, Tennessee, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Alexander
authors.affiliation: Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
authors.forename: T
authors.initials: T
authors.lastname: Lotfi
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: H
authors.initials: H
authors.lastname: Alaouie
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: R A
authors.initials: RA
authors.lastname: Afifi
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002648:Child; D015438:Health Behavior; D006801:Humans; D010287:Parent-Child Relations; D010379:Peer Group; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology* / Q000639:trends; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000523:psychology; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water
keywords: Global health; Media; Non-cigarette tobacco products; Packaging and Labelling; Prevention