title: Health effects associated with waterpipe smoking.
abstract: OBJECTIVE
  It is widely held that waterpipe smoking (WPS) is not associated with health hazards. However, several studies have documented the uptake of several toxicants and carcinogens during WPS that is strongly associated with harmful health effects. This paper reviews the literature on the health effects of WPS.
  
  
  METHODS
  Three databases-PubMed, MEDLINE and EMBASE-were searched until August 2014 for the acute and long-term health effects of WPS using the terms 'waterpipe' and its synonyms (hookah, shisha, goza, narghileh, arghileh and hubble-bubble) in various spellings.
  
  
  METHODS
  We included original clinical studies, case reports and systematic reviews and focused on clinical human studies. ∼10% of the identified studies met the selection criteria.
  
  
  METHODS
  Data were abstracted by all three authors and summarised into tables. Abstracted data included study type, results and methodological limitations and were analysed jointly by all three authors.
  
  
  RESULTS
  WPS acutely leads to increased heart rate, blood pressure, impaired pulmonary function and carbon monoxide intoxication. Chronic bronchitis, emphysema and coronary artery disease are serious complications of long-term use. Lung, gastric and oesophageal cancer are associated with WPS as well as periodontal disease, obstetrical complications, osteoporosis and mental health problems.
  
  
  CONCLUSIONS
  Contrary to the widely held misconception, WPS is associated with a variety of adverse short-term and long-term health effects that should reinforce the need for stronger regulation. In addition, this review highlights the limitations of the published work, which is mostly cross-sectional or retrospective. Prospective studies should be undertaken to assess the full spectrum of health effects of WPS, particularly in view of its growing popularity and attractiveness to youth.
authors: Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon.
authors: Ziad M
authors: ZM
authors: El-Zaatari
authors: Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Boston University School of Medicine, Boston, Massachusetts, USA.
authors: Hassan A
authors: HA
authors: Chami
authors: Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon.
authors: Ghazi S
authors: GS
authors: Zaatari
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D009059:Mouth Diseases / Q000209:etiology; D009369:Neoplasms / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012140:Respiratory Tract Diseases / Q000209:etiology; D012907:Smoking / Q000009:adverse effects*; D014867:Water
chemical_list: D014867:Water
keywords: Global health; Non-cigarette tobacco products; Smoking Caused Disease