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But waterpipe tobacco smoking is significantly associated with lung cancer, respiratory illness, low birth-weight, and periodontal disease.

Published in Biomedical Health Central Public Health, the paper is the first systematic review of the prevalence of waterpipe smoking across countries, age groups, and genders and includes 38 relevant studies conducted in the U.S., the United Kingdom, Australia and Estonia, and countries in the Arab Gulf, including Lebanon, Pakistan, Egypt, Syria, Bahrain, Kuwait, Oman, Qatar, the United Arab Emirates, and Yemen.

Target populations were middle or high school students as young as 13 years of age, university students, adults, and pregnant women.

“Waterpipe smoking is a real epidemic in the world and it’s picking up in the U.S. too,” says Elie Akl, associate professor of medicine, family medicine, and social and preventive medicine at the University at Buffalo.

The highest rates of waterpipe smoking is in Middle Eastern and Asian countries, where the practice has a centuries-long tradition, but it is increasing in the U.S. and other western countries, as well.

“The surveys included in this review found an alarming prevalence of waterpipe smoking among middle and high school students in the U.S.,” Akl says. “It was especially true of Arab-American students, who reported waterpipe usage ranging from 12 to 15 percent.”

Current waterpipe smoking among adults is at 6 percent in Pakistan, 4-12 percent in the Arabic Gulf region, at 11 percent in Australia among Arab-speaking adults and 15 percent in Lebanon.

Group waterpipe smoking was high in Lebanon, at 5 percent, and in Egypt ranging between 11 and 15 percent. In Lebanon, between 5 and 6 percent of pregnant women also reported waterpipe smoking during pregnancy and in the U.S., approximately 10 percent of university students reported waterpipe smoking.

The findings should be a wake-up call to public health agencies that waterpipe smoking should be directly addressed in tobacco-control strategies.

“Awareness campaigns need to take into account that waterpipe smoking is increasing, especially among youth, and that it may be a gateway to cigarette use in adulthood,” he says.

“The problem is that some people are advocating the hookahs, or waterpipes, as safer than cigarettes,” he explains. “It’s perceived as less addictive. And because in the hookah, the smoke comes through a column of water, which is supposed to filter the smoke, it’s been seen as safer than cigarettes and other forms of tobacco consumption.”

“Waterpipe smoking is seen as a more social, more sophisticated, more fashionable way of smoking tobacco,” he says, noting that hookah bars are now opening up in cities throughout the U.S., in other western countries, and in the Middle East.

“This review reveals a need for a better understanding of the epidemiology of this new epidemic, especially concerning how waterpipe smoking may lead to cigarette smoking, so that public health agencies can best address these behaviors, particularly among youth.”

Researchers from Wayne State University and the University of Balamand in Beirut contributed to the study.

More news from University at Buffalo: http://www.buffalo.edu/news/