Can users of waterpipe be helped to quit by smoking cessation interventions

Waterpipe smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region. Its use is now spreading worldwide. It is smoked socially, and is often shared between friends or family at home, or in bars and cafes that provide waterpipes to patrons. In the absence of relevant data, many waterpipe tobacco smokers believe that this form of tobacco use is less lethal and addictive than other methods of tobacco smoking, because the smoke passes through water on its way to the user. At least in some cultures, women and girls are more likely to use a waterpipe than to use other forms of tobacco, and it is popular among younger smokers. Current evidence suggests that waterpipe smoking may be as addictive as other forms of tobacco use, and may also carry similar or greater risks to health. We searched for controlled trials in the Cochrane Tobacco Addiction Review Group specialized register, in February 2011. We also searched a number of electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL, using a variety of names and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for published and unpublished trials in any language, and especially in areas where waterpipe use is widespread. We have not found any completed trials of smoking cessation interventions among waterpipe users. The authors of this review are conducting a pilot study of waterpipe smoking cessation, which will be reported in future updates. More research is needed on this tobacco use method's addictive properties, and on its associated health risks, both for users and exposed non-smokers. Evidence-based information about waterpipe should be collected and circulated to discourage the uptake and spread of its use so that it is no longer seen as normal or 'cool'. Effective treatments should be developed to help waterpipe smokers quit.

Authors' conclusions: 

Epidemiological and observational evidence suggests that waterpipe use is rapidly growing in popularity worldwide. It is widely and erroneously perceived to be less lethal than other forms of tobacco use. Women, girls, and young people are more likely to take up waterpipe smoking, especially in the Eastern Mediterranean Region. More research is needed on its addictive properties, and on the associated health risks, both for users and exposed non-smokers. Evidence-based information about waterpipes' addictive and harmful properties should be developed and disseminated in order to deglamourise and denormalise its use. A clear understanding of dependence development in young waterpipe smokers should guide the development of effective cessation treatments for waterpipe smokers. Such treatments need to be tested with the help of high quality randomized trials.

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Background: 

Waterpipe smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region, but its use is now spreading worldwide. It is smoked socially, often being shared between friends or family at home, or in dedicated bars and cafes that provide waterpipes to patrons. Because the smoke passes through a reservoir of water, waterpipe tobacco smoking is perceived as being less lethal than other methods of tobacco use. At least in some cultures, women and girls are more likely to use a waterpipe than to use other forms of tobacco, and it is popular among younger smokers. Accumulating evidence suggests that waterpipe smoking may be as addictive as other forms of tobacco use, and may carry similar risks to health.

Objectives: 

To evaluate the effectiveness of tobacco cessation interventions for waterpipe users.

Search strategy: 

We searched the Cochrane Tobacco Addiction Review Group specialized register, in February 2011. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language, and especially in regions where waterpipe use is widespread. We have also used our own existing bibliography, compiled from conducting an earlier exhaustive review of the literature on waterpipe smoking.

Selection criteria: 

We sought randomized, quasi-randomized or cluster-randomized controlled trials of smoking cessation interventions for waterpipe smokers of any age or gender. The primary outcome of interest was abstinence from tobacco use, preferably sustained and biochemically verified, for at least six months from the start of the intervention.

Data collection and analysis: 

Each author intended to extract data and assess trial quality independently by standard Cochrane Collaboration methodologies, but no eligible trials were identified.

Main results: 

We found no completed intervention trials targeting waterpipe smokers. A pilot randomized controlled trial by the authors of this review is underway, and will be reported in future updates.