Dr Mohammed Jawad Honorary Clinical Research Fellow, Department of Primary Care and Public Health, Imperial College London
Abstract
Introduction: Very little is known about waterpipe tobacco smoking (WTS) despite its growing prevalence in countries such as the United Kingdom. This reviews aims to summarise the recent literature pertaining to WTS dependence and cessation.
Methods: In March 2013, electronic databases were searched in English for literature pertaining to WTS dependence and cessation published in the last ten years.
Findings: Depending on the user’s smoking habits, one waterpipe session may contain up to ten cigarettes’ worth of nicotine, though nicotine content of WTS brands remains unregulated and unstandardised. Regular waterpipe smokers may exhibit nicotine-modulated behaviours such as cravings and withdrawal symptoms; however traditional cigarette measures of dependence may not be applicable to WTS. There is reduced perception of addiction among waterpipe smokers and non-smokers across Middle Eastern and Western countries. These perceptions may be modified with minimally invasive interventions such as health education. Waterpipe users are less interested in quitting and make fewer attempts to do so than cigarette smokers. There are several reports of unsuccessful quit attempts but no documented interventions for WTS cessation.
Conclusions: WTS may contain enough nicotine to induce dependence in its users and has the potential to interact with cigarette cessation programmes. More research is needed to understand dependence in waterpipe users and barriers to cessation.
