| Summary: | Introduction
Despite its known adverse effects on human health, waterpipe smoking
is increasing in popularity worldwide. However, compared to cigarettes, regulation
of waterpipe product smoking lags behind and presents unique challenges. In
search for regulatory options, this systematic review analyzes 36 studies on the
differential effects on human health of the waterpipe characteristics including
smoking products, heating sources, device components, and packages.
Methods
A systematic review was performed according to PRISMA guidelines,
revealing 443 unique citations. After screening, 36 studies were included in the
results. Research articles were selected to inform on differential effects caused
by product characteristics on adverse health effects, attractiveness, addictiveness
and prevalence of waterpipe use.
Results
Flavors are the key aspect that defines attractiveness of waterpipe product
smoking. All waterpipe products, with or without nicotine, produce toxicants in
similar quantities as cigarettes. Heating sources for waterpipe tobacco include
charcoals and electrical heating. Both heating sources increase toxicant emissions
in different ways. Hoses and mouth tips are device components that are often
shared in waterpipe smoking. Sharing influences attractiveness by enriching the
social experience. At the same time, it influences the transfer of infectious diseases
by bacteria and viruses from one smoker to another. Studies showed that more
generic and less attractive packages with health warnings are effective in reducing
the attractiveness of waterpipe smoking.
Conclusions
Based on our findings, we advise to include all waterpipe products,
tobacco and non-tobacco, with or without nicotine, in tobacco product regulations
and smoking bans in order to: ban waterpipe molasses with characterizing flavors
or ban the use of flavorings at any level; mandate dissemination of information
on all waterpipe tobacco elements to the national regulator; prescribe testing to
regulate contents of waterpipe smoking products and heating sources. Moreover, we advise to stimulate research on emissions of waterpipes.
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