Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review.

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in the hookah use is being seen because of the misconception amongst public that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells had shown consistently mutagenic, oxidative and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants and 31 respiratory irritants. An enormous data exists showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST elevation myocardial ischemia, recurrent ischemia and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with increasing use of hookah, its health effects, options for hookah smoking cessation and public health policy initiatives to mitigate waterpipe use.