{
  "abstract": "The prevalence of waterpipe smoking (WPS) is increasingly recognised as a growing global public health concern. Available studies show that WPS exposes users to toxicants at levels similar to or higher than those in cigarette smoke, contributing to respiratory disease, cardiovascular damage and cancer. The WHO has flagged WPS as a growing threat, especially among adolescents and young adults, where use is rapidly increasing. Yet research progress is constrained by small samples, inconsistent exposure measures and inadequate adjustment for confounders. These limitations highlight the need for more rigorous epidemiological, clinical and toxicological studies. Importantly, the persistence and expansion of WPS cannot be explained solely by individual behaviours or perceptions of health risk. A range of socioeconomic, political and commercial forces—including industry marketing, weak regulatory oversight, cultural acceptance, low cost and the spread of waterpipe cafés—continues to drive WPS and shape patterns of use. These structural factors are likely to undermine the impact of current public health measures but remain under-researched. Expanding the evidence based on these upstream determinants is crucial for developing more effective and context-appropriate policies. In response to these challenges, experts from multiple disciplines convened in June 2024 to examine the evolving WPS epidemic. Participants emphasised the need for comprehensive, multisectoral strategies that integrate robust research, strengthen surveillance systems and target public awareness initiatives. The meeting concluded with a set of recommendations outlining priority research areas and a strategic roadmap aimed at addressing the complex and escalating public health threat posed by WPS.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy",
        "Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Fatemeh Toorang"
    },
    {
      "affiliations": [
        "Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA"
      ],
      "name": "Arash Etemadi"
    },
    {
      "affiliations": [
        "Department of Biochemistry, University of Kashmir, Hazratbal, Srinagar, India"
      ],
      "name": "Nazir Ahmad Dar"
    },
    {
      "affiliations": [
        "City University of New York (CUNY) Medical School and the Journal of Cancer Education, New York, New York, USA"
      ],
      "name": "Amr Soliman"
    },
    {
      "affiliations": [
        "Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Dusseldorf, Germany"
      ],
      "name": "Stephanie Klosterhalfen"
    },
    {
      "affiliations": [
        "Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran"
      ],
      "name": "Alireza Ansari-Moghaddam"
    },
    {
      "affiliations": [
        "Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC), Lyon, France"
      ],
      "name": "Akram Ghantous"
    },
    {
      "affiliations": [
        "Department of Family Medicine, Faculty of Medicine, American University of Beirut and WHO FCTC Waterpipe tobacco smoking knowledge hub, Beirut, Beirut Governorate, Lebanon"
      ],
      "name": "Maya Romani"
    },
    {
      "affiliations": [
        "Health Units, Faculty of Social Sciences, Tampere University, Tampere, Finland"
      ],
      "name": "Maryam Hadji"
    },
    {
      "affiliations": [
        "Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Angela Punzo"
    },
    {
      "affiliations": [
        "Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Hamideh Rashidian"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Fereshte Lotfi"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Monireh Sadat Seyyedsalehi"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Andrei Cosmin Siea"
    },
    {
      "affiliations": [
        "Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Cristiana Caliceti"
    },
    {
      "affiliations": [
        "Tobacco Free Initiative, Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Eastern Mediterranean (WHO EMRO), Cairo, Egypt"
      ],
      "name": "Sophia El-Gohary"
    },
    {
      "affiliations": [
        "Tobacco Control Center, WHO Collaborating Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar"
      ],
      "name": "Ahmad Mohd AlMulla"
    },
    {
      "affiliations": [
        "Department Surgery, College of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia"
      ],
      "name": "Ahmed Yahia Al Ameer"
    },
    {
      "affiliations": [
        "Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Reza Malekzadeh"
    },
    {
      "affiliations": [
        "Department of Clinical Biochemistry, College of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia"
      ],
      "name": "Mohammad Muzaffar Mir"
    },
    {
      "affiliations": [
        "WHO FCTC Knowledge Hub for Waterpipe Tobacco Smoking, the American University of Beirut, Beirut, Lebanon"
      ],
      "name": "Ghazi S Zaatari"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA"
      ],
      "name": "Wasim Maziak"
    },
    {
      "affiliations": [
        "Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA"
      ],
      "name": "Neal D Freedman"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy",
        "Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA"
      ],
      "name": "Paolo Boffetta"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy",
        "Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Kazem Zendehdel"
    }
  ],
  "title": "Waterpipe smoking and health outcomes: review of evidence and road map for an international consortium",
  "uid": "bf53c5af-aece-53c2-a1d0-b4343463ddb0"
}