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Spread and prevalence

In this section, we present the epidemiology of waterpipe use in the six WHO regions.

African Region

  1. Research on waterpipe use in Africa is limited.
  2. Three empirical studies in South Africa were conducted among students.
    1. The first study: 60% of poor high-school students reported ever having used a waterpipe, while 20% reported daily use.
    2. The second study: among medical students in Pretoria, 19% of the participants had ever used a waterpipe.
    3. The third study: among university students in Western Cape, 40% of the participants reported current use of waterpipes, and, of these, 70% reported daily use.
  3. Almost half the users (48%) thought that the harmful effects of waterpipe smoking were greatly exaggerated.
  4. In the Global Adult Tobacco Survey in Nigeria in 2012, a very low prevalence was found of current use of tobacco products other than cigarette smoking (0.8% overall, 1.6% males, 0.1% females) in the entire population aged ≥ 15 years.
  5. Empirical evidence is lacking for Algeria, Ethiopia, Kenya, Nigeria, Sudan, Uganda and the United Republic of Tanzania but reports indicate a proliferation of fashionable hookah bars in the larger urban centers in all these countries, which are frequented mainly by the young and business people.

Region of the Americas

  1. Some research has been done and published in Canada and the USA.
  2. A study in Canada showed that the prevalence of current and any use of waterpipes increased by 2.6% among young people between 2006 and 2010.
  3. In the USA, the latest data on adults (aged ≥ 18 years) indicate prevalence rates of 0.5% for use every day and on some days and 3.9% for use every day, on some days and rarely, while use every day, on some days and rarely among 18–24-year-olds was 18.2%
  4. In a national study in the USA, of the 104 434 university students for whom complete information was available on cigarette, waterpipe and cigar use, results show that after cigarette smoking, waterpipe smoking was the most frequent form of tobacco use.
  5. Significant WTS does not appear to be common in Latin America (Limited literature)
  6. The Global Adult Tobacco Survey showed:
    1. Very low rates in Brazil in 2008, Mexico in 2009, Uruguay in 2010 and Argentina in 2012, with an overall prevalence of < 0.2% in all four countries.
    2. The rates for young adults were similarly low.

Eastern Mediterranean Region

  1. Which includes Middle Eastern and North African countries has the highest prevalence of waterpipe use in the world especially among young people.
  2. A longitudinal study of smoking among young people in the Region in 2008–2010 showed the prevalence of WTS increased by 40% within 2 years of follow-up.
  3. In a representative study of 13–15-year-old schoolchildren in various countries in the Region, the prevalence of waterpipe smoking ranged from 9% to 15%
  4. In these studies, the prevalence of waterpipe smoking was actually higher than that of cigarette smoking

A Global Youth Tobacco Survey showed that:

  1. Use of Waterpipe tobacco products was more frequent than cigarette smoking among children aged 13–15 in all 17 countries of the Region.
  2. Data on adults are available from the Global Adult Tobacco Surveys for Egypt (2009) and Qatar (2013) for the population aged ≥ 15 years:
    1. The prevalence of waterpipe use was 6.2% for males and 0.3% for females in Egypt.
    2. The prevalence of waterpipe use was for males and 1.6% for females in Qatar
    3. In Egypt, the men who smoked waterpipes tended to be older (40–54 years), live in rural areas and be less educated, consistent with previous results, reflecting the old tradition of waterpipe smoking in Egypt

European Region

  1. According to the Global Adult Tobacco Survey, the overall current and daily prevalence of waterpipe smoking in the population aged ≥ 15 years were lower than those of cigarette smoking.
  2. Countries with the highest rate of use are the Russian Federation in 2009 (4.4%), Turkey in 2008 (4.0%), Ukraine in 2010 (3.2%) and Romania in 2011 (0.3%). In these countries, users were young (18–24 years), they lived in urban areas and were better educated and tended to be occasional rather than daily users.
  3. According to a Eurobarometer report in 2012 on the prevalence of and attitudes to tobacco in the 28 countries of the European Union among people aged ≥ 15 years:
    1. 16% reported that they had tried a waterpipe at least once
    2. Use of waterpipes was most widespread in Latvia (42%), Estonia (37%) and Lithuania (36%) Use of waterpipes was least widespread in Ireland (5%), Portugal (5%), Malta (8%) and Spain (8%)
    3. Austria, Czech Republic and Luxembourg had the greatest percentage increases in waterpipe use.
    4. The largest decrease was reported in Sweden.
    5. In the United Kingdom the prevalence among university students was 8–11%, and that among secondary school students was 8%.
  4. In a study of 920 high-school students in France (mean age, 18 years), 40% reported experimenting with tobacco products other than cigarettes, including waterpipes.
  5. In a study of schoolchildren in Israel, 22% reported weekly use of waterpipes.
  6. Israel also showed a high prevalence of waterpipe use among schoolchildren (< 18 years) up to 40%.

South-East Asia Region

Global Adult Tobacco Survey data collected between 2008 and 2011 on waterpipe use was available for Bangladesh and Thailand in 2009, India in 2010 and Indonesia in 2011:

  1. The prevalence among men was highest in Bangladesh (1.3%), followed by India (1.1%), Indonesia (0.3%) and then Thailand (0.03%).
  2. The prevalence among women was highest in India (0.6%), Bangladesh 27 (0.2%), Thailand (0.01%) and Indonesia (0.0%).
  3. In India, the prevalence of waterpipe smoking was significantly higher in people aged > 50 years than in those aged < 30 years and the use was higher in rural rather than urban areas (1.1% vs 0.0%) and in those with lower rather than higher educational attainment (1.4% vs 0.0%). The use was higher among current cigarette smokers than among non-cigarette smokers (5.6% vs 0.6%)

South-Western Pacific Region

  1. There is a long history of smoking tobacco through “bong” waterpipes in Asia, which are different from traditional middle eastern waterpipes
  2. Bong waterpipes are not usually included in research on waterpipe tobacco smoking.
  3. Bong waterpipes can be made of bamboo, metal or glass and are used in countries such as China, the Lao People’s Democratic Republic, Myanmar and Vietnam.
  4. Bong waterpipes is used by older, rural, less educated men.
  5. Bong waterpipes are misconceived as less harmful than the Eastern Mediterranean hookah waterpipe.
  6. In a comparison of 13 countries the highest rate of waterpipe tobacco smoking among males (aged ≥ 15 years) was found in Vietnam in 2010 (13.0%) in older age groups (40–54 years) those living in rural areas and less educated people.
  7. The prevalence in Vietnamese women was very low (0.2%).
  8. A Global Adult Tobacco Survey in China in 2010 showed a prevalence in the population aged ≥ 15 years of only 0.65% for males and 0.08% for females.
  9. A Global Adult Tobacco Survey in Malaysia in 2011, the prevalence in people aged ≥ 15 years was 1.0% for males and 0.1% for females.

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Related references

  1. Advisory Note - Waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators, 2nd edition
  2. Global youth tobacco survey (GYTS)
  3. Tobacco questions for surveys
  4. The waterpipe: time for action by Wasim Maziak