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waterpipes contain water through which smoke passes prior to reaching the smoker. Names for the waterpipe also differ, and include "narghile" in East Mediterranean countries including Turkey and Syria, "shisha" and "goza" in Egypt and some North African countries, and "hookah" in India (8). Waterpipes can be purchased from dedicated supply shops, including Internet vendors, which also sell charcoal, tobacco and accessories. Waterpipes are now being marketed as portable, with the introduction of accessories such as carrying cases with shoulder straps. Some accessories are sold with claims to reduce the harmfulness of the smoke, such as mouthpieces that contain activated charcoal or cotton, chemical additives for the water bowl, and plastic mesh fittings to create smaller bubbles. None of these accessories have been demonstrated to reduce smokers' exposure to toxins orrisk oftobacco-caused disease and death. Health effects Contrary to ancient lore and popular belief, the smoke that emerges from a waterpipe contains numerous toxicants known to cause lung cancer, heart disease, and other diseases (4). Waterpipe tobacco smoking delivers the addictive drug nicotine, and, as is the case with other tobacco products, more frequent use is associated with the smokers being more likely to report that they are addicted (9). A waterpipe smoking session may expose the smoker to more smoke over a longer period of time than occurs when smoking a cigarette. Cigarette smokers typically take 8-12, 40-75 ml puffs over about 5-7 minutes and inhale 0.5 to 0.61itres of smoke (10). In contrast, waterpipe smoking sessions typically last 20-80 minutes, during which the smoker may take 50-200 puffs which range from about 0.15 to 1 litre each (6). The waterpipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes. While the water does absorb some of the nicotine, waterpipe smokers can be exposed to a sufficient dose of this drug to cause addiction (8, 11). Nicotine intake is an important regulator of tobacco intake in general, as evidenced by the fact that cigarette smokers tend to smoke until they get enough nicotine to satisfy their need and addiction, but not so much as to cause nausea (12,13). It is likely that the reduced concentration of nicotine in the waterpipe smoke may result in smokers inhaling higher amounts of smoke and thus exposing 75A-11