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themselves to higher levels ofcancer-causing chemicals and hazardous gases such as carbon monoxide than if none of the nicotine was absorbed by the water; however, this issue needs further study (4, 14,1.x. This puts waterpipe smokers and second-hand smokers at risk for the same kinds of diseases as are caused by cigazette smoking, including cancer, heart disease, respiratory disease, and adverse effects during pregnancy (1~. Regional and global patterns of waterpipe smoking Waterpipe smoking is often social, and two or more people may share the same waterpipe (3, c~. In South-West Asia and North. Africa, it is not uncommon for children to smoke with their parents (1 ~. If used in a commercial establishment such as a cafe or restaurant, the waterpipe is ordered (often from a menu of flavours) and an employee prepares it from an in-house stock (8). Globally, the highest rates of smoking occur in the African Region (primarily North Africa), the Eastern Mediterranean Region and the South-East Asia Region (~. Since the 1990s waterpipe smoking appears to be spreading among new populations such as college students and young persons in the United States, Brazil and European countries. Waterpipe smoking appears to be stimulated by unfounded assumptions of relative safety compared to cigarettes, as well as the social nature of the activity (I8). Commercial marketing, often with implicit or explicit safety-related claims, may also be contributing to the spread of waterpipe smoking across the globe. Waterpipe smokers may use waterpipes exclusively; however, many smokers may also smoke cigarettes. In some countries in which cigazette smoking is concentrated among men, waterpipe smoking appears more evenly distributed between both sexes (8, 19). All these findings reinforce the need to conduct more research on waterpipes and the issues surrounding their use, and then to disseminate the information on the health risks to all countries. Science base and conclusions Waterpipe smoking has not been studied as intensively as has cigarette smoking; however, preliminary research on patterns of smoking, the chemistry of the smoke that is inhaled, and health effects supports the idea that waterpipe smoking is associated with many of the same risks as cigarette smoking, and may, in fact, involve some unique health risks. The science base supports the following conclusions: 75A-12