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Research needs <br />There is surprisingly little reseazch addressing tobacco smoking using a <br />waterpipe, especially given that there are many millions of current waterpipe <br />smokers and that waterpipe use is spreading across the globe. A more thorough <br />understanding of waterpipe smoking, risks, and health effects requires <br />worldwide efforts to study: <br />1. Types and patterns of smoking across regions and cultures. <br />2. National and global trends in waterpipe smoking. <br />3. How the chemical and physical properties of the smoke depend on the <br />waterpipe set-up and smoking conditions (geometry of waterpipe, <br />amount/type of coal and tobacco used, puffmg behaviour, etc.). <br />4. Methods for evaluating toxicant yield, smoker exposure, and resultant <br />absorption. <br />5. Patterns of smoking by individuals and how different smoking patterns <br />relate to the smokers' intake of smoke toxicants, including nicotine, <br />cazcinogens, cazbon monoxide, and other disease-causing compounds. <br />6. Relationships among yield, exposure, and absorption biomazkers. <br />7. Pharmacology and toxicology of smoke as assessed in laboratory tests <br />using biological assays and in actual use by people. <br />8. Epidemiology of waterpipe-associated disease risk, including addiction <br />and transmission ofnon-tobacco, communicable diseases. <br />9. The influence of cultural and social practices on initiation and <br />maintenance. <br />10. The relationship between waterpipe smoking and other forms of tobacco, <br />including substitution and multiple product smoking. <br />11. The relationship between waterpipe smoking and the use of other drugs, <br />including marijuana. <br />12. Development of prevention and cessation strategies. <br />75A-14 <br />