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WHO Study Group on Tobacco Product Regulation <br />Advisory Note: <br />Waterpipe Tobacco Smoking: Health Effects, Research Needs and <br />Recommended Actions by Regulators <br />Purpose of advisory <br />This advisory note, formulated by the WHO Study Group on Tobacco Product <br />Regulation (TobReg), addresses the growing concerns about the increasing <br />prevalence and potential health effects of tobacco smoking using waterpipes, <br />also called "waterpipe tobacco smoking". The purposes of the advisory are to <br />provide guidance to WHO and its Member States, to inform regulatory <br />agencies in their efforts to implement the provisions of the WHO Framework <br />Convention on Tobacco Control concerning education and communications, <br />and to educate consumers about the risks of waterpipe smoking. The advisory <br />also provides guidance to researchers and research agencies interested in <br />facilitating a more thorough understanding of the health effects of tobacco <br />waterpipe smoking, and to those engaged in developing tobacco smoking <br />prevention and cessation programmes so that such programmes accommodate <br />the unique aspects of waterpipe smoking. <br />Background and history <br />Waterpipes have been used to smoke tobacco and other substances by the <br />indigenous peoples of Africa and Asia for at least four centuries (1). According <br />to one historical account (1), a waterpipe was invented in India by a physician <br />during the reign of Emperor Akbaz (who ruled from 1556 to1605) as a <br />purportedly less harmful method of tobacco use. The physician <br />Hakim Abul Fath suggested that tobacco "smoke should be first passed <br />through a small receptacle of water so that it would be rendered hazmless" (2). <br />Thus, a widespread but unsubstantiated belief held by many waterpipe users <br />today -that the practice is relatively safe - is as old as the waterpipe itself (3). <br />Mazketing tools associated with waterpipes and waterpipe tobacco may <br />reinforce this unsubstantiated belief (4). For example, the label of a popular <br />waterpipe tobacco brand sold in South-West Asia and North America states <br />"0.5% nicotine and 0% tar". <br />75A-9 <br />