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It links increased prevalence to peer influence, social acceptance, and safety misconceptions, and cites evidence on high nicotine levels, toxic flavoring agents, oxidative stress, and inflammation comparable to cigarette effects even after a single session. It also highlights nicotine dependence, cognitive and mental health impairments, broad disease associations, and transmission risks via communal pipes, urging awareness and stricter regulation, especially on social media.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/waterpipe-tobacco-smoking-an-urgent-public-health-concern-among-adolescents-and-young-adults/439821/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/waterpipe-tobacco-smoking-an-urgent-public-health-concern-among-adolescents-and-young-adults/439821.png","ImageObject",300,407,{"name":92,"@type":93},"Stanford","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is waterpipe tobacco smoking becoming more common among adolescents and young adults?","Question",{"text":112,"@type":113},"It is increasingly driven by peer influence, social acceptance, and misconceptions about its safety.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What harms does waterpipe smoke pose compared with cigarettes?",{"text":117,"@type":113},"Smoke contains higher nicotine concentrations and toxic flavoring agents, and oxidative stress and inflammation can injure endothelial cells in a way comparable to cigarettes, even after a single session.",{"name":119,"@type":110,"acceptedAnswer":120},"What public health actions does the letter recommend?",{"text":121,"@type":113},"It calls for awareness campaigns and rigorous regulations on waterpipe marketing—particularly on social media—along with proactive interventions and further research on harms to prevent waterpipe use from being portrayed as safe and socially acceptable.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},439821,1790797540,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Letter to the Editor  \nWaterpipe tobacco smoking: an urgent public health concern among adolescents and young adults  \nSaniya Devi, MBBSa , Sanhia Maheshwari, MBBSa , Najeeb Ahmed, MBBSb , Muddassir Khalid, MBBSc ,*  \nDear Editor,  \nWaterpipe tobacco smoking is increasingly common, especially among adolescents and young adults, driven by peer influence, social acceptance, and misconceptions about its safety[1] . A recent study discovered that approximately 25% of students have ever smoked a waterpipe, frequently as a result of a lack of knowledge regarding the health effects and hazardous constituents of the substance. The rates of waterpipe use were four times higher among students with limited awareness, and the highest rates were observed among senior students[2] .  \nSmoke from waterpipes contains a higher concentration of nicotine than cigarettes. Users are exposed to elevated concentrations of toxic flavoring agents, including pulmonary irritants such as cinnamaldehyde[3] . Oxidative stress and inflammation can result in endothelial cell injury. This condition is comparable to that caused by cigarettes, even after a single waterpipe session[4] . Similar to other tobacco products, nicotine dependence can result from prolonged use, indicating its potential for addiction[5] . Research suggests that healthy adult waterpipe consumers experience substantial impairments in memory, attention, and alertness, which are closely linked to elevated levels of anxiety and depressive symptoms[6] . Additionally, there is a correlation between respiratory disease, cardiovascular disease, esophageal and lung malignancies, periodontal disease, and obstetric complications, including low birth weight[7] . The transmission of communicable diseases has also been linked to the use of communal water pipes. The World Health Organization has issued a warning regarding the transmission of herpes, H. pylori, hepatitis, and fungal infections. Pulmonary tuberculosis was associated with the regular smoking of communal waterpipes in a case report that was indexed in PubMed[8] . Additionally, prominent brands, including  \naDepartment of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan, bDepartment of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan and cDepartment of Medicine, Nishtar Medical University, Multan, Pakistan  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Medicine, Nishtar Medical University, Multan 60000, Pakistan. Tel.: +923330333544.  \n[E-mail: dr.muddassirkhalid@gmail.com](E-mail: dr.muddassirkhalid@gmail.com) (M. Khalid).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This isan open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nAnnals of Medicine & Surgery (2026) 88:1030–1031  \nReceived 5 November 2025; Accepted 10 November 2025  \nPublished online 24 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004381](http://dx.doi.org/10.1097/MS9.0000000000004381)  \nthose that manufacture e-cigarettes and hookahs, are utilizing social media to market and promote their products. They present tobacco use as a socially permissible behavior among young adults and normalize it[9] .  \nConsequently, it is imperative to implement awareness campaigns and rigorous regulations regarding waterpipe marketing, particularly on social media, to dispel misconceptions and reduce the initiation of waterpipe use among adolescents and young adults. Furthermore, we support the implementation of proactive interventions to reduce marketing strategies and prevent waterpipe smoking from being portrayed as a safe, socially acceptable alternative to cigarette smoking, as well as increased public awareness and additional resear","cbCaikiM8hsA5jXX","https://ap.wps.com/l/cbCaikiM8hsA5jXX","pdf",164048,"English","# Letter to the Editor\n## Public health concern and prevalence\n## Toxicity, dependence, and health outcomes\n## Communal pipe risks and infectious disease transmission\n## Risk-reduction recommendations, awareness, and regulation","[{\"question\":\"Why is waterpipe tobacco smoking becoming more common among adolescents and young adults?\",\"answer\":\"It is increasingly driven by peer influence, social acceptance, and misconceptions about its safety.\"},{\"question\":\"What harms does waterpipe smoke pose compared with cigarettes?\",\"answer\":\"Smoke contains higher nicotine concentrations and toxic flavoring agents, and oxidative stress and inflammation can injure endothelial cells in a way comparable to cigarettes, even after a single session.\"},{\"question\":\"What public health actions does the letter recommend?\",\"answer\":\"It calls for awareness campaigns and rigorous regulations on waterpipe marketing—particularly on social media—along with proactive interventions and further research on harms to prevent waterpipe use from being portrayed as safe and socially acceptable.\"}]","Waterpipe Tobacco Smoking: An Urgent Public Health Concern among Adolescents and Young Adults | PDF",1790690315]