Public perception and misconceptions about water pipe smoking: a scoping review of implications for cardiovascular health awareness and policy
Tochukwu R. Nzeako, Chukwuka Elendu, George S. Blewusi, Ebube C. Mbah, Samuel B. Governor, Ijeoma Ezeife, Courage O. Idahor, Olayiwola Bolaji, Belinda A. Eze, Tyagi Varun, Davidson J. Ozoemena, Mohamed Y. AliBackground:
Water pipe smoking (hookah, shisha, narghile) is increasingly popular worldwide, particularly among adolescents and young adults. Misconceptions about its health risks persist despite growing evidence of its harmful cardiovascular effects.
Objective:
This scoping review aims to map the existing literature on public perceptions and misconceptions about water pipe smoking and its cardiovascular health implications, with the goal of informing awareness efforts and policy interventions.
Methods:
Following the PRISMA-ScR guidelines, we systematically searched, charted, and summarized 96 peer-reviewed studies published between 2000 and 2024 in major databases. Studies were included if they addressed public perception, knowledge, or cardiovascular outcomes related to water pipe use. Data were synthesized descriptively to highlight key themes and evidence gaps.
Results:
Most included studies (52%) were observational, with a regional focus on Middle Eastern and South Asian populations (67%). Common misconceptions included beliefs that water filtration reduces harm and that water pipe smoking is safer than cigarettes. Evidence shows significant exposure to harmful substances such as carbon monoxide, nicotine, heavy metals, and carcinogens, with reported associations with cardiovascular outcomes including atherosclerosis, myocardial infarction, and hypertension. Social acceptability, flavored tobacco, and weak regulation in low- and middle-income countries further promote its use.
Conclusions:
Water pipe smoking poses substantial cardiovascular risks that are poorly understood by the public. This scoping review highlights the need for culturally sensitive health education, robust public health campaigns, and stronger policy enforcement. Future research should adopt standardized reporting methods to better characterize long-term cardiovascular impacts, dual tobacco use patterns, and policy effectiveness.