There has been a marked decline in cigarette smoking in the United States since the 1964 U.S. Surgeon General’s Report due to sustained and effective regulatory public health and clinical efforts.1,2 However, there has been an increase since the 1990s in the use of non-cigarette nicotine-delivery products, including water pipes.3-5 Water pipe smoking (WPS), also known as hookah, shisha, narghile, arghile, and hubble bubble (depending on the world region), is a 500-year-old form of tobacco use historically engaged in by older men in the Middle East, North Africa, and Asia. The practice of WPS has been a symbol of social sharing and cultural
