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1.2 Tobacco consumption and social influence Tobacco consumption is the leading preventable risk factor for chronic disease and mortality worldwide, responsible for over seven million annual deaths from direct consumption and 1.2 million from second-hand smoke (World Health Organization, 2025)

This effect may well occur, and one prospective study that investigated it in Jordanian youth (age 1316 years) suggests that tolerance may manifest itself not as increased waterpipe use but rather initiation and increasing use of tobacco cigarettes.106 If this form of cross-tolerance from waterpipe toward cigarettes is reliable and generalises to other populations, it further supports the idea that WTS is a grave and immediate public health threat

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With just one hand, cigarette packs can be opened and closed

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Boston: Department of Nutrition at the Harvard T.H