Waterpipe Smoking Among Japanese Teens and Young Adults: an Emerging Public Health Concern

Introduction Waterpipe (shisha) smoking has gained popularity among teens and young adults and is now prevalent in Japan. Yet, waterpipe smoking in the Japanese population remains understudied. This study examined the prevalence, characteristics, and knowledge/attitudes related to waterpipe use among Japanese teens and young adults, aiming to inform efforts to prevent further use. Methods A cross-sectional analysis of the 2024 Japan Society and New Tobacco Internet Survey was conducted among individuals aged 16–29 years (N = 5564). Inverse probability weighting was used to generate estimates representative of the Japanese national population. Descriptive analyses assessed waterpipe use prevalence, use status, and reasons for use. Multivariable logistic regression—controlling for demographic, socioeconomic, and substance use covariates—evaluated associations between knowledge/attitudes and any lifetime (versus never) waterpipe use. Results Among teens and young adults, 10.2% reported waterpipe use, with 65% of current users smoking occasionally. Usage was highest among the 20–24 age group. Common reasons for use included peer influence (59.7%), interest in shisha bars/cafés (54.2%) or interest in flavors (47.9%), and perceived reduced harm (40.7%). After adjusting for covariates, perceiving waterpipe use as less harmful (adjusted odds ratio [AOR] = 1.75) or “cool” (AOR = 1.44) remained strongly associated with significantly higher odds of lifetime use. Conclusions Waterpipe smoking prevalence among young people in Japan is a public health concern, driven by peer influence, product appeal, and misperceptions of reduced harm. Targeted education and regulation to address perceptions about harm and social acceptability, along with continued monitoring, are warranted. Implications To our knowledge, this is the first study to examine waterpipe smoking among teens and young adults in Japan, the most prevalent age group for waterpipe smokers globally. The reasons cited for use were similar to those in other countries, including peer influence and appealing flavors, with misconceptions about reduced harm and viewing waterpipe use as “cool” being particularly associated with use. Efforts to address misperceptions of reduced harm and social desirability are essential to reducing youth vulnerability. Our findings highlight the need for continued monitoring, targeted education, and policy interventions to tackle this emerging public health concern.