Waterpipe smoking is a traditional habit in Arab World, Turkey, Middle East and Central Asia. Recently it became popular in many countries, mostly among young people. A background of growing prevalence is discussed separately for countries with an old tradition of water pipe smoking and for those where it appeared recently. Contrary to smokers belief numerous studies indicate that waterpipe being responsible for adverse health effects is not a safe alternative for cigarette smoking. Furthermore, waterpipe smoking is conducive to tobacco smoking dependence and may leave a part of the group as cigarette smokers. Hence, tobacco control policies should cover also waterpipe smoking.