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This information is sorely needed, and its lack may underlie recent commentary suggesting that, in populations in which WTS is becoming more prevalent today, the likelihood of dependence is unclear.115 This lack of clarity must be addressed empirically, and there is an urgent need for a waterpipe-specific dependence measure that takes into account features of this method of tobacco use that make it different from other forms, including its time-consuming preparation and consumption, intermittent use patterns and variety of unique sensory cues.91 Such a measure will benefit from research regarding cigarette smoking and smokeless tobacco use, but also likely will require a broad, conceptual mapping approach that takes advantage of current theory in drug dependence as well as expert consensus and makes extensive use of the literature reviewed here to guide item selection

What can we do

Its also important to note that employees who are defined as tobacco or nicotine users can avoid paying the tobacco surcharge by opting into a reasonable alternative standard (RAS)

Courier Journal