title: Cross-country comparison of waterpipe use: nationally representative data from 13 low and middle-income countries from the Global Adult Tobacco Survey (GATS).
abstract: OBJECTIVE
  Evidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys.
  
  
  METHODS
  Data were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008-2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session.
  
  
  RESULTS
  GATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness.
  
  
  CONCLUSIONS
  GATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use.
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Morton
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Song
authors.affiliation: World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: Heba
authors.initials: H
authors.lastname: Fouad
authors.affiliation: World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: Fatimah El
authors.initials: FE
authors.lastname: Awa
authors.affiliation: World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: Randa
authors.initials: R
authors.lastname: Abou El Naga
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Luhua
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Palipudi
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Samira
authors.initials: S
authors.lastname: Asma
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003906:Developing Countries; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water
keywords: Low/Middle income country; Non-cigarette tobacco products; Surveillance and monitoring