title: Double trouble: Exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents.
abstract: BACKGROUND
  In youth, both waterpipe tobacco smoking (WTS) and nonmedical use of prescription drugs (NMUPD) are globally growing concerns. This study assesses for the first time the lifetime and past-year associations between WTS and four classes of psychoactive prescription drugs.
  
  
  METHODS
  Cross-sectional data (2011) on 986 high school students attending public and private high schools in Beirut (Lebanon) was analyzed. Schools were selected using proportionate random cluster sampling from a comprehensive list of schools provided by the Ministry of Education.
  
  
  RESULTS
  Almost half (46%) had tried WTS compared to 25% who had ever tried cigarettes. Lifetime prevalence estimates of NMUPD were: pain relievers (8.2%), sedatives/tranquilizers (5.6%), stimulants (3.5%), antidepressants (2.5%), and sleeping pills (2.3%). WTS was associated with increased odds of sedatives/tranquilizer use (OR = 3.22, 95% CI: 1.25, 8.25), pain reliever use (OR = 4.31, 95% CI: 2.02, 9.17), and sleeping medication use (OR = 8.31, 95% CI: 2.37, 29.20), controlling for sex, age, school type, and other substance use. For cigarettes, the associations were consistently either weaker or non-existent, except with stimulant use (OR = 5.29, 95% CI: 1.55, 18.05).
  
  
  CONCLUSIONS
  While public health professionals have watched with caution the global prevalence of youth cigarette use-worldwide, an insidious alternative form of tobacco use has grown. Further research is needed to understand the unique risk factors and motives associated with WTS and how these relate to NMUPD in order to inform the development of effective intervention programs and policies that support youth positive health decisions.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA. Electronic address: leonazahlan@gmail.com.
authors.forename: Leona
authors.initials: L
authors.lastname: Zahlan
authors.affiliation: Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Bliss street, Riad el Solh, 11072020 Beirut, Lebanon. Electronic address: lg01@aub.edu.lb.
authors.forename: Lilian
authors.initials: L
authors.lastname: Ghandour
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. Electronic address: ny05@aub.edu.lb.
authors.forename: Nasser
authors.initials: N
authors.lastname: Yassin
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236 Riad El Solh, Beirut 1107 2020, Lebanon. Electronic address: ra15@aub.edu.lb.
authors.forename: Rima
authors.initials: R
authors.lastname: Afifi
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA. Electronic address: ssm2183@columbia.edu.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D009042:Motivation; D063487:Prescription Drug Misuse / Q000523:psychology*; D055553:Prescription Drugs / Q000009:adverse effects; D011619:Psychotropic Drugs / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
chemical_list: D055553:Prescription Drugs; D011619:Psychotropic Drugs
keywords: Adolescent; Lebanon; Nonmedical use; Prescription drugs; Smoking; Waterpipe