title: Waterpipe Tobacco Smoking Prevalence and Correlates in 25 Eastern Mediterranean and Eastern European Countries: Cross-Sectional Analysis of the Global Youth Tobacco Survey.
abstract: BACKGROUND
  Waterpipe tobacco smoking is highly prevalent among young people in some settings. There is an absence of nationally representative prevalence studies of waterpipe tobacco use and dual use with other tobacco products in young people.
  
  
  METHODS
  We conducted a secondary analysis of the Global Youth Tobacco Survey, a nationally representative cross-sectional study of students aged 13-15 years. Of 180 participating countries, 25 included optional waterpipe tobacco smoking questions: 15 Eastern Mediterranean and 10 Eastern European countries. We calculated the prevalence of current (past 30-day) waterpipe tobacco use, including dual waterpipe and other tobacco use, and used logistic regression models to identify sociodemographic correlates of waterpipe tobacco smoking. Individual country results were combined in a random effects meta-analysis.
  
  
  RESULTS
  Waterpipe tobacco smoking prevalence was highest in Lebanon (36.9%), the West Bank (32.7%) and parts of Eastern Europe (Latvia 22.7%, the Czech Republic 22.1%, Estonia 21.9%). These countries also recorded greater than 10% prevalence of dual waterpipe and cigarette use. In a meta-analysis, higher odds of waterpipe tobacco smoking were found among males (Adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] = 1.18% to 1.59%), cigarette users (AOR = 6.95, 95% CI = 5.74% to 8.42%), those whose parents (AOR = 1.54, 95% CI = 1.31% to 1.82%) or peers smoked (AOR = 3.53, 95% CI = 2.97% to 4.20%) and those whose parents had higher educational attainment (Father, AOR = 1.47, 95% CI = 1.14% to 1.89%; Mother, AOR = 1.62, 95% CI = 1.07% to 2.46%). We report on regional- and country income-level differences.
  
  
  CONCLUSIONS
  Waterpipe tobacco smoking, including dual waterpipe and cigarette use, is alarmingly high in several Eastern Mediterranean and Eastern European countries. Ongoing waterpipe tobacco smoking surveillance is warranted.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom mohammed.jawad06@imperial.ac.uk.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Jawad
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D014943:Global Health / Q000191:economics / Q000208:ethnology*; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000208:ethnology; D010379:Peer Group; D015995:Prevalence; D012907:Smoking / Q000191:economics / Q000208:ethnology*; D013334:Students; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000191:economics; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology