title: Waterpipe Use and Susceptibility to Cigarette Smoking Among Never-Smoking Youth.
abstract: BACKGROUND
  Susceptibility to cigarette smoking, defined as the lack of a firm decision against smoking, is a strong predictor of regular smoking and addiction. Several modifiable risk factors have been identified among never cigarette smokers, and one potential factor of interest is waterpipe use. The purpose of this study is to determine the association of waterpipe use with susceptibility to cigarette smoking among never-smoking youth.
  
  
  METHODS
  In a pooled analysis of 17 Arab nations with nationally representative Global Youth Tobacco Surveys conducted during 2002-2011, tobacco-related information was obtained from 30,711 never-smoking adolescents representing 4,962,872 youth. Study outcome was susceptibility to cigarette smoking, and primary exposure was waterpipe use. Data were analyzed in 2014 using weighted logistic regression models, including stratified models by gender, to determine the odds of susceptibility to cigarette smoking with waterpipe use, adjusting for confounders.
  
  
  RESULTS
  Overall, 20% of never-smoking youth were susceptible to cigarette smoking, ranging from 13.1% in Oman to 32.6% in Somalia; 5.2% currently used waterpipe, ranging from 0.3% in Morocco to 23.5% in Kuwait. The estimated odds of susceptibility to cigarette smoking were 2.5 (95% CI=1.9, 3.4) times higher for adolescents who used waterpipe in the past month compared with those who did not, controlling for confounders. Estimates were similar when stratified by gender.
  
  
  CONCLUSIONS
  Waterpipe use is associated with susceptibility to cigarette smoking. Study findings identify a novel risk factor for never smokers to initiate smoking and will help the public health community develop and implement policies around waterpipe use prevention.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas. Electronic address: spveeran@utmb.edu.
authors.forename: Sreenivas P
authors.initials: SP
authors.lastname: Veeranki
authors.affiliation: Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan.
authors.forename: Sukaina
authors.initials: S
authors.lastname: Alzyoud
authors.affiliation: Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan;
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Kheirallah
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D018912:Arabs / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008877:Middle East / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*