title: Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012-13 Pakistan Demographic and Health Survey.
abstract: BACKGROUND
  Despite the general decline in cigarette smoking, use of alternative forms of tobacco has increased particularly in developing countries. Waterpipe (WP) and Chewing Tobacco (CT) are two such alternative forms, finding their way into many populations. However, the burden of these alternative forms of tobacco and their socio demographic determinants are still unclear. We assessed the prevalence of WP and CT use among women of reproductive age group in Pakistan.
  
  
  METHODS
  Data from the most recent Pakistan Demographic and Health Survey 2012-13 (n = 13,558) was used for this analysis. Information obtained from ever married women, aged between 15 and 49 years were analyzed using two separate data subgroups; exclusive WP smokers (total n = 12,995) and exclusive CT users (total n = 12,771). Univariate and Multivariate logistic regression analyses were conducted and results were reported as crude and adjusted Odds Ratio with 95% confidence intervals.
  
  
  RESULTS
  Prevalence of WP smoking and CT were 4% and 2%, respectively. After multivariate adjustments, ever married women who were: older than 35 years (OR; 4.68 95% CI, 2.62-8.37), were poorest (OR = 4.03, 95% CI 2.08-7.81), and had no education (OR = 9.19, 95% CI 5.10-16.54), were more likely to be WP smokers. Similarly, ever married women who were: older than 35 years (OR = 3.19, 95% CI 1.69-6.00), had no education (OR = 4.94, 95% CI 2.62-9.33), were poor (OR = 1.64, 95% CI 1.07-2.48) and had visited health facility in last 12 months (OR = 1.81, 95% CI 1.22-2.70) were more likely to be CT users as well.
  
  
  CONCLUSIONS
  Older women with lower socio-economic profile were more likely to use WP and CT. Focused policies aiming towards reducing the burden of alternate forms of tobacco use among women is urgently needed to control the tobacco epidemic in the country.
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. tahir.khan@duhs.edu.pk.
authors.forename: Muhammad Tahir
authors.initials: MT
authors.lastname: Khan
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. shah.hashmi@duhs.edu.pk.
authors.forename: Shahkamal
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. sidra.zaheer@duhs.edu.pk.
authors.forename: Sidra
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. syeda.kanwal@duhs.edu.pk.
authors.forename: Syeda Kanwal
authors.initials: SK
authors.lastname: Aslam
authors.affiliation: Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan. dr.naveedduhs@yahoo.com.
authors.forename: Naveed Ali
authors.initials: NA
authors.lastname: Khan
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. azeezhena@gmail.com.
authors.forename: Hina
authors.initials: H
authors.lastname: Aziz
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. nabil.rashid@duhs.edu.pk.
authors.forename: Nabil
authors.initials: N
authors.lastname: Rashid
authors.affiliation: School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan. kashif.shafique@glasgow.ac.uk.|Institute of Health and Wellbeing, Public Health, University of Glasgow, 1-Lilybank Gardens, Glasgow, G12 8RZ, UK. kashif.shafique@glasgow.ac.uk.
authors.forename: Kashif
authors.initials: K
authors.lastname: Shafique
mesh_terms: D000328:Adult; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult