title: Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners.
abstract: BACKGROUND
  Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking.
  
  
  METHODS
  We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly.
  
  
  RESULTS
  f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking.
  
  
  CONCLUSIONS
  While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom.|Academic Unit of Primary Care and Population Sciences, University of Southampton, Hampshire, SO16 6YD, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Jawad
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom.
authors.forename: Elham
authors.initials: E
authors.lastname: Choaie
authors.affiliation: Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8BB, United Kingdom.
authors.forename: Leonie
authors.initials: L
authors.lastname: Brose
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom.
authors.forename: Omara
authors.initials: O
authors.lastname: Dogar
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, CF14 4YS, United Kingdom.
authors.forename: Aimee
authors.initials: A
authors.lastname: Grant
authors.affiliation: Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jenkinson
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: McEwen
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom.
authors.forename: Lion
authors.initials: L
authors.lastname: Shahab
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013334:Students; D006113:United Kingdom / Q000453:epidemiology; D014495:Universities; D055815:Young Adult