Current ��non-cigarette tobacco uses����widely considered a proxy to water-pipe smoking in the EMR��increased by 6 percentage points from 2003 to 2007 in Jordan (from 20% to 26%). So, roughly speaking, and assuming a steady trend, it is estimated that 2�C3 percentage points of the observed water-pipe smoking increase during the selleckchem Dorsomorphin study period is maybe attributable to the population trend. This is equivalent to 30�C50% of the observed increase in current water-pipe smoking in this study (Table 1). However, we think that the true effect of the population trend in our study, while still important, is smaller than that in GTYS because of the younger age of our population. One of the salient epidemiological patterns of water-pipe smoking, at least in the EMR, concerns women��s susceptibility to water-pipe smoking.

This is evidenced by the greater gender difference in cigarette smoking compared with water pipe in the EMR (Maziak, Ward, & Eissenberg, 2007). In this study, current water-pipe smoking among girls was four times higher at baseline��and two times higher at 2-year follow-up��than cigarette smoking. No such differences were observed in boys. This relatively higher prevalence of water-pipe use among girls may indicate a more social tolerance of water-pipe smoking than cigarette��s (Maziak et al., 2004). For example, in a study by Tamim et al. (2007) of 2,443 schoolchildren in Lebanon (average age 15), about one-quarter of cigarette smokers, compared with two-thirds of water-pipe smokers, said that one or both parents knew about their smoking.

Given that water-pipe smoking is associated with considerable health effects and that it can lead to cigarette smoking, those trends may translate into increased smoking prevalence among women in the EMR with corresponding increase in smoking-related morbidity and mortality among them. Compared with water pipe, this study showed that cigarette smoking uptake seems to have a later but more accelerated time dynamic. So, while current water-pipe smoking increased by about 42% within the 2-year observation period, cigarette smoking almost tripled. Part of this may be due to the higher prevalence of water-pipe smoking at baseline compared with cigarette smoking (as presented in Table 1). That is, those who are likely to become water-pipe smokers take up the habit at a younger age.

It also can be due to the faster development of dependence among cigarette smokers compared with water pipe because of easy accessibility of cigarettes and their faster nicotine delivery. However, caution must be practiced when extrapolating from one method of tobacco use to another in terms Batimastat of use patterns, dependence, or policy. For example, available evidence indicates a difference in the dependence experience between cigarette and water-pipe smokers, with more prominent social domain for water-pipe dependence (Maziak et al., 2005).