Association between waterpipe use and susceptibility to cigarette smoking among adolescents and young adults who never smoked: A systematic review and meta-analysis

INTRODUCTION: Several factors associated with susceptibility to cigarette smoking have been identified, yet there is little evidence on the possible effects of waterpipe use. With this systematic review and meta-analysis, we aimed to investigate the relationship between waterpipe use and cigarette smoking susceptibility among adolescents and young adults who never smoked. METHODS: Eligible studies were searched in PubMed, Springer Link, ScienceDirect and Cochrane Library up to August 2022. The pooled odds ratio (OR) and 95% confidence intervals (CI) of cigarette smoking susceptibility with waterpipe use were estimated using a random-effects model. Publication bias was assessed by Egger’s regression asymmetry test and Begg’s rank correlation test with Begg’s funnel plot. RESULTS: A total of 59710 participants, including 3559 waterpipe users from six studies, were identified in this analysis. Results showed that the odds of susceptibility to cigarette smoking were nearly two times (OR=1.90; 95% CI: 1.59–2.26) greater for never smoker adolescents and young adults who used waterpipe tobacco, compared to those who were never users. In subgroup analyses, the pooled OR was 2.19 (95% CI: 1.52–3.14) and 1.70 (95% CI: 1.51–1.92) for current and ever use of waterpipe, while the pooled OR was 1.99 (95% CI: 1.35–2.95) and 1.87 (95% CI: 1.45–2.39) in Arab and non-Arab nations, respectively. CONCLUSIONS: Our findings suggest that waterpipe use was associated with greater odds of susceptibility to cigarette smoking among adolescents and young adults who never smoked. Tailored public health policies and regulations on waterpipe smoking may help to protect youth never smokers from initiation of cigarette smoking.