Multiple tobacco use among young adult waterpipe smokers in Egypt

The use of multiple tobacco products is an emerging trend. Studies on multiple use among waterpipe smokers are limited.

We aimed to estimate the proportion of other tobacco products used by current adult waterpipe smokers in Egypt and identify the determinants of multiple tobacco product use.

Population-based surveys were conducted using interview questionnaires during 2015-2017 in urban Cairo and rural Menoufia. Participants aged 18 years and older were selected using purposive quota non-random sampling. The total sample included 2 014 participants. We analysed the data on 1 490 current waterpipe smokers. Variables recorded included: tobacco use, health beliefs, waterpipe smoking behaviour, sociodemographic characteristics, and perceived effectiveness of pictorial health warnings on waterpipe tobacco packs. Current waterpipe smokers were classified as waterpipe-only users and multiple tobacco product users.

Almost half (47.9%) of the current waterpipe smokers used multiple tobacco products; 93.4% were dual users and 6.6% poly-users. The other tobacco products used were cigarettes (86.4%), electronic nicotine delivery systems (ENDS) (7.0%) or both (6.6%). Multiple users were more likely to be younger than waterpipe-only users. Young adult female waterpipe smokers used ENDS 12 times more than young adult males (48.8% versus 4.1% respectively). Non-daily waterpipe smoking, usually smoking at cafes, higher education and knowledge of pictorial health warnings were independent predictors of multiple tobacco product use.

Multiple tobacco product use was common among current waterpipe smokers in our study. Interventions to tackle non-cigarette and multiple tobacco use, especially in young adults, are urgently needed.