According to anecdotal evidence, waterpipe smoking may lead to the initiation of cigarette smoking among young people. This hypothesis is yet to be examined using an appropriate study design and a theoretical model for behavioral change. To compare the risk of cigarette smoking initiation among waterpipe-only smokers and never smokers in a school-based sample of adolescents from Irbid, Jordan.
Risk of initiation of cigarette smoking among waterpipe smokers was significantly higher than among never smokers after adjusting for potential confounders aHR 1. The association between waterpipe and cigarette smoking initiation was dose-dependent.
Waterpipe smoking led to the initiation of cigarette smoking among this cohort of Jordanian adolescents; the effect was dose-dependent.
Waterpipe smoking is widely believed to be less harmful, less addictive and generally safer than cigarette smoking. Several researchers have recently suggested that waterpipe smoking can lead to cigarette use.
As evidence for waterpipe use patterns and delivery of the addictive substance, nicotine, has accumulated, the waterpipe-to-cigarette gateway concept was developed further to suggest a possible pathway for this transition.
