Self-reported addiction to and perceived behavioural control of waterpipe tobacco smoking and its patterns in Egypt: policy implications

Background: Studies on waterpipe tobacco dependency are currently limited. Aims: This study assessed self-reported addiction to waterpipe tobacco smoking among Egyptian waterpipe smokers and identified the associated sociodemographic factors, perceived behavioural control and patterns of waterpipe tobacco smoking. Methods: Cross-sectional surveys were conducted on Egyptian adults in 2015 and 2017. Data on 1490 current waterpipe smokers were analysed including: sociodemographic characteristics, waterpipe tobacco smoking behaviour (age at starting, frequency, amount, company and place of smoking, and expenditure), perceived harm of waterpipe tobacco smoking, and self-reported addiction to and perceived behavioural control of waterpipe smoking (ability to quit, difficulty in quitting, quit attempts and intention to quit). Results: A quarter (25.8%) of the participants self-reported addiction to waterpipe tobacco smoking (males 27.1%, females 11.6%). Participants who considered themselves addicted reported less confidence in their ability to quit, fewer quit attempts, less intention to quit and less perceived harm of waterpipe smoking than those not addicted (P < 0.001). Variables associated with self-reported addiction were: younger age at starting waterpipe tobacco smoking (ORa = 2.2, 95% CI: 1.7-2.9), daily waterpipe tobacco smoking (ORa = 2.0, 95% CI: 1.1-3.5), smoking alone (ORa = 2.0, 95% CI: 1.4-2.8), being married (ORa = 1.8, 95% CI: 1.2-2.9), and monthly spending on waterpipe smoking of >= 150 Egyptian pounds (US$ 8.6) (ORa = 4.1, 95% CI: 2.9-5.6). Conclusions: Comprehensive waterpipe-specific policies are needed including education on waterpipe tobacco smoking dependency, increased taxation to decrease affordability of waterpipe tobacco and cessation programmes addressing perceived self-efficacy and addiction to waterpipe tobacco smoking.