Akl E A, Ward K D, Bteddini D, Khaliel R, Alexander A C, Lotfi T, Alaouie H, Afifi R A
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Tob Control. 2015 Mar;24 Suppl 1(Suppl 1):i13-i21. doi: 10.1136/tobaccocontrol-2014-051906. Epub 2015 Jan 24.
The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review.
The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms.
Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10-29 years.
Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results.
The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels.
The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.
本叙述性综述的目的是强调全球青少年水烟吸食流行率上升的决定因素。健康促进生态模型（EMHP）是本综述的指导框架。
检索了以下电子数据库：Cochrane图书馆、MEDLINE、EMBASE、PsycINFO、科学引文索引和全文版护理学与健康领域数据库（CINAHL Plus）。检索词包括水烟及其多种变体词汇。
纳入1990年至2014年间发表的、英文撰写的、可获取全文且涉及10 - 29岁年龄组的文章。
保留了在EMHP的任何层面分析水烟吸食决定因素的文章，无论其方法学的严谨程度如何：共纳入131篇文章。文章按照一个标准模板进行编码，该模板提取了方法以及结果。
综述发现，用于评估青少年水烟吸食决定因素的方法通常较为传统且缺乏严谨性：四分之三的研究为横断面调查，且大多数纳入的是非代表性样本。在该框架内，综述确定了个人、人际、组织、社区和政策层面的水烟吸食决定因素。
该综述提出了控制青少年水烟吸食的潜在干预措施，重点是创造性地利用社交媒体，以及包含水烟吸食特殊性的烟草控制政策。该综述还进一步表明，需要开展严谨的定性研究，以便更好地将决定因素置于具体情境中，以及开展前瞻性观察性和实验性研究，跟踪并操控这些因素，以评估它们作为干预目标的可行性。
