Al Oweini Dana, Jawad Mohammed, Akl Elie A
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Public Health Policy Evaluation Unit, Imperial College London, London, UK.
Tob Control. 2019 Jul 30. doi: 10.1136/tobaccocontrol-2018-054870.
There is a concern that waterpipe tobacco smoking (WTS) can lead to the later initiation of cigarette smoking, a concept referred to as the 'gateway theory'. The objective of the study was to systematically review the literature for the association of WTS with later initiation of cigarette smoking.
We searched Medline, Embase and ISI Web of Science in April 2018 without using any language or date restrictions. We selected eligible studies, abstracted data and assessed the risk of bias using a duplicate and independent approach. We meta-analysed the ORs across eligible studies using the inverse variance method and the random-effects model. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology.
We included eight papers reporting on six eligible prospective cohort studies with a total of 21 224 participants, belonging to the adolescent and young adult age categories. The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with 'cigarette smoking initiation' (ever cigarette use) was 2.54 (95% CI 1.60 to 4.02) at 6 months to 3 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with 'current cigarette smoking' (past 30-day cigarette use) was 2.04 (95% CI 1.32 to 3.15) at 1-2 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between past 30-day waterpipe user (compared with never waterpipe user) at baseline, with current cigarette smoking (past 30-day cigarette use) 2.46 (95% CI 1.73 to 3.49) at 6 months to 1 year follow-up (high certainty evidence).
Our findings indicate that WTS is associated with more than doubling of the odds of later initiation of cigarette smoking, supporting the gateway theory. Strengthening WTS policies is a priority and further research is needed on the development and evaluation of appropriate clinical and public health interventions.
有人担心水烟吸食会导致日后开始吸食卷烟，这一概念被称为“门户理论”。本研究的目的是系统回顾关于水烟吸食与日后开始吸食卷烟之间关联的文献。
我们于2018年4月检索了Medline、Embase和ISI科学网，未设任何语言或日期限制。我们选择符合条件的研究，提取数据，并采用重复和独立的方法评估偏倚风险。我们使用逆方差法和随机效应模型对符合条件的研究中的比值比进行荟萃分析。我们使用推荐分级评估、制定和评价方法评估证据的确定性。
我们纳入了8篇报告6项符合条件的前瞻性队列研究的论文，共有21224名参与者，年龄在青少年和青年成人范畴。在6个月至3年的随访中（中等确定性证据），基线时曾经吸食水烟者（与从未吸食水烟者相比）与“开始吸食卷烟”（曾经吸食过卷烟）之间关联的合并调整后比值比为2.54（95%置信区间1.60至4.02）。在1至2年的随访中（中等确定性证据），基线时曾经吸食水烟者（与从未吸食水烟者相比）与“当前吸食卷烟”（过去30天吸食过卷烟）之间关联的合并调整后比值比为2.04（95%置信区间1.32至3.15）。在6个月至1年的随访中（高确定性证据），基线时过去30天吸食水烟者（与从未吸食水烟者相比）与当前吸食卷烟（过去30天吸食过卷烟）之间关联的合并调整后比值比为2.46（95%置信区间1.73至3.49）。
我们的研究结果表明，水烟吸食与日后开始吸食卷烟的几率增加一倍以上有关联，支持门户理论。加强水烟吸食相关政策是当务之急，需要进一步研究合适的临床和公共卫生干预措施的制定和评估。
