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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012–13 Pakistan Demographic and Health Survey

BMC Public Health > Ausgabe 1/2015
Muhammad Tahir Khan, Shahkamal Hashmi, Sidra Zaheer, Syeda Kanwal Aslam, Naveed Ali Khan, Hina Aziz, Nabil Rashid, Kashif Shafique
Wichtige Hinweise
Muhammad Tahir Khan and Shahkamal Hashmi contributed equally to this work.

Competing interests

We declare to have no competing interests.

Authors’ contribution

MTK & SH conceived the idea of the paper and both have contributed equally in this paper. SZ led all analyses; SKA and NAK led the writing of first draft and final manuscript. HA, NR, KS contributed in the final drafting of the paper. KS supervised the study. All authors read and approved the final manuscript.



Despite the general decline in cigarette smoking, use of alternative forms of tobacco has increased particularly in developing countries. Waterpipe (WP) and Chewing Tobacco (CT) are two such alternative forms, finding their way into many populations. However, the burden of these alternative forms of tobacco and their socio demographic determinants are still unclear. We assessed the prevalence of WP and CT use among women of reproductive age group in Pakistan.


Data from the most recent Pakistan Demographic and Health Survey 2012–13 (n = 13,558) was used for this analysis. Information obtained from ever married women, aged between 15 and 49 years were analyzed using two separate data subgroups; exclusive WP smokers (total n = 12,995) and exclusive CT users (total n = 12,771). Univariate and Multivariate logistic regression analyses were conducted and results were reported as crude and adjusted Odds Ratio with 95 % confidence intervals.


Prevalence of WP smoking and CT were 4 % and 2 %, respectively. After multivariate adjustments, ever married women who were: older than 35 years (OR; 4.68 95 % CI, 2.62–8.37), were poorest (OR = 4.03, 95 % CI 2.08–7.81), and had no education (OR = 9.19, 95 % CI 5.10–16.54), were more likely to be WP smokers. Similarly, ever married women who were: older than 35 years (OR = 3.19, 95 % CI 1.69–6.00), had no education (OR = 4.94, 95 % CI 2.62–9.33), were poor (OR = 1.64, 95 % CI 1.07–2.48) and had visited health facility in last 12 months (OR = 1.81, 95 % CI 1.22–2.70) were more likely to be CT users as well.


Older women with lower socio-economic profile were more likely to use WP and CT. Focused policies aiming towards reducing the burden of alternate forms of tobacco use among women is urgently needed to control the tobacco epidemic in the country.
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