Comment on “Waterpipe Smoking among Herat University Students: Prevalence, Attitudes, and Associated Factors”

Editor in Chief

I read with great interest the article entitled: “Waterpipe Smoking among Herat University Students: Prevalence, Attitudes, and Associated Factors” by Niazi et al.1 They reported that 54.1% of men and 81.7% of women had used waterpipe for at least once, but, at the time of the study, 27.0% of men and 7.6% of women were considered as waterpipe users. Therefore, the prevalence of the current waterpipe users compared to usual waterpipe users in women shows a significant decrement compared to men. The authors failed to discuss this important decrement for female waterpipe users. Although they attributed this decrement to gather a smaller number of female university students compared to the male counterparts, this could not be the case; because the prevalence of usual use of waterpipe in females was higher before coming to Herat university. Its mean that females begin use of waterpipe during childhood or lower age, but they are not addicted as much as males. It has been suggested that 67% of children who begin smoking in the sixth grade become regular smokers in adulthood.2 Hence, the question is why the rate of addiction shows such a huge reduction in woman waterpipe users? The response to this question can be considered in implementing strategies to reduce the rate of waterpipe smoking.

Niazi et al. reported that for man, the participant’s age, father’s education, friends’ waterpipe use, and family waterpipe use, and for woman, friends’ waterpipe use, family waterpipe use, and economic status were associated with the increased waterpipe use by the participants. Therefore, initial observations suggest that the economic status may have an important effect on the rate of waterpipe use in women compared to men. These data must be interpreted with caution and another possible area of future research would be to investigate why the use of waterpipe has so much reduction in women.