Nonmedical use of Psychoactive Prescription Drugs among adolescents: What's Waterpipe Smoking Got to do with it?

Waterpipe tobacco smoking (WTS), an unsafe and maybe worse alternative to cigarette smoking, is a growing epidemic worldwide and in the Eastern Mediterranean Region. While previous studies have found a positive association between cigarette smoking and nonmedical use of prescription drugs (NMUPD), the link to WTS is still unknown. To address this gap, this study examined the association between WTS and four different classes of prescription drugs, using data that emanated from a  cross-sectional 2011 survey conducted among students (n=986) attending technical and formal schools (both public and private) in Beirut, Lebanon. Self-reported prevalence of current waterpipe smoking was approximately 25.8%. Lifetime and past-12 months NMUPD prevalence were (simultaneously): sedatives/tranquilizers (5.6%, 3.5%), pain relievers (8.2%, 6.2%), stimulant (3.5%, 2.1%), sleeping (2.3%, 1.0%), and anti-depressants (2.5%, 1.3%). In multivariable analysis, current waterpipe smoking was positively associated with past-12 months NMUPD: sedatives/tranquilizers (OR=3.28, 95%CI: 1.09,9.85), pain reliever medications (OR=4.82, 9%%CI: 2.0003,11.44), and sleeping medications (OR=6.36, 95%CI: 1.68, 24.04), controlling for sex, age, school type, use of other substances (alcohol, cigarettes, and illegal drugs), as well as academic performance, parental disapproval of substance use, and amount of monthly pocket money. In the realm of an increasing concern over the worldwide rising  prevalence of waterpipe smoking as well as prescription drug use, this study sheds light on perhaps an additional deleterious health outcome of WTS- associations that are important to further understand for more effective preventive interventions.