Trends and correlates of waterpipe use in the European Union: analysis of selected Eurobarometer surveys (2009-2017).

Introduction: To assess the trends and correlates of waterpipe use between 2009 and 2017 in the 28 European Union (EU) member states.

Methods: We analysed data from wave 72.3 (2009, n=27,788); wave 77.1 (2012, n=26,751); wave 82.4 (2014, n=27,801); and wave 87.1 (2017, n=27,901) of the Eurobarometer survey. Representative samples of EU residents aged ≥15 years were asked to report ever use of waterpipe. Regular waterpipe use, i.e. at least once a month was also assessed in 2017. Associations of ever and current use with sociodemographic factors were assessed with multi-level logistic regression.

Results: The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, but there was wide variation between EU member states, ranging from 2.3% (Croatia, 2009) to 41.7% (Latvia, 2017). Regular waterpipe use was highest in Austria (3.6%), Latvia (2.5%) and Belgium (2.0%) in 2017. Respondents aged 15-24 years were 11.43 times more likely (95% Confidence Interval [CI]: 10.71-12.21) to have ever used waterpipe compared to those 55 years and older. Regular and ever waterpipe use were also more likely among current and former cigarette smokers. Males (adjusted Odds Ratio [aOR]=1.64; 95% CI: 1.58-1.70) and those living in urban areas (aOR=1.36; 95% CI: 1.30-1.42) were more likely to have ever used waterpipe.

Conclusion: A substantial proportion of EU citizens, especially young men, have tried waterpipe. Regular use is relatively limited, but more systematic surveillance is required to monitor trends across the EU.

Implications: Data on waterpipe use in the European Union (EU) are scarce. The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, with wide variation between EU member states. Males, those living in urban areas, younger respondents and current or former cigarette smokers were more likely to be ever or regular users of waterpipe.