Direct and Indirect Estimation of the Prevalence of Waterpipe and Cigarette Smoking Among Adults in Arak: An Approach Based on Network Scale-up Method

Indirect methods for estimating hidden populations are essential. The present study aimed to assess the prevalence of cigarette and waterpipe consumption in the Arak metropolis, Iran, directly and indirectly through network scale-up.

This cross-sectional study was conducted on 1,604 participants. Daily and weekly cigarette and waterpipe consumption data were collected to measure the prevalence directly. The indirect network scale-up method was used to estimate the size of cigarette and hookah smokers. A confidence interval of 95% was considered.

About 49.9% of the participants were men. The average age of men was 39.8 and women 38.7 years. In the direct method, the prevalence of smoking at least one cigarette per day during the last year in women and men was 1.8% (1.0-3.0) and 38.3% (34.9-41.9), respectively. The prevalence of using waterpipe at least once a day during the last year was as much as 0.9% (0.03-1.8) and 4.1% (2.8-5.7) for women and men. In the indirect method of network scale-up during the last year, the prevalence of continuous smoking was 4.8% (4.3-5.0) in women and 19.7% (19.6-19.9) in men. The prevalence of waterpipe in women was calculated at 7.8% (7.8-8.0) and 9.8% (9.7-9.9) in men.

Based on the results, the prevalence of waterpipe and cigarette smoking was high in the Arak, especially among young people. It is suggested to the health system policymakers to pay attention to measures related to reducing the prevalence of these two risk factors, especially among young people, in their health plans.