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Introduction Tobacco use in women of reproductive age group (15–9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). Aims and Methods We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. Results The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI −1.6 to −0.1) lower whereas it was 0.33 kg (95% CI −0.9 to 0.3) higher for ST users. Conclusions Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. Implications The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of sheesha smokers among medical students and to examine the factors associated with sheesha smoking. Methodology: A total of 578 medical students from both public & private sector in Rawalpindi were selected by consecutive sampling technique. Preformed & pretested questionnaire was administered to them after assuring of confidentiality & taking their informed verbal consent. Results: Five seventy eight medical students were administered questionnaire, 207 (36%) of them confessed that they smoke sheesha, 82(39.42%) out of them were regular sheesha smokers while 125(60.09%) said they smoke sheesha occasionally. Out of 207sheesha smokers 84(40.5%) started for fun sake, 39(19.5%) out of curiosity, 56 (27%) for style 28 (13.5%) started smoking sheesha because of peer pressure. Of smokers 123(59%) believed that sheesha smoking was less harmful than cigarette. 69 (33%) of sheesha smokers had no plans to quit sheesha smoking. Conclusion: Lack of correct information & mistaken believe that sheesha smoking is less harmful than other methods of tobacco smoking is reason for its high use among youth. Moreover its easy availability at restaurants and cafés has made it a social activity that promises both pleasure & entertainment. [ABSTRACT FROM AUTHOR]