Beyond cigarettes: waterpipe tobacco use as a key driver of paediatric asthma in Jordan.

Background: Asthma is a prevalent chronic disease among children worldwide. Exposure to parental environmental tobacco smoke is a known risk factor for paediatric asthma, but the specific impact of different tobacco products, such as waterpipe, is not well established. In Jordan, where waterpipe smoking is culturally accepted and widespread, understanding its association with childhood asthma is critical. This study aimed to assess the association between parental tobacco use-particularly waterpipe smoking-and the presence of physician-diagnosed paediatric asthma in Jordan.

Methods: A hospital-based case-control study was conducted at Princess Rahma Pediatric Hospital in Irbid, Jordan, from March to May 2023. A total of 360 children participated, including 180 cases with physician-diagnosed asthma and 180 controls without asthma. Data were collected through structured interviews with parents, gathering information on sociodemographic factors, parental tobacco use (cigarettes, waterpipe, e-cigarettes), maternal tobacco exposure during pregnancy, and growth parameters. Logistic regression analyses were performed to identify associations between parental tobacco use and paediatric asthma, adjusting for potential confounders.

Results: Boys were significantly more likely to have asthma than girls (adjusted OR (AOR) = 2.13; 95% CI: 1.34 to 3.40). Parental waterpipe smoking was significantly associated with increased odds of paediatric asthma (AOR = 2.55; 95% CI: 1.40 to 4.65). Maternal tobacco exposure during pregnancy nearly tripled the risk of asthma in children (AOR = 2.83; 95% CI: 1.58 to 5.09). Parental cigarette smoking and e-cigarette use were not significantly associated with asthma in children.

Conclusions: Parental waterpipe smoking is a significant risk factor for physician-diagnosed paediatric asthma in Jordan. These findings underscore the urgent need for public health interventions targeting waterpipe smoking among parents, especially pregnant women, to reduce the risk of asthma in children.