Prevalence and factors associated with waterpipe tobacco smoking in South Africa: a scoping review

Abstract

Waterpipe tobacco smoking (WTS) is a growing public health concern globally, with notable gaps in the literature regarding prevalence and determinants of WTS in South Africa (SA). We searched CINAHL, PsycINFO, PubMed, and Scopus databases for studies published from January 1, 2010, to January 31, 2025, and identified 11 cross-sectional surveys. The review protocol is registered in PROSPERO (CRD420261332363). The Joanna Briggs Institute critical appraisal tool was applied, and outcomes were integrated into a narrative analysis. This scoping review synthesizes evidence on the prevalence and determinants of waterpipe tobacco smoking (WTS) in South Africa, examining: i) prevalence and age of initiation; ii) substances used in and alongside the waterpipe; and iii) associated intrapersonal, interpersonal, and environmental factors. Results showed that ever-WTS prevalence was >40% among university students and >20% among high school students. WTS in the past 30 days was between 6.7% and 54% in universities, between 10.9% and 60% in high school settings, and around 25% in community settings. Waterpipe smokers are more likely to be male and to smoke cigarettes. Adding marijuana to waterpipes was reported in seven studies. Study participants smoked waterpipe out of boredom and to relax and exhibited significantly lower perceptions of the risk of WTS. Prevalence of smoking waterpipe with friends and family indicated important social factors for WTS. Though critical appraisal was low for some studies, there was sufficient evidence to conclude that prevention and cessation interventions should be tailored to address the waterpipe´s social components among young people and high-risk populations.

Publication Title

Pan African Medical Journal

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