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In young people, water pipe use increases with age but is low in all age groups

[PubMed Abstract] The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff

Key strengths include the exceptionally large sample size, long follow-up, and detailed adjustment for clinical, behavioral, and socioeconomic confounders, allowing robust assessment of interactions between initiation age and smoking intensity

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The study limitations include the inability to capture malformations in pregnancies that do not result in a live birth, and possible misclassification of outcome and of exposure to varenicline or to smoking