The major single cause of preventable and premature mortality is considered to be smoking. Smoking is an undeniably behavior established in adolescence. While cigarette smoking among adolescents has been a significant public health problem for years, water pipe smoking is considered to be a new global public health threat.

The objectives of this study are to describe trends of cigarette smoking and the prevalence of water pipe smoking and to study the association between cigarette and water pipe smoking among adolescents in Estonia. This is a school-based survey of a nationally representative sample using standardized methodology. The target groups of the survey were 11-, 13-, and 15-year-old schoolchildren (13826 children), 6656 boys and 7170 girls.

Cigarette and water pipe smoking was determined on a 4-stage scale: every day, at least once a week, less than once a week, and not smoking. In this way researchers wanted to examine gender- and age-specific smoking trends and to study the association between cigarette and water pipe smoking. At the end of the study, researchers found that smoking was higher among boys than girls in all age groups during the whole study period. The smoking rate increased in 1994-2002 and then slightly decreased in both genders. The increase in smoking was larger among girls. Also was found that one fourth of the boys and one sixth of the girls were water pipe smokers.

The results of this study show us once again that anti-tobacco prevention and control programs can decrease smoking among the youth.