Waterpipe (WP) tobacco smoking increases the risk of smoking-related health problems. In this study, we sought to identify the unobserved class memberships of WP-associated initial nicotine dependence (ND) symptoms and assess the predictors of each latent class. This cross-sectional study was conducted among a convenience sample of 900 current (past 30-day) WP smokers who were recruited from 94 WP-serving venues surrounding Tehran and Ardebil metropolitans in Iran. All participants completed a self-administrated questionnaire. We performed latent class analysis using PROC LCA in SAS to identify class memberships of initial ND symptoms using 10-item Hooked on Nicotine Checklist. Five latent classes were identified as non-dependent (25.4 %), low dependent (7.1 %), low-moderate dependent (19.6 %), moderate dependent (15.6 %), and high dependent (32.2 %). Using flavored WP tobacco significantly increased the odds of belonging to low-moderate dependent class [adjusted OR (aOR) = 1.89; 95 % confidence interval (CI): 1.07–3.34] compared to non-dependent class. Also, having academic education decreased the odds of belonging to low-moderate dependent (aOR = 0.43; 95 %CI: 0.26–0.67) and moderate dependent (aOR = 0.39; 95 %CI: 0.23–0.67) class in comparison to non-dependent class. Also, WP smoking initiation at an older age was associated with belonging to high dependent (OR = 2.05; 95 %CI: 1.39–3.03) class compared to non-dependent. This study revealed that nearly half of WP smokers fell under moderate and high-dependent classes. Our findings showed that some items of HONC had more role in the clustering of participants based on ND symptoms. The WP-specific cessation programs and targeted clinical trials should consider the diversity of ND levels among smokers to achieve successful quit rates among these smokers. Additionally, limiting flavors would be a strong strategy to limit the rate of ND, especially among young people who are eager to smoke flavored WP tobacco.

水烟 (WP) 吸烟会增加与吸烟相关的健康问题的风险。在这项研究中，我们试图确定 WP 相关的初始尼古丁依赖 (ND) 症状的未观察到的类别成员资格，并评估每个潜在类别的预测因子。这项横断面研究是在 900 名当前（过去 30 天）WP 吸烟者的便利样本中进行的，他们是从伊朗德黑兰和 Ardebil 大都市周围的 94 个 WP 服务场所招募的。所有参与者都完成了一份自我管理的问卷。我们使用 SAS 中的 PROC LCA 进行潜在类别分析，以使用 10 项 Hooked on Nicotine Checklist 来识别初始 ND 症状的类别成员资格。五个潜在类别被确定为非依赖 (25.4%)、低依赖 (7.1%)、中低依赖 (19.6%)、中度依赖 (15.6%) 和高度依赖 (32. 2%）。使用调味的 WP 烟草显着增加了属于中低依赖类别的几率 [调整后的 OR (aOR) = 1.89；95 % 置信区间 (CI)：1.07–3.34] 与非依赖类相比。此外，与非学历教育相比，接受学术教育降低了属于低中度依赖（aOR = 0.43；95 %CI：0.26–0.67）和中度依赖（aOR = 0.39；95 %CI：0.23–0.67）类别的几率。依赖类。此外，与非依赖性相比，年龄较大的 WP 吸烟与属于高度依赖性（OR = 2.05；95 %CI：1.39-3.03）类别相关。这项研究表明，近一半的 WP 吸烟者属于中度和高度依赖类别。我们的研究结果表明，HONC 的某些项目在基于 ND 症状的参与者聚类中具有更大的作用。特定于 WP 的戒烟计划和有针对性的临床试验应考虑吸烟者中 ND 水平的多样性，以实现这些吸烟者的成功戒烟率。此外，限制口味将是限制 ND 发病率的强有力策略，尤其是在渴望吸食调味 WP 烟草的年轻人中。