Alternatively, it is possible that girls who do not smoke have more nonsmoking friends and experience pressure from peers who do not belong to their social network (Hoffman, Sussman, Unger, & Valente, 2006), and it is possible that experiencing peer pressure from individuals outside of Chilean girls�� Enzastaurin MM social network may reinforce negative views toward cigarettes. Both of these explanations could be true, and further research is needed to test these hypotheses. Peer pressure to smoke did not influence boys�� smoking-related attitudes. It is possible that peer pressure to smoke in Chilean boys leads to smoking not by creating more positive smoking-related attitudes but through another pathway, and more r
Tobacco use continues to be the leading cause of preventable morbidity and mortality worldwide (World Health Organization, 2008).

Due to the adoption of successful policies and interventions, tobacco use has been on the decline over the past 30 years in most developed societies, especially among adults (Centers for Disease Control and Prevention, 2007; van der Wilk and Jansen, 2005). These successes, however, are still limited in many parts of the world, mainly due to lack of adoption, or enforcement, of tobacco control policies (World Health Organization, 2011). The Eastern Mediterranean region (EMR), consisting mainly of Arab countries, is one region that continues to experience an escalating tobacco epidemic. For example, between 1990 and 1997, cigarette consumption increased 24% in the Middle East, while most other regions did not witness such a trend (Shafey, 2007).

The EMR, moreover, is threatened by a reemerging method of tobacco use, namely water-pipe smoking (a.k.a., hookah, shisha, narghile) (Maziak, Ward, Afifi Soweid, & Eissenberg, 2004). A water pipe has a head, a body, a bowl, and a hose with a mouthpiece. The tobacco is filled in a concavity in the head, and a piece of lit charcoal is placed on top of the tobacco. When users inhale through the mouthpiece, air is drawn over the charcoal, becomes heated, and produces smoke as it passes through the tobacco on its way through the water and to the smoker (Shihadeh, 2003). Epidemiological trends in water-pipe smoking are alarming, and what started as a ��social�� phenomenon in the EMR has become a global phenomenon.

Prevalence estimates of water-pipe smoking surpassed those of cigarette smoking among youth in the EMR, and the rest of the world is catching up. According to various estimates, Cilengitide about a quarter of youth in several societies in the EMR are current (past month) water-pipe smokers (Maziak, 2011). These trends are even registering at younger ages, as was demonstrated by the Global Youth Tobacco Survey (GYTS). The GYTS is the most comprehensive global surveillance effort of tobacco use among youth involving more than half a million of 13- to 15-year olds assessed from 209 surveys in 95 countries.