ResearchArticle Waterpipe Nicotine Dependence and Depressive Symptoms among Adolescent Waterpipe and Dual Users Ahmad Abbadi , 1 Jawad Alnahar , 2 Sohaib Zoghoul , 3 Abdullah Bsoul , 2 Salameh Alarood, 2 Abdel-Hameed Al-Mistarehi , 4 and Sukaina Alzyoud 1,5 1 World Health Organization, Jordan Country Office, Amman, Jordan 2 Hashemite University, Amman, Jordan 3 Medical Education Department, Hamad Medical Corporation, Doha, Qatar 4 Jordan University of Science and Technology, Irbid, Jordan 5 Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Amman, Jordan Correspondence should be addressed to Ahmad Abbadi; ahmad.o.abbadi93@gmail.com Received 28 January 2020; Revised 13 October 2020; Accepted 23 October 2020; Published 6 November 2020 Academic Editor: Angel Dzhambov Copyright © 2020 Ahmad Abbadi et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Waterpipe nicotine dependence and its association with depressive symptoms and dual usage among adolescents are currently not examined in the literature. Adolescents are a vulnerable population that is susceptible to depression and initiation of tobacco use. We aim, in this novel study, to assess the association between depressive symptoms and waterpipe nicotine de- pendence among adolescents in Jordan, evaluate the association between waterpipe smoking status (waterpipe smoker vs. dual user) and waterpipe nicotine dependence, and assess the internal validity of the Waterpipe Nicotine Dependence Scale (WNDS). Method. A cross-sectional study among adolescents of grade 9 th to 12 th in Jordan was conducted through multistage cluster random sampling. e self-reported Arabic Youth Tobacco Use Composite Measure Questionnaire (YTUCM) was used to collect the surveys that include demographic information, smoking status, and the WNDS to assess waterpipe nicotine dependence and depressive symptoms. Multiple linear regression and the t-test were used to analyze the data. Findings. One thousand three hundred and three surveys were collected, of which 1082 were included in the study (443 males and 639 females). 64.9% of the sample were nontobacco users, while 20.1% were waterpipe- (WTP-) only smokers, 11.4% were dual users, and 3.7% were cigarettes-only users. After adjusting for weights, 66.6% were nonsmokers, 19.2% were WTP-only smokers, 10.2% were dual users, and 3.9% were cigarettes-only smokers. Using multiple linear regression, depressive symptoms were significantly associated with WTP nicotine dependence (β 0.618), upon adjusting for confounders. Furthermore, dual users were associated with higher WTP nicotine dependence (β 12.034) compared to WTP-only smokers after adjusting for confounders. Cronbach’s alpha for the WNDS was 0.955. Conclusions. Our study shows that there is a statistically significant association between depressive symptoms and WTP nicotine dependence and higher dependence among dual users compared to WTP-only smokers. e WNDS can be a useful tool to assess WTP nicotine dependence with high internal consistency. However, a longitudinal study is needed to further understand the association and temporality between the depressive symptoms and WTP nicotine dependence. Additionally, research is needed to shorten the WNDS while maintaining high internal consistency and assess the external validity of the WNDS and the short- and long-term consequences of dual usage. 1. Introduction Unlike other regions of the world, where tobacco con- sumption is decreasing, the East Mediterranean Region (EMR) is increasing in prevalence with projected sustained growth by 2025 [1]. Currently, Jordan has the highest prevalence of male smokers in the region and has the second highest male smokers’ prevalence in the world at 70.2% [2]. In 2020, Guardian has reported on a recent unpublished study by the Jordanian Government in collaboration with Hindawi Journal of Environmental and Public Health Volume 2020, Article ID 2364571, 10 pages https://doi.org/10.1155/2020/2364571