Abstract
Background
There has been a global upsurge of waterpipe (WP) smoking over the past several years. This can be attributed at least partly to various factors like lack of knowledge regarding its health effects, social acceptability, and intensive preventive programs focusing selectively on cigarettes smoking.
Purpose
This study aimed to determine the prevalence and psychosocial determinants of WP smoking among secondary school adolescents in Al Hassa, Saudi Arabia, and also to assess their attitudes toward WPs smoking and knowledge regarding the related health effects.
Methods
Cross-sectional study included 1,652 students of both genders selected by multistage proportionate sampling method. Data collection was carried out using a self-administered anonymous Arabic version of the Global Youth Tobacco Survey, modified with items dedicated to WP smoking. Items to assess participants' knowledge about the health-related hazards and attitude towards WP were added. Patient Health Questionnaire was used to screen for the presence of anxiety and depressive disorders.
Results
Of the included adolescents, 358 (21.7%) were current smokers; cigarettes (46.1%), both cigarettes and WP (16.5%), and only WP (37.4%). Current WP users accounted for 193; 96.4% were males and 62.7% were ≥18 years of age. Outing, boredom, meeting friends, and family gatherings were the most frequently stated motives. WP users demonstrated a higher incidence of depressive and generalized anxiety disorders. Common assumptions regarding WP smoking included: WP smoking is less harmful than cigarettes and with no addictive property as stated by 47.8% and 65.9% of adolescents, respectively, harmful substances are purified through water filtration as believed by 59.2%, and it is more socially acceptable than cigarettes as agreed by 54.1%. Hierarchical regression analysis showed that male gender and increasing age of adolescents, WP smoking among close family and friends, and socializing motives were significant predictors for the current WP smoking state.
Conclusion
Social acceptability, poor knowledge of WP health-related hazards, and socio-demographics are favoring the current increasing trend of WP use among adolescents in Al Hassa, Saudi Arabia.
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References
Peto R, Lopez AD. In: Koop CE, Pearson CE, MR (eds) Critical issues in global health; 2001. Jossey-Bass, San Francisco, CA.
WHO. World No-Tobacco Day. Director-General of the World Health Organization for World No-Tobacco Day, 1999, (http://www.forcesnl.org/WHO/ADVISORY98.PDF, last accessed 1 February 2010).
Jha P, Chaloupka FJ (eds) Tobacco Control in Developing Countries. Oxford United Press for the World Bank and WHO, 2000, Oxford.
Ward KD, Hammal F, VanderWeg MW, et al. Are waterpipe users interested in quitting? Nicotine Tob Res. 2005;7(1):149–56.
Wolfram RM, Chehne F, Oguogho A, et al. Narghile (waterpipe) smoking influences platelet function and (iso-)eicosanoids. Life Sci. 2003;74:47–53.
Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics. 2005;116(1):e113–9.
Maziak W, Fouad FM, Asfar T, et al. Prevalence and characteristics of narghile smoking among university students in Syria. Int J Tuberc Lung Dis. 2004;8:882–9.
Kandela P. Nargile smoking keeps Arabs in Wonderland. Lancet. 2000;30(356(9236)):1175.
Maziak W, Rastam S, Eissenberg T, et al. Gender and smoking status based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria. Prev Med. 2004;38:479–84.
Tamim H, Terro A, Kassem H, et al. Tobacco use by university students, Lebanon, 2001. Addiction. 2003;98:933–9.
Memon A, Moody PM, Sugathan TN, et al. Epidemiology of smoking among Kuwaiti adults: prevalence, characteristics and attitudes. Bull WHO. 2000;78:1306–15.
Ward KD, Eissenberg T, Gray JN, et al. Characteristics of U.S. waterpipe users: a preliminary report. Nicotine Tob Res. 2007;9(12):1339–46.
Khoja TA, Farid SM. Saudi Arabia Family Health Survey 1996: Principal report. Riyadh: Ministry of Health; 2000.
Saeed AA, al-Johali EA, al-Shahry AH. Smoking habits of students in secondary health institutes in Riyadh City, Saudi Arabia. J R Soc Heal. 1993;113(3):132–5.
Al-Damegh SA, Saleh MA, Al-Alfi MA, et al. Cigarette smoking behavior among male secondary school students in the Central region of Saudi Arabia. Saudi Med J. 2004;25(2):215–9.
GYTS: Core Questionnaire. Centers for Disease Control and Prevention [website] (http://www.cdc.gov/tobacco/global/GYTS/questionnaire.htm, accessed 15 June 2009).
Jawaid A, Zafar AM, Rehman TU, et al. Knowledge, attitudes and practices of university students regard waterpipe smoking in Pakistan. Int J Tuverc Lung Dis. 2008;12(9):1077–84.
Anjam Q, Ahmed F, Ashfaq T. Knowledge, attitude and perception of waterpipe smoking (Shisha) among adolescents aged 14–19 years. J Pakistan Med Asso. 2008;58:312–7.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;10(282(18)):1737–8.
Becker S, Al Zaid K, Al Faris E. Screening for somatization and depression in Saudi Arabia: a validation study of the PHQ in primary care. Int J Psychiatry Med. 2002;32:271–83.
Diez-Quevedo C, Rangil T, Sanchez-Planell L, et al. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med. 2001;63(4):679–86.
Henkel V, Mergl R, Kohnen R, et al. Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups. Gen Hosp Psychiatry. 2004;26(3):190–8.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Kessler RC, Berglund P, Borges G, et al. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;25(293(20)):2487–95.
Jarallah JS, Bamgboye EA, Al-ansary LA, et al. Predictors of smoking among male junior secondary school students in Riyadh, Saudi Arabia. Tob Control. 1996;5:26–9.
DeCoster J. Applied linear regression notes set 1. 2006; http://www.stathelp.com/notes.htm.
Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–2.
Abou-Zeid AH, Hifnawy TM, Abdel Fattah M. Health habits and behavior of adolescent schoolchildren, Taif, Saudi Arabia. Eastern Mediter Health J. 2009;15(6):1525–34.
Moh'd Al-Mulla A, Abdou Helmy S, Al-Lawati J, et al. Prevalence of tobacco use among students aged 13–15 years in Health Ministers' Council/Gulf Cooperation Council Member States, 2001–2004. J Sch Health. 2008;78(6):337–43.
Al-Turki YA. Smoking habits among medical students in Central Saudi Arabia. Saudi Med J. 2006;27(5):700–3.
Al-Turki YA, Al-Rowais NA. Prevalence of smoking among female medical students in the College of Medicine, Riyadh, Saudi Arabia. Saudi Med J. 2008;29(2):311–2.
Jackson D, Aveyard P. Waterpipe smoking in students: prevalence, risk factors, symptoms of addiction, and smoke intake. Evidence from one British university. BMC Public Health. 2008;8:174.
Kandela P. Signs of trouble for hubble bubble. Lancet. 1997;349:9063–6.
Radwan GN, Mohamed MK, El-Setouhy M, et al. Review on water pipe smoking. J Egypt Soc Parasitol. 2003;33(3 Suppl):1051–71.
Primack BA, Switzer GE, Dalton MA. Improving measurement of normative beliefs involving smoking among adolescents. Arch Pediatr Adolesc Med. 2007;161(5):434–9.
Mohammed HR, Newman IM, Tayeh R. Sheesha smoking among a sample of future teachers in Kuwait. Kuwait Med J. 2006;38(2):107–13.
Bilir N, Dogan BG, Yildis AN. [Smoking behaviour. Publication No. 7.] Ankara, Hacettepe Public Health Foundation, 1997 [in Turkish].
Rend DJ, McNeill, Glynn TJ. Reducing the prevalence of smoking in youth in Western countries: an international overview. Tob Control. 1995;4:266–77.
Abolfotouh MA, Abdel Aziz M, Badawi IA, et al. Smoking intervention program for male secondary-school students in Saudi Arabia. East Mediterr Health J. 1997;3:90–100.
WHO: World Health Organization. Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. Geneva, Switzerland 2005.
Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control. 1994;3:242–7.
Al-Faris EA, Al-Rajhi MM, Al-Nour MA. Smoking among females attending a health centre in Riyadh, Saudi Arabia. Ann Saudi Med. 1994;15:525–8.
Merdad LA, Al-Zahrani MS, Farsi JM. Smoking habits among Saudi female university students: prevalence, influencing factors and risk awareness. Ann Saudi Med. 2007;27(5):366–9.
Krosnick SA, Judd CM. Transitions in social influence at adolescence: who induces cigarette smoking? Dev Psychol. 1982;18:359–68.
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Amin, T.T., Amr, M.A.M., Zaza, B.O. et al. Predictors of Waterpipe Smoking Among Secondary School Adolescents in Al Hassa, Saudi Arabia. Int.J. Behav. Med. 19, 324–335 (2012). https://doi.org/10.1007/s12529-011-9169-2
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DOI: https://doi.org/10.1007/s12529-011-9169-2