Table 1 shows that a highest percentage of students first heard and knew about hookah from friends (55%) and most of them (86.1%) knew that there is a café shop for hookah smoking near their residence. It was found that the friends who smoke hookah are the highest group among the people who surround the hookah user (65.2%) followed by close relatives (31.6%), brothers/sisters (31.6%) and father/mother (4.5%).
Participant’s opinion about different types of smoking and its effect on health from the worst to the better rate order was hookah, cigarette, e-cigarette and tobacco gum.
The student’s knowledge about Islam’s opinion regarding shisha smoking as mostly being discouraged (47.3%) or forbidden (20.9%).
More than two-thirds (70.6%) of the students think that waterpipe smoking is more acceptable socially than cigarette smoking and only 37.1% of them thought that waterpipe smoking was less harmful and less addictive than cigarette smoking. There was an agreement for the need for regulations to prevent or forbid hookah café places (81.5%).
Table 1: First heard about hookah, Café near a residence, smoke hookah from the surrounding, Opinion of participants regarding the harmfulness of tobacco, Islam’s opinion, social acceptance, hookah harmfulness and addictiveness, and regulations against hookah café.
|
No
|
%
|
First, heard/know about Hookah?
|
|
|
|
Father & Mother
|
|
36
|
4.3
|
Brothers, Sister & Cousin
|
|
143
|
16.9
|
Friends
|
|
466
|
55.0
|
Media and Newspaper
|
|
73
|
8.6
|
Saw a Hookah Café shop
|
|
120
|
14.2
|
Others (internet)
|
|
40
|
4.7
|
The present of Cafe for hookah smoking around students’ residence
|
|
729
|
86.1
|
Who smoke hookah from those surrounding the student
|
|
|
|
Father &Mother
|
|
38
|
4.5
|
Brothers &Sisters
|
|
69
|
8.1
|
Other close relatives
|
|
268
|
31.6
|
Friends
|
|
552
|
65.2
|
None
|
|
76
|
9.0
|
Which is of the following types of smoking are more harmful to health?
|
Tobacco gum
|
50
|
5.9
|
Cigarette
|
293
|
34.6
|
e-cigarette
|
202
|
23.8
|
Hookah
|
302
|
35.7
|
Hookah smoking in Islam.
|
Forbidden
|
177
|
20.9
|
Discouraged
|
401
|
47.3
|
Allowed
|
79
|
9.3
|
Do not know
|
190
|
22.4
|
Is hookah smoking is acceptable socially more than Cigarette smoking?
|
Yes
No
|
598
249
|
70.6
29.4
|
Is hookah smoking is less harmful and less addictive than cigarette smoking?
|
Yes
No
|
314
533
|
37.1
62.9
|
Do agree on regulations to forbid café places
|
Yes
|
690
|
81.5
|
|
No
|
157
|
18.5
|
Regarding the average number of hookah smoked in the last 30 days, table 2 shows that 28.1% tried it once, 16.6% tried it twice, and 11.3% tried it three times. Among hookah smokers, 85.5% smoked it in the last six months. Age at first hookah use was the highest at the age of 16 and 15 (27.4 % and 26.3 % respectively), followed by the age of 14 (15.1%). The average number of hookah smoking sessions among current regular users per day was one in 13.3%, two, three, four, five times and more in 34.3, 31, 20.7 & 0.8% respectively. The prevalence of sharing the mouthpiece with others during hookah smoking was never in 30.7%, sometimes in 34.6%, most of the time in 15.1%, and always in 19.7% of the students.
Table 2: Number of hookahs smoked (last month), hookah smoking in the last 6 months, age first smoked hookah, hookah sessions per day, duration of sessions, mouthpiece sharing, confident to quit hookah smoking.
|
|
No
|
%
|
The average number of hookah smoked in the past 30 days (even one puff).
|
1
|
110
|
28.1
|
2
|
65
|
16.6
|
3
|
44
|
11.3
|
4
|
16
|
4.1
|
5
|
23
|
5.9
|
6
|
6
|
1.5
|
7---13
|
48
|
12.4
|
14---20
|
32
|
8.3
|
21---27
|
3
|
0.9
|
28---49
|
32
|
8.2
|
≥50
|
12
|
3.4
|
Smoking hookah in the last 6 months
|
Yes
|
335
|
85.7
|
No
|
56
|
14.3
|
Age you first smoked hookah
|
<10 years
|
6
|
1.5
|
10
|
14
|
3.6
|
11
|
7
|
1.8
|
12
|
19
|
4.9
|
13
|
30
|
7.7
|
14
|
59
|
15.1
|
15
|
103
|
26.3
|
16
|
107
|
27.4
|
≥17 years
|
46
|
11.8
|
The average number of hookah smoking sessions/day among regular users
|
One
|
52
|
13.3
|
Two
|
134
|
34.3
|
Three
|
121
|
31.0
|
Four
|
81
|
20.7
|
Five & more
|
3
|
0.8
|
Sharing the mouth-piece with others during hookah smoking
|
Never
|
120
|
30.7
|
Sometimes
|
135
|
34.6
|
Most of the times
|
59
|
15.1
|
Always
|
77
|
19.7
|
How confident that you can quit hookah smoking
|
Completely confident
|
239
|
61.2
|
Confident
|
83
|
21.3
|
Some Confident
|
30
|
7.7
|
Not that Confident
|
22
|
5.6
|
Not Confident at all
|
17
|
4.3
|
Duration of hookah smoking at each session (minutes)
|
<15 minutes
|
58
|
15.0
|
15---
|
20
|
5.1
|
30---
|
95
|
24.3
|
45---
|
24
|
6.2
|
60---
|
139
|
35.6
|
≥120 minutes
|
55
|
14.2
|
|
|
|
|
Regarding the place of hookah smoking, high rate of students smoke at Café shop (61.1%) and more than three-quarters of participants in this study get their hookah tobacco from a hookah shop (78%).
Low prevalence rate (only 12.9%) think that Electronic cigarette (e-cigarette) can be a substitute to hookah smoking but high percentage of them (61.3%) do not know if it is less harmful and less addictive than hookah smoking.
Table 3 demonstrates the association between hookah smoking among students and various factors. The association was significant with friends (first heard about hookah), media, café around residence, brother & sister (who smoke around student) and friends, Cigarette more harmful than other types of smoking, Islam discourage smoking, socially acceptable and within regulation to forbid café shop.
Table 3: Bivariate analysis for association of different factors affecting hookah smoking.
|
Hookah smoking among high school students (even one puff)
|
P-value
|
Yes
|
No
|
No
|
%
|
No
|
%
|
From where the student first heard/know about Hookah?
|
|
|
|
|
|
Father &Mother
|
Yes
|
18
|
4.6
|
18
|
3.9
|
0.637
|
No
|
373
|
95.4
|
438
|
96.1
|
|
Brother, Sister & Cousin
|
Yes
|
72
|
18.4
|
71
|
15.6
|
0.271
|
No
|
319
|
81.6
|
385
|
84.4
|
|
Friends
|
Yes
|
233
|
59.6
|
233
|
51.1
|
0.013
|
No
|
158
|
40.4
|
223
|
48.9
|
|
Media and Newspaper
|
Yes
|
23
|
5.9
|
50
|
11.0
|
0.009
|
No
|
368
|
94.1
|
406
|
89.0
|
|
Saw a Hookah Café shop
|
Yes
|
52
|
13.3
|
68
|
14.9
|
0.502
|
No
|
339
|
86.7
|
388
|
85.1
|
|
Others (internet)
|
Yes
|
14
|
3.6
|
26
|
5.7
|
0.147
|
No
|
377
|
96.4
|
430
|
94.3
|
|
There is a Cafe for hookah smoking around students’ residence
|
Yes
|
354
|
90.5
|
375
|
82.2
|
0.0001
|
No
|
25
|
6.4
|
33
|
7.2
|
|
Do not know
|
12
|
3.1
|
48
|
10.5
|
|
Who smoke hookah from those surrounding the student
|
|
|
|
|
|
Father & Mother
|
Yes
|
23
|
5.9
|
15
|
3.3
|
0.069
|
No
|
368
|
94.1
|
441
|
96.7
|
|
Brother & Sister
|
Yes
|
40
|
10.2
|
29
|
6.4
|
0.040
|
No
|
351
|
89.8
|
427
|
93.6
|
|
Other close relatives
|
Yes
|
131
|
33.5
|
137
|
30.0
|
0.280
|
No
|
260
|
66.5
|
319
|
70.0
|
|
Friends
|
Yes
|
282
|
72.1
|
270
|
59.2
|
0.0001
|
No
|
109
|
27.9
|
186
|
40.8
|
|
None
|
Yes
|
13
|
3.3
|
63
|
13.8
|
0.0001
|
No
|
378
|
96.7
|
393
|
86.2
|
|
In student opinion: Which is of the following types of smoking are more harmful to health?
|
Tobacco gum
|
26
|
6.6
|
24
|
5.3
|
0.0001
|
Cigarette
|
170
|
43.5
|
123
|
27.0
|
|
e-cigarette
|
95
|
24.3
|
107
|
23.5
|
|
Hookah
|
100
|
25.6
|
202
|
44.3
|
|
In student opinion: hookah smoking in Islam.
|
Forbidden
|
53
|
13.6
|
124
|
27.2
|
0.0001
|
Discouraged
|
190
|
48.6
|
211
|
46.3
|
|
Allowed
|
54
|
13.8
|
25
|
5.5
|
|
Do not know
|
94
|
24.0
|
96
|
21.1
|
|
Think that hookah smoking is acceptable socially more than Cigarette smoking?
|
Yes
|
316
|
80.8
|
282
|
61.8
|
0.0001
|
No
|
75
|
19.2
|
174
|
38.2
|
|
Think that hookah smoking is less harmful and less addictive than cigarette smoking?
|
Yes
|
215
|
55.0
|
99
|
21.7
|
0.0001
|
No
|
176
|
45.0
|
357
|
78.3
|
|
Agree on regulations to forbid café places
|
Yes
|
283
|
72.4
|
407
|
89.3
|
0.0001
|
No
|
108
|
27.6
|
49
|
10.7
|
|
In Table 4, logistic regression reveals that all sub variables among who smoke from surrounding students, hookah acceptable socially, hookah less harmful than cigarette, Islam forbid smoking, and regulation to forbid café shop are significantly associated with hookah smoking among high school students.
Table 4: multivariate logistic regression of risk factors affecting hookah smoking
|
B
|
df
|
P value
|
Odds Ratio
|
95% C.I. for odds ratio
|
Lower
|
Upper
|
First heard/know about Hookah? (café near residence (Ref)
|
|
|
|
|
|
|
Friends
|
0.051
|
1
|
0.948
|
1.052
|
0.226
|
4.891
|
Father& Mother
|
0.070
|
1
|
0.921
|
1.073
|
0.268
|
4.288
|
Brother, Sister and cousin
|
-0.154
|
1
|
0.822
|
0.857
|
0.225
|
3.273
|
Media & Newspaper
|
0.456
|
1
|
0.537
|
1.578
|
0.371
|
6.709
|
Saw a café shop
|
0.240
|
1
|
0.734
|
1.271
|
0.318
|
5.080
|
Who smoke hookah from those surrounding (None (Ref)
|
|
|
|
|
|
|
Father & Mother
|
-1.863
|
1
|
0.001
|
0.155
|
0.052
|
0.459
|
Brother & Sister
|
-1.997
|
1
|
0.0001
|
0.136
|
0.054
|
0.340
|
Close relatives
|
-1.577
|
1
|
0.0001
|
0.207
|
0.095
|
0.451
|
Friends
|
-1.687
|
1
|
0.0001
|
0.185
|
0.087
|
0.394
|
Which is of the following types of smoking are more harmful to health (e-cigarette (Ref)
|
|
|
|
|
|
|
Cigarette
|
-0.226
|
1
|
0.526
|
0.798
|
0.396
|
1.605
|
Hookah
|
-0.506
|
1
|
0.011
|
0.603
|
0.408
|
0.892
|
Tobacco gum
|
-0.378
|
1
|
0.074
|
0.685
|
0.452
|
1.037
|
Hookah smoking is acceptable socially more than Cigarette smoking? No (Ref)
|
-0.680
|
1
|
0.0001
|
0.507
|
0.355
|
0.724
|
Hookah smoking is less harmful and less addictive than cigarette smoking? (No (Ref)
|
-1.195
|
1
|
0.0001
|
0.303
|
0.215
|
0.426
|
Hookah smoking in Islam. (Do not know (Ref)
|
|
|
|
|
|
|
Forbidden
|
0.600
|
1
|
0.015
|
1.823
|
1.126
|
2.950
|
Discouraged
|
-0.024
|
1
|
0.905
|
0.976
|
0.656
|
1.451
|
Allowed
|
-0.458
|
1
|
0.146
|
0.633
|
0.341
|
1.173
|
Agree on regulations to forbid café places. (No (Ref)
|
0.947
|
1
|
0.0001
|
2.578
|
1.694
|
3.923
|