Our sample had 978 subjects with a mean age of 24.69 ± 7.603 with 25.7% being male. Smoking prevalence in Syrian provinces is in (Figure 1). Their characteristics are demonstrated in Table 1. In our sample, 372 (38%, CI 95%: 35.0%-41.1%) subjects smoked shisha, cigarettes or both, 160 (16.4%. CI 95%: 14.1%, 18.7%) subjects smoked cigarettes, 287 (29.3% CI 95%: 26.5%, 32.3%) subjects smoked shisha, and 76 (7.8% CI 95%: 6.0-9.5) subjects smoked both cigarettes and shisha. Furthermore, 112 cigarette smoking subjects (6.4% of the sample, 70.9% of cigarette smokers) reported daily cigarette smoking without ceasing in the last year, and 115 shisha smoking subjects (11.8% of the sample, 40.4% of shisha smokers) reported daily shisha smoking without ceasing in the last year (Figure 2). Other factors of war and characteristics such as the current medical conditions and taking medications are demonstrated in Table 2. Our sample included 619 university students with mean age of 21.44 ± 1.811 and 140 (22.6%) being male. Prevalence of cigarette and shisha smoking in age groups according to gender are demonstrated in figure 3.
Among university students, 217 (35.1%, CI 95%: 31.3%-38.8%) subjects smoked shisha, cigarettes or both, 83 (13.4%, CI 95%: 11.1%, 16.0%) subjects smoked cigarettes, 182 (29.4% CI 95%: 26.0%, 33.1) subjects smoked shisha, and 48 (7.8%, CI 95%: 5.7%, 9.9%) smoked both shisha and cigarettes. Furthermore, 57 cigarette smoking subjects (9.2% of the sample, 68.7% of cigarette smokers) among university students reported daily cigarette smoking without ceasing in the last year, and 72 shisha smoking subject (11.6% of the sample, 39.8% of shisha smokers) reported daily shisha smoking without ceasing in the last year. In the sample overall, 10% (CI 95%: 7.8%-12.4%) of the females smoked cigarettes and 27.6% (CI 95%: 24.5%-30.9%) of them smoked shisha. While 7.9% (CI 95%: 5.6%-10.6%) of university students females smoked cigarettes, 28% (CI 95%: 23.8%-32.1%) of them smoked shisha. Furthermore, overall 34.7% (CI 95%: 28.3%-41.0%) of males smoked cigarettes and 34.3% (CI 95%: 29.1%-40.2%) of them smoked shisha. However, in university students 32.1% (CI 95%: 25.0%-40.7%) of males smoked cigarettes and 34.3% (CI 95%: 26.4%-42.1%) of them smoked shisha. Only 21 responders aged under 16 or 17 years, one (4.8%) of them smoked cigarettes, and four (19%) of them smoked shisha. Smoking patterns and characteristics of the subjects of our sample are demonstrated in Table 3. Education fields affected smoking patterns (P<0.001); subjects in non-medical education fields smoked cigarettes (P<0.001) or shisha (P<0.001) more than subjects in medical education fields. However, studying social studies was associated with smoking cigarettes P=0.004 and shisha P=0.004 more than studying other fields.
Male gender was associated more frequently with smoking cigarettes P<0.001 (OR, 4.762; 95% CI 3.333-6.757), smoking shisha P=0.047 (OR, 1.364; 95% CI 1.003-1.855), and both together P<0.0001 (OR, 3.236; 95% CI 2.012-5.208). Male gender was also more correlated with daily cigarette smoking rather than intermittent smoking P<0.001 (OR, 2.899; 95% CI 1.865-4.505). Male gender was also positively correlated with more years of smoking P<0.001, number of packs per day P=0.009 and frequency of shisha per week P=0.004 but not the duration of shisha session P>0.05. Females were found to be more social smokers than males P<0.001. Although cigarette smoking was found more frequently in older subjects (older than 30 years age groups) P=0.008, shisha smoking was found more frequently in younger subjects (younger than 30 years age groups) P=0.023. However, no significant difference was found in smoking shisha and cigarettes together between age groups. Furthermore, years of age were positively correlated with being a cigarette smoker P=0.001, but not with shisha smoking and smoking both together P>0.05. Comparing the age group of (18-24) years with other age groups, we found a significant difference in cigarette smoking P>0.001 (OR, 1.804; 95% CI 1.271-2.562) as cigarette smoking is more frequent in other age groups. Such is the case for smoking overall of cigarettes and/or shisha P=0.005 (OR, 1.486; 95% CI 1.125-1.962), but interestingly not with shisha smoking. Having a job was associated more frequently with smoking cigarettes P<0.0001 (OR, 2.286; 95% CI 1.621-3.225), shisha P=0.008 (OR, 1.463; 95% CI 1.102-1.942), and smoking them both P<0.0001 (OR, 2.634; 95% CI 1.636-4.238). Furthermore, type of job affected smoking patterns; being a labourer (OR, 5.758; 95% CI 2.597-12.765), working as a clerk or in a restaurant (OR, 5.080; 95% CI 2.336-11.049), or a technician (OR, 2.617; 95% CI 1.596-4.292) were more frequently associated with smoking cigarettes P=0.001. Working as a clerk or in a restaurant (OR, 2.950; 95% CI 1.394-6.242), or a technician (OR, 1.986; 95% CI 1.296-3.042) were more frequently associated shisha smoking P=0.004. This was also for with smoking both shisha and cigarettes P<0.001 or any form of smoking P<0.001 (Figure 4). Losing someone in the war was associated with smoking cigarettes P=0.002, and smoking in general P<0.001; this loss included close family members, distant family members or friends. However, this association was not found with shisha smoking or smoking both shisha and cigarettes together P>0.05. Having distress from war noises was correlated with cigarette smoking P=0.014 (OR, 1.538; 95% CI 1.089-2.174) and smoking both cigarettes and shisha P=0.037 (OR, 1.642; 95% CI 1.027-2.632), but not with smoking shisha (P>0.05). Changing place of living due to war was not associated with smoking cigarettes, shisha, or both (P>0.05). However, number of times of changing place of living due to war was associated with smoking P=0.032, the higher the number of changing place of living due to war, the more frequently positive smoking cigarettes became, but this was not found with shisha smoking or cigarette and shisha smoking together (P>0.05). Shisha was also correlated with losing someone from the war P=0.05. More shisha smoking was found in high educational level subjects P=0.042 which was also found with shisha and cigarette smoking P=0.002. No statistically significant difference was found when comparing smoking cigarettes, shisha or both with marital status, SES, and having medical conditions (P>0.05). Comparisons of smoking cigarettes and shisha with other variables are demonstrated in Table 4. We did not find a correlation with marital status or SES in regards to consistency of smoking, number of cigarette packs, frequency of shisha every week, duration of shisha session, and preferred time for shisha P>0.05.
When using one-way ANOVA test, years of smoking, the number of cigarette packs, frequency of shisha per week, and duration of shisha per session were not associated with SES levels P>0.05. However, a lower SES was found in older ages above 30 years P=0.0002. We also found that more years of smoking was associated with type of work P=0.010 (Figure 4), but not with other variables of cigarettes, or shisha P>0.05. When using Pearson correlation, significant positive correlations were found between years of smoking and the number of packs per day r=0.195, frequency of shisha per week r=0.309 and duration of shisha per session r=0.172. Furthermore, a positive correlation was found between the frequency of hookah per week and the duration of hookah per session r=0.182. No correlations were found between age and the number of packs per day, frequency of shisha per week, and duration of hookah per session. For the number of packs there was no correlation with any hookah related variable P>0.05 (Table 4). Changing living place due to war was associated with number of packet per day P=0.017, and losing someone due to war was positively associated with losing someone due to war P=0.022