Tobacco use is one of the leading causes of death globally. The estimated number of people who used tobacco in 2015 was 1.1 billion.(1) According to the WHO, over 6 million deaths across the world in 2017 were a result of exposure to tobacco, either because of direct use or second-hand exposure.(2) The rate of tobacco use showed an increase in the Eastern Mediterranean Region.(1) In Saudi Arabia, 17.1% of both sexes and 3.0% of females aged 15 or older currently smoke.(3) One popular method of tobacco use in Arab culture that has recently become more popular across the world is shisha, or as they called it in other places, "argila.(4) The estimated number of people who smoke shisha worldwide is 100 million.(5) Shisha can be defined as flavoured tobacco whose smoke is more aromatic compared to other tobacco products’.(6,4) Shisha consists of four parts: head, body, water bowl and hose. After a coal on the shisha's head heats up the tobacco, the smoker inhales the smoke from the head after it passes through the water bowl into the smoker's lungs.(7)
Many studies have shown that shisha has the same negative health effects of cigarette smoking. Furthermore, one hour of shisha smoking has a similar effect as smoking 100 cigarettes.(8) In addition, various studies have shown that shisha use is one of the most important risk factors associated with ailments such as respiratory diseases, oral cancer, lung cancer, stomach cancer, heart diseases, reduced lung function and decreased fertility.(9)
The factors that can be associated with shisha smoking include age, sex and income. One factor that may explain the popularity of shisha smoking could be people’s tendency to socialize through a shared activity or interest.(10)
Shisha smoking has become more popular among college students in many countries. In 2012 in the USA 11.5% of the student's population in Florida were shisha smokers, while in Pakistan (2008), 22% of female college students were smokers.(11,8) Moreover, some studies have shown that in Arab countries there is a high prevalence of shisha smoking among college students. At the national level of Saudi Arabia in Dammam ‘on the Arabian Gulf is the capital city of Saudi Arabia‘s eastern province, a study conducted showed that 3.7% of the female students were shisha smokers.(12) 2% of female students were shisha smokers in a study carried out at King Saud University in Riyadh.(13)
The Ministry of Health in Saudi Arabia predicts an increase of shisha smoking among females in the future, which would be a serious issue because tobacco use is associated with many diseases.(9,14) Measuring the knowledge and attitude towards shisha smoking will help to find out what insufficient information students have and what their attitudes are towards shisha smoking. Determining the number of shisha smokers and analysing the factors behind smoking will help to explain why the students are shisha smokers, That will help to build a stronger strategy to avoid the increase of shisha smoking by establishing public health campaigns.
This study aims to measure the knowledge of and attitude towards shisha use among health college students at Princess Nourah University in Riyadh, Saudi Arabia.