The important findings in this study were: Smoking is still challenge and promotion is the first trigger factor even though all the awareness campaigns of the harmful effects of smoking, which reflects the role of tobacco companies. This finding accepts with the study performed by Krugman, Dean M., et al [5] and also accepted with Cauchi, Daniel, and Julian Mamo [6] who recommended banning of tobacco sales to adolescents. Study shows war as a trigger factor for smoking between young workers and students in healthy field that supports the study performed by Kakaje, A., et al. in Syria [7] and Haddad, Chadia, et al in Lebanon after civil war, which refers to high prevelance rates of smoking after war according to the WHO records [8]. Family problems were important trigger factor for beginning of smoking or severe the case of smoker in 24% of cases in the study, and that is closed to results of Banzer, Raphaela, et al. [9].
Studying failure was the less important factor between the factors we study, and that looks to be closed to Azevedo, Renata Cruz Soares de study that suggests the higher education as a risk factor correlated with failure to quit smoking among smokers [10]. Men smokes more than women, and there is a high significance for gender in the study (P=0.009). Living with smoker is a risk factor to be an active smoker, and passive smokers on risk of heart disease by inspiriting other’s smoke, even they didn’t smoke. A Chinese study suggests living with smoker as an important factor against smoking cessation [11], which supports our study result that find an important statically significance (p<0.001) between the 2 groups of study (smokers, non-smokers).
The healthy awareness about risks of smoking in general, and the risk between shisha and tuberculosis [12], was important factor in our study and has a significance (p=0.041) which is so closed to the study [13]
This study suggests weight as a risk factor for smoking. More weight, more smoke. There’s many studies suggests smoking as a reason of overweight in younger ages, which is so close to many studies [14, 15, 16], even though, from the opposite side, there are many studies suggests weight gain after smoking cessation [17, 18]
Risk estimate for the 2 subgroups of smokers were summarize in table4.
One of the important outcomes of this study, smoking shisha has a high prevalence between younger smokers, and that is a risk factor, closing to the result of Nelson, R. [19]. Another study was performed in KSA [20] showed a high prevalence of shisha smoking between male students of medical colleges, which is accepted with our result. Hookah or shisha is another face of cigarettes, and tobacco companies try to produce it as an alternative of cigarettes. Many participants when you ask them, do you smoke, they answer no but when you ask about shisha, then yes! By comparing this result with study performed in USA [21] that clears most of shisha smokers think that isn’t harmful to their health, and that is also bright the result of the role of awareness of shisha harmful effects on health in general, and pulmonary diseases in specialty.
The most important limitations of this study are the ability to define the real dose of tobacco between people who smokes shisha, the time of smoking was closed to suspect in our study.
Other limitation was in responding; most of women weren’t responding well, so they were excluded, smoking in some regions is sensitive subject to girls, so we need more information regarding this point.