General Characteristics of the Sample
Total 812 responses to the online questionnaire were received. Four-hundred and sixty-eight (57.6%) responses were originally from Palestine, one-hundred and sixty-eight (20.7%) responses were from Turkey, one-hundred and twenty (14.8%) responses were from Jordan and the remain responses were from other countries like Syria, Iraq and Egypt. The highest number of responses was received from An-Najah National University 258 student (35.1%) followed by Zaytoonah University of Jordan 172 students (21.2%) 147 students (18.1%) from other Palestinian universities, 115 students (14.2%) from different Turkish universities, while 66 students (8.1%) were from Girne American University in North Cyprus, and the remains student’s responses come from other Jordanian Universities. Participants represented many disciplines, categorized to four main category of faculties; the majority of students were from Faculty of Medical Sciences (n = 465), Faculty of Engineering (n = 71), Faculty of Educational Social Sciences (n = 50), Faculty of Sciences (n = 22) and from other faculties (n = 204) (Table. 1).
Table 1 Demographic Data of The Participating Students
|
|
F
|
%
|
Age
|
17-19
|
88
|
10.8
|
|
19- 21
|
321
|
39.5
|
|
21-23
|
259
|
31.9
|
|
23-25
|
69
|
8.5
|
|
More than 25
|
75
|
9.2
|
|
Total
|
812
|
100
|
Monthly income
|
200-500
|
149
|
18.3
|
|
500-1000
|
260
|
32
|
|
1000-2000
|
243
|
29.9
|
|
More than 25
|
160
|
19.7
|
|
Total
|
812
|
100
|
Country
|
Palestine
|
468
|
57.6
|
|
Jordan
|
120
|
14.8
|
|
Turkey
|
168
|
20.7
|
|
Other
|
56
|
6.9
|
|
Total
|
812
|
100
|
University
|
An-Najah National
|
285
|
35.1
|
|
Alzaytoona
|
172
|
21.2
|
|
Girne American
|
66
|
8.1
|
|
Other Turkish
|
115
|
14.2
|
|
Other Jordanian
|
27
|
3.3
|
|
Other Palestinian
|
147
|
18.1
|
|
Total
|
812
|
100.0
|
Faculty
|
Medical Sciences
|
465
|
57.3
|
|
Sciences
|
22
|
2.7
|
|
Engineering
|
71
|
8.7
|
|
Educational & social sciences
|
50
|
6.2
|
|
Other
|
204
|
25.1
|
|
Total
|
812
|
100.0
|
Level of study
|
First year – third year
|
411
|
50.6
|
|
Fourth year- sixth year
|
349
|
43.0
|
|
Master degree
|
45
|
5.5
|
|
PhD degree
|
7
|
.9
|
|
Total
|
812
|
100
|
Current Residency
|
With the family
|
534
|
65.8
|
|
Private students' dormitory
|
194
|
23.9
|
|
Government students' dormitory
|
17
|
2.1
|
|
Other
|
67
|
8.3
|
|
Total
|
812
|
100
|
Prevalence and patterns of Shisha smoking
Overall, 31.77% (n = 258) of the study sample were current Shisha smokers, 21.67% (n = 176) reported ever smoking Shisha and 46.55% (n =378) never smoked Shisha (Figure1). The Palestinian students were the most current smokers of Shisha among the other nationalities and their prevalence of smoking Shisha was (n = 169, 169/468 = 36.11%) followed by Jordanian students with mean prevalence 34.17% over the total prevalence of overall students, the prevalence of shisha smokers in the Turkish students (20.23%) was the lowest between the other nationalities. While, half of Turkish students had been smoked Shisha (n =84, 50.0%). Figure.1 shows that the Palestinian and Jordanian students has almost very close percentage of current, ever or never smoking shisha, and this might be because of very close culture, but the percentages among the Turkish students was totally different.
Fig. 1 the total prevalence of shisha smokers, and the prevalence of current, ever, never smokers according to nationalities.
Approximately half of Shisha smokers answered that they are daily smoking Shisha Table 2. Two-thirds of current Shisha smoker Jordanian students were smoking Shisha at least once daily, and less than half of current Shisha Palestinian smokers were smoking Shisha daily, while 44% of Turkish current Shisha smokers were smoking Shisha around once monthly. Eighty five percentage of current Shisha student’s smokers were smoking Shisha during the meeting with their friends Table.2. However, approximately 42% of current Shisha smokers believe that they will be addicted to shisha smoking, 58.5 % and 44.2% of Jordanian and Palestinian respectively answered “yes” they will be addicted to Shisha smoking, while 58% of Turkish students answered “no” for the same question (Table 2).
The bivariate analysis showed that the country to which student belongs to was significantly associated with shisha smoking frequency (P = 0.000), the time of smoking Shisha, and attitude concerning addiction to Shisha smoking (P = 0.006).
Table 2 Percentage for the frequency & the event, of Shisha smoking and students opinion of Shisha addiction among different countries.
|
Country
|
|
|
Palestine
|
Jordan
|
Turkey
|
Other country
|
Total
|
How often do you smoke Shisha?
|
Minimum once a day
|
47.3%
|
65.9%
|
14.7%
|
92.9%
|
48.4%
|
Minimum once a week
|
34.1%
|
4.9%
|
14.7%
|
7.1%
|
25.4%
|
Minimum once a month
|
17.4%
|
26.8%
|
44.1%
|
|
21.5%
|
Not a sure
|
1.2%
|
2.4%
|
26.5%
|
|
4.7%
|
Total
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
When you always smoking shisha?
|
During Study
|
7.9%
|
12.2%
|
5.9%
|
21.4%
|
9.1%
|
During a meeting with friends
|
64.6%
|
46.3%
|
50.0%
|
35.7%
|
58.1%
|
During social meetings
|
15.9%
|
36.6%
|
23.5%
|
28.6%
|
20.9%
|
Other
|
11.6%
|
4.9%
|
20.6%
|
14.3%
|
11.9%
|
Total
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
Did you believe that you could become addicted to Shisha smoking?
|
Yes
|
44.2%
|
58.5%
|
17.6%
|
42.9%
|
42.9%
|
No
|
40.0%
|
34.1%
|
58.8%
|
50.0%
|
42.1%
|
Maybe
|
15.8%
|
7.3%
|
23.5%
|
7.1%
|
15.0%
|
Total
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
100.0%
|
|
|
|
|
|
|
|
|
|
P Value for the questions were 0.000, 0.033 & 0.006, respectively
The differences among the prevalence of Shisha smoker’s students of different universities can be observed in Figure. 2. The highest percentage was among the other Palestinian universities (40.8%) and lowest percentage was in Girne American university (16.7%). However, the highest percentage of daily smoker Shisha between the students who are current smokers was in Al Zaytoona University (75.5%), and approximately 64% of current smokers in this university believe that they will be addicted to smoking Shisha (Figure.2).
Fig. 2 the percentage differences of shisha smoker’s prevalence, daily smokers, and students answered “yes”.
Table 3 shows that the monthly income was considered as one of the main factors that may affect the prevalence of smoking Shisha, 260, 243, 160, and 149 of students have family monthly income between 500-1000$, 1000-2000$, more than 2000$ and 200-500$, respectively. The highest prevalence of Shisha smoking was for the students with lowest monthly income with percentage 40.93% of them were current smokers (Table.3) The prevalence of Shisha smokers according to the age differences and different country, and the total results showed that the highest percentage for the current Shisha smokers' students was an age more than 25 years old category (i.e. total 75 students 32 of them were smokers approximately 43%) (Figure 3).
Table 3. Family monthly income versus prevalence of current, ever and never shisha smokers.
Monthly Income
|
Are you smoking or smoked shisha?
|
Total
|
% of current smokers
|
Yes, I smoke shisha
|
Yes, I had smoke shisha
|
No, I never smoke shisha
|
200-500 $
500-1000 $
1000-2000 $
more than 2000$
Total
|
61
|
30
|
58
|
149
|
40.93%
|
64
|
61
|
135
|
260
|
24.61%
|
91
|
44
|
108
|
243
|
37.44%
|
42
|
41
|
77
|
160
|
26.25%
|
258
|
176
|
378
|
812
|
|
* % of current smokers was calculated for each category individually (example 61/149 X 100% = 40.93%), P Value was 0.083
Fig. 3 the prevalence of smoking shisha in different countries (Palestine, Jordan, Turkey and other country) according to different age category (17-19, 19-21 years old etc.).
Table 4 shows that more than half of students (n = 465, 57.26%) were from the Medical science collages, and we can observe that their prevalence of smoking Shisha (29.67%) was lower than the mean average, while the students from the engineering collage (n =71, 8.74%) have the highest prevalence of smoking Shisha (39.34%) which over the mean average, and the prevalence of smoking Shisha for the students from Faculty of Educational Social Sciences 30%, Faculty of Sciences 31.81% and from another Faculties was 34.31% (Table 4). According to the results of the bivariate analysis, the faculty to which the student affiliates was significantly associated with Shisha smoking (P = 0.000).
Table 4 Different Faculty versus prevalence of current, ever and never shisha smokers.
Faculty
|
Are you smoking or smoked shisha?
|
Total
|
% of current smokers
|
Yes, i smoke shisha
|
Yes, i had smoke shisha
|
No, i never smoke shisha
|
|
Faculty of Medical Sciences
|
138
|
72
|
255
|
465
|
29.67%
|
Faculty of Sciences
|
7
|
0
|
15
|
22
|
31.81%
|
Faculty of Engineering
|
28
|
23
|
20
|
71
|
39.43%
|
Faculty of Educational Social Sciences
|
15
|
11
|
24
|
50
|
30.00%
|
Another of Faculty
|
70
|
70
|
64
|
204
|
34.31%
|
Total
|
258
|
176
|
378
|
812
|
|
* Percentage of current smokers was calculated for each category individually (example 138/465 X 100% = 29.67%), P Value was 0.000
Table 5 shows that almost half of the sample (n = 411students) was from the students within first-third year level of study, 42.98% of students were within fourth-sixth years level of study, 5.54% were master degree students and less than 1% of students were PhD degree students (n =7 students). We found that the majority of students were within bachelor degree, and their prevalence of smoking Shisha was very close to the mean average, while 52 students were graduated students ,master and PhD degree, and their prevalence of smoking Shisha (44.23%) was over the mean average and 23 of them were current Shisha smokers (Table.5). Approximately two-thirds of students were living with their families (n = 534) and their prevalence of smoking Shisha was very close to the mean average while the prevalence of smoking Shisha of students who leaves in Private Students' dormitory or apartments was higher than the mean average (n = 194, 35.05%). Table 5 shows that there were no significant associated between Shisha smoking and both study level (P = 0.502) and current residency (P = 0.183).
Table 5 Level of study and current residency versus prevalence of current, ever and never shisha smokers.
|
Are you smoking or smoked shisha?
|
Total
|
% of current
smokers
|
Yes, i smoke shisha
|
Yes, i had smoke shisha
|
No, i never smoke shisha
|
Level
of Study
|
First Year- Third Year
|
126
|
91
|
194
|
411
|
30.65%
|
Fourth Year- Sixth Year
|
109
|
78
|
162
|
349
|
31.23%
|
Master Degree
|
21
|
5
|
19
|
45
|
46.66%
|
PhD Degree
|
2
|
2
|
3
|
7
|
28.57%
|
Current
Residency
|
With my family
|
165
|
101
|
268
|
534
|
30.89%
|
Private Students' Dormitory
|
68
|
41
|
85
|
194
|
35.05%
|
Government Students' Dormitory
|
5
|
6
|
6
|
17
|
29.41%
|
|
Other
|
20
|
28
|
19
|
67
|
29.85%
|
Total
|
258
|
176
|
378
|
812
|
|
|
|
|
|
|
|
|
|
* % of current smokers was calculated for each category individually (example 68/194 X 100% = 35.05%), P Values were for study level (P = 0.502) and current residency (P = 0.183).