Skip to main content
Top
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study

Authors: Marina Tucktuck, Rula Ghandour, Niveen M. E. Abu-Rmeileh

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

During the last two decades, waterpipe tobacco smoking (WTS), also known as hookah, witnessed a global increase in use, especially among youth. Little information is known about the burden of WTS among Palestinian youth. A cross-sectional study was conducted to estimate the prevalence of WTS and cigarette smoking and explore the associated factors among a sample of Palestinian university students.

Methods

1891 students, from five Palestinian universities in the West Bank and Gaza Strip, completed a self-administered, web-based survey in 2014–2015. The questionnaire, which was based on the Global Adults Tobacco Survey (GATS), had questions on WTS and cigarette smoking patterns and socio-demographic and university-related characteristics. Binary logistic regression analyses were computed to investigate associated factors with WTS and cigarette smoking.

Results

50.9% of the sample was women. The mean age was 20.1 ± 2.0. Overall, 30.0% of participants were current tobacco smokers and 33.4% reported ever smoking tobacco through a waterpipe. The prevalence of current WTS (24.4%) surpassed the prevalence of current cigarette smoking (18.0%), with a significantly higher prevalence among men compared to women. The gender gap for WTS (36.4% vs. 12.9%) was smaller than that for cigarette smoking (32.8% vs. 3.6%). Binary logistic regression models for the total sample (men and women) revealed that men were more likely to be current waterpipe and cigarette tobacco smokers compared to women (AOR = 4.20, 95% CI = 3.22–5.48, and AOR = 10.91, 95% CI = 7.25–16.42, respectively). Geographic area of residence, faculty of study and self-reported academic achievement were also associated with the likelihood of being current waterpipe and cigarette tobacco smokers.

Conclusion

A high prevalence of WTS was reported among our study sample, and it surpassed the prevalence of cigarette smoking. Interventions to curb the practice of tobacco smoking among Palestinian youth should be tailored differently to WTS and cigarette smoking, be gender-sensitive and specific and target the regional variation in the smoking behavior.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008. Geneva: The MPOWER package; 2008. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008. Geneva: The MPOWER package; 2008.
2.
go back to reference World Health Organization, WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva; 2011. World Health Organization, WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva; 2011.
3.
go back to reference World Health Organization, Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva; 2013. World Health Organization, Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva; 2013.
4.
go back to reference World Health Organization, WHO global report on trends in prevalence of tobacco smoking 2015. 2015. World Health Organization, WHO global report on trends in prevalence of tobacco smoking 2015. 2015.
5.
go back to reference WHO Study Group on Tobacco Product Regulation (TobReg), Waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators - 2nd ed. World Health Organization; 2015. WHO Study Group on Tobacco Product Regulation (TobReg), Waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators - 2nd ed. World Health Organization; 2015.
6.
go back to reference El-Zaatari, ZM, Chami HA, Zaatari GS, Health effects associated with waterpipe smoking. Tob Control. 2015;24:i31-i43. El-Zaatari, ZM, Chami HA, Zaatari GS, Health effects associated with waterpipe smoking. Tob Control. 2015;24:i31-i43.
8.
go back to reference Maziak W, et al. The global epidemiology of waterpipe smoking. Tob Control. 2015;24:i3-i12. Maziak W, et al. The global epidemiology of waterpipe smoking. Tob Control. 2015;24:i3-i12.
9.
go back to reference Jawad M, et al. To what extent should waterpipe tobacco smoking become a public health priority? Addiction. 2013;108(11):1873–84.CrossRefPubMed Jawad M, et al. To what extent should waterpipe tobacco smoking become a public health priority? Addiction. 2013;108(11):1873–84.CrossRefPubMed
10.
go back to reference Anjum Q, Ahmed F, Ashfaq T. Knowledge, attitude and perception of water pipe smoking (shisha) among adolescents aged 14-19 years. J Pak Med Assoc. 2008;58(6):312.PubMed Anjum Q, Ahmed F, Ashfaq T. Knowledge, attitude and perception of water pipe smoking (shisha) among adolescents aged 14-19 years. J Pak Med Assoc. 2008;58(6):312.PubMed
11.
go back to reference Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics. 2005;116(1):e113–9.CrossRefPubMed Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics. 2005;116(1):e113–9.CrossRefPubMed
12.
go back to reference Kheirallah KA, et al. Waterpipe tobacco smoking among Arab youth; a cross-country study. Ethnicity & disease. 2016;26(1):107.CrossRef Kheirallah KA, et al. Waterpipe tobacco smoking among Arab youth; a cross-country study. Ethnicity & disease. 2016;26(1):107.CrossRef
13.
go back to reference Jawad M, Lee JT, Millett C. Waterpipe tobacco smoking prevalence and correlates in 25 Eastern Mediterranean and Eastern European countries: cross-sectional analysis of the Global Youth Tobacco Survey. Nicotine & Tobacco Research [Abstract], 2015: p. ntv101. Jawad M, Lee JT, Millett C. Waterpipe tobacco smoking prevalence and correlates in 25 Eastern Mediterranean and Eastern European countries: cross-sectional analysis of the Global Youth Tobacco Survey. Nicotine & Tobacco Research [Abstract], 2015: p. ntv101.
14.
go back to reference Arrazola RA, et al. Tobacco use among middle and high school students-United States, 2011-2014. MMWR. Morbidity and mortality weekly report. 2015;64(14):381–5.PubMed Arrazola RA, et al. Tobacco use among middle and high school students-United States, 2011-2014. MMWR. Morbidity and mortality weekly report. 2015;64(14):381–5.PubMed
15.
go back to reference Jawad M, et al. Waterpipe tobacco use in the United Kingdom: a cross-sectional study among university students and stop smoking practitioners. PLoS One. 2016;11(1):e0146799.CrossRefPubMedPubMedCentral Jawad M, et al. Waterpipe tobacco use in the United Kingdom: a cross-sectional study among university students and stop smoking practitioners. PLoS One. 2016;11(1):e0146799.CrossRefPubMedPubMedCentral
16.
17.
go back to reference Almerie MQ, et al. Cigarettes & waterpipe smoking among medical students in Syria: a cross-sectional study. Int J Tuberc Lung Dis. 2008;12(9):1085.PubMedPubMedCentral Almerie MQ, et al. Cigarettes & waterpipe smoking among medical students in Syria: a cross-sectional study. Int J Tuberc Lung Dis. 2008;12(9):1085.PubMedPubMedCentral
18.
go back to reference Jradi H, et al. Cigarette and waterpipe smoking associated knowledge and behaviour among medical students in Lebanon. East Mediterr Health J. 2013;19(10):861.PubMed Jradi H, et al. Cigarette and waterpipe smoking associated knowledge and behaviour among medical students in Lebanon. East Mediterr Health J. 2013;19(10):861.PubMed
20.
go back to reference Palestinian Ministry of Health, Annual Health Report - 2014. 2014. Palestinian Ministry of Health, Annual Health Report - 2014. 2014.
21.
go back to reference Palestinian Central Bureau of Statistics and Palestinian Ministry of Health, The Palestinian Central Bureau of Statistics (PCBS) and the Ministry of Health (MoH) are issuing a Press Release on the occasion of International Day of Giving up Smoking (Word No Tobacco Day) on 31/5/2012. 2012. Palestinian Central Bureau of Statistics and Palestinian Ministry of Health, The Palestinian Central Bureau of Statistics (PCBS) and the Ministry of Health (MoH) are issuing a Press Release on the occasion of International Day of Giving up Smoking (Word No Tobacco Day) on 31/5/2012. 2012.
22.
go back to reference Palestinian Central Bureau of Statistics, Final Report of the Palestinian Family Survey 2010 2013: Ramallah – State of Palestine. Palestinian Central Bureau of Statistics, Final Report of the Palestinian Family Survey 2010 2013: Ramallah – State of Palestine.
23.
go back to reference Palestinian Central Bureau of Statistics, Youth Survey 2015 - Main Findings. 2016: Ramallah - Palestine. Palestinian Central Bureau of Statistics, Youth Survey 2015 - Main Findings. 2016: Ramallah - Palestine.
24.
go back to reference Ministry of Education and Higher Education, Higher Education Statistical Yearbook - 2014-2015. 2015: Ramallah - Palestine. Ministry of Education and Higher Education, Higher Education Statistical Yearbook - 2014-2015. 2015: Ramallah - Palestine.
25.
go back to reference Global Adult Tobacco Survey Collaborative Group. Tobacco questions for surveys: a subset of key questions from the Global Adult Tobacco Survey (GATS). Atlanta: Centers for disease control and prevention; 2011. Global Adult Tobacco Survey Collaborative Group. Tobacco questions for surveys: a subset of key questions from the Global Adult Tobacco Survey (GATS). Atlanta: Centers for disease control and prevention; 2011.
27.
go back to reference Mandil A, et al. Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005. East Mediterr Health J. 2007;13(6):1449–58.PubMed Mandil A, et al. Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005. East Mediterr Health J. 2007;13(6):1449–58.PubMed
28.
go back to reference Al Mohamed H, Amin T. Pattern and prevalence of smoking among students at King Faisal University, Al Hassa, Saudi Arabia. East Mediterr Health J. 2010;16(1):56–64. Al Mohamed H, Amin T. Pattern and prevalence of smoking among students at King Faisal University, Al Hassa, Saudi Arabia. East Mediterr Health J. 2010;16(1):56–64.
29.
go back to reference Daniels KE, Roman NV. A descriptive study of the perceptions and behaviors of waterpipe use by university students in the Western Cape, South Africa. Tob Induc Dis. 2013;11(1):4.CrossRefPubMedPubMedCentral Daniels KE, Roman NV. A descriptive study of the perceptions and behaviors of waterpipe use by university students in the Western Cape, South Africa. Tob Induc Dis. 2013;11(1):4.CrossRefPubMedPubMedCentral
30.
go back to reference Labib N, et al. Comparison of cigarette and water pipe smoking among female university students in Egypt. Nicotine Tob Res. 2007;9(5):591–6.CrossRefPubMed Labib N, et al. Comparison of cigarette and water pipe smoking among female university students in Egypt. Nicotine Tob Res. 2007;9(5):591–6.CrossRefPubMed
31.
go back to reference Abughosh S, et al. Ethnicity and waterpipe smoking among US students. Int J Tuberc Lung Dis. 2012;16(11):1551–7.CrossRefPubMed Abughosh S, et al. Ethnicity and waterpipe smoking among US students. Int J Tuberc Lung Dis. 2012;16(11):1551–7.CrossRefPubMed
32.
go back to reference Jawad M, et al. Waterpipe smoking: prevalence and attitudes among medical students in London [short communication]. Int J Tuberc Lung Dis. 2013;17(1):137–40.CrossRefPubMed Jawad M, et al. Waterpipe smoking: prevalence and attitudes among medical students in London [short communication]. Int J Tuberc Lung Dis. 2013;17(1):137–40.CrossRefPubMed
33.
go back to reference Akl E, et al. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control. 2015;24:i13-i21. Akl E, et al. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control. 2015;24:i13-i21.
34.
go back to reference Jawad M, et al. Waterpipe tobacco smoking legislation and policy enactment: a global analysis. Tob Control. 2015;24:i60-i65. Jawad M, et al. Waterpipe tobacco smoking legislation and policy enactment: a global analysis. Tob Control. 2015;24:i60-i65.
35.
go back to reference Obeidat SR, et al. Prevalence, social acceptance, and awareness of waterpipe smoking among dental university students: a cross sectional survey conducted in Jordan. BMC Res Notes. 2014;7(1):832.CrossRefPubMedPubMedCentral Obeidat SR, et al. Prevalence, social acceptance, and awareness of waterpipe smoking among dental university students: a cross sectional survey conducted in Jordan. BMC Res Notes. 2014;7(1):832.CrossRefPubMedPubMedCentral
36.
go back to reference Afifi R, et al. Social norms and attitudes linked to waterpipe use in the eastern Mediterranean region. Soc Sci Med. 2013;98:125–34.CrossRefPubMed Afifi R, et al. Social norms and attitudes linked to waterpipe use in the eastern Mediterranean region. Soc Sci Med. 2013;98:125–34.CrossRefPubMed
37.
go back to reference Nakkash RT, Khalil J, Afifi RA. The rise in narghile (shisha, hookah) waterpipe tobacco smoking: a qualitative study of perceptions of smokers and non smokers. BMC Public Health. 2011;11(1):315.CrossRefPubMedPubMedCentral Nakkash RT, Khalil J, Afifi RA. The rise in narghile (shisha, hookah) waterpipe tobacco smoking: a qualitative study of perceptions of smokers and non smokers. BMC Public Health. 2011;11(1):315.CrossRefPubMedPubMedCentral
38.
go back to reference Salameh P, et al. Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMC Open. 2014;4(2):e004378.CrossRef Salameh P, et al. Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMC Open. 2014;4(2):e004378.CrossRef
39.
go back to reference Grekin ER, Ayna D. Waterpipe smoking among college students in the United States: a review of the literature. J Am Coll Heal. 2012;60(3):244–9.CrossRef Grekin ER, Ayna D. Waterpipe smoking among college students in the United States: a review of the literature. J Am Coll Heal. 2012;60(3):244–9.CrossRef
40.
41.
42.
go back to reference Akl EA, et al. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduct J. 2013;10(1):1.CrossRef Akl EA, et al. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduct J. 2013;10(1):1.CrossRef
43.
go back to reference Musmar S. Smoking habits and attitudes among university students in Palestine: a cross-sectional study. East Mediterr Health J. 2012;18(5):454.PubMed Musmar S. Smoking habits and attitudes among university students in Palestine: a cross-sectional study. East Mediterr Health J. 2012;18(5):454.PubMed
44.
go back to reference Wetter DW, et al. Prevalence and predictors of transitions in smoking behavior among college students. Health Psychol. 2004;23(2):168.CrossRefPubMed Wetter DW, et al. Prevalence and predictors of transitions in smoking behavior among college students. Health Psychol. 2004;23(2):168.CrossRefPubMed
45.
go back to reference Roohafza H, et al. Smoking motivators are different among cigarette and waterpipe smokers: the results of ITUPP. J Epidemiol Glob Health. 2015;5(3):249–58.CrossRefPubMed Roohafza H, et al. Smoking motivators are different among cigarette and waterpipe smokers: the results of ITUPP. J Epidemiol Glob Health. 2015;5(3):249–58.CrossRefPubMed
46.
go back to reference Shomar RTA, et al. Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine. Cent Eur J Public Health. 2014;22(2):80.CrossRefPubMed Shomar RTA, et al. Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine. Cent Eur J Public Health. 2014;22(2):80.CrossRefPubMed
47.
go back to reference Khalil J, et al. Women and waterpipe tobacco smoking in the eastern Mediterranean region: allure or offensiveness. Women Health. 2013;53(1):100–16.CrossRefPubMed Khalil J, et al. Women and waterpipe tobacco smoking in the eastern Mediterranean region: allure or offensiveness. Women Health. 2013;53(1):100–16.CrossRefPubMed
48.
go back to reference Hammal F, et al. A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control. 2008;17(2):p. e3-e3. Hammal F, et al. A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control. 2008;17(2):p. e3-e3.
50.
go back to reference Eissenberg T, et al. Waterpipe tobacco smoking on a US College campus: prevalence and correlates. J Adolescent Health. 2008;42(5):526–9.CrossRef Eissenberg T, et al. Waterpipe tobacco smoking on a US College campus: prevalence and correlates. J Adolescent Health. 2008;42(5):526–9.CrossRef
52.
go back to reference Wechsler H, et al. Increased levels of cigarette use among college students: a cause for national concern. JAMA. 1998;280(19):1673–8.CrossRefPubMed Wechsler H, et al. Increased levels of cigarette use among college students: a cause for national concern. JAMA. 1998;280(19):1673–8.CrossRefPubMed
53.
go back to reference Primack BA, et al. Waterpipe smoking among US university students. Nicotine Tob Res. 2013;15(1):29–35.CrossRefPubMed Primack BA, et al. Waterpipe smoking among US university students. Nicotine Tob Res. 2013;15(1):29–35.CrossRefPubMed
54.
go back to reference Husseini, A. Smoking and associated factors in the occupied Palestinian territory. Palestine: Institute of Community and Public Health, Birzeit University; 2010. Husseini, A. Smoking and associated factors in the occupied Palestinian territory. Palestine: Institute of Community and Public Health, Birzeit University; 2010.
55.
go back to reference Roberts B, et al. Tobacco use and nicotine dependence among conflict-affected men in the republic of Georgia. Int J Environ Res Public Health. 2013;10(6):2185–97.CrossRefPubMedPubMedCentral Roberts B, et al. Tobacco use and nicotine dependence among conflict-affected men in the republic of Georgia. Int J Environ Res Public Health. 2013;10(6):2185–97.CrossRefPubMedPubMedCentral
56.
go back to reference Abu-Rmeileh NM, et al. Smoking among adolescents and teenagers living under conflict: cross-sectional surveys in three settings. The Lancet [Abstract], 2011. Abu-Rmeileh NM, et al. Smoking among adolescents and teenagers living under conflict: cross-sectional surveys in three settings. The Lancet [Abstract], 2011.
57.
go back to reference Roberts ME, et al. Association between trauma exposure and smoking in a population-based sample of young adults. J Adolesc Health. 2008;42(3):266–74.CrossRefPubMedPubMedCentral Roberts ME, et al. Association between trauma exposure and smoking in a population-based sample of young adults. J Adolesc Health. 2008;42(3):266–74.CrossRefPubMedPubMedCentral
58.
go back to reference Bailey S, Murray D. The status of youth in Palestine. 2009. Sharek Youth Forum. Bailey S, Murray D. The status of youth in Palestine. 2009. Sharek Youth Forum.
59.
go back to reference Alzyoud S, et al. Waterpipe smoking among middle and high school Jordanian students: patterns and predictors. Int J Environ Res Public Health. 2013;10(12):7068–82.CrossRefPubMedPubMedCentral Alzyoud S, et al. Waterpipe smoking among middle and high school Jordanian students: patterns and predictors. Int J Environ Res Public Health. 2013;10(12):7068–82.CrossRefPubMedPubMedCentral
60.
go back to reference Pennanen M, et al. Longitudinal study of relations between school achievement and smoking behavior among secondary school students in Finland: results of the ESFA study. Subst Use Misuse. 2011;46(5):569–79.CrossRefPubMed Pennanen M, et al. Longitudinal study of relations between school achievement and smoking behavior among secondary school students in Finland: results of the ESFA study. Subst Use Misuse. 2011;46(5):569–79.CrossRefPubMed
61.
go back to reference Ministry of Health, Palestinian National Health Strategy 2011–2013: Setting Direction - Getting Results 2010. Ministry of Health, Palestinian National Health Strategy 2011–2013: Setting Direction - Getting Results 2010.
62.
go back to reference Palestinian Legislative Council Palestinian Legislative Council - Public Health Law. 2005. Palestinian Legislative Council Palestinian Legislative Council - Public Health Law. 2005.
Metadata
Title
Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study
Authors
Marina Tucktuck
Rula Ghandour
Niveen M. E. Abu-Rmeileh
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4524-0

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue