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Abstract
BackgroundDeterminants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents.MethodsA total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression.ResultsThirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4–7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2–9.5) and scored high on the depression scales (95 % confidence interval 1.6–6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7–9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1–5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1–31.2).ConclusionThe current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, including peer pressure and exposure to media marketing, as well as mental health among users.
Highlights
Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population
Tobacco free waterpipe products are available in the market, some products contain tobacco even if it is not mentioned on the package [7]
Toxicity analysis comparing tobacco free waterpipe products with tobacco containing waterpipe products show that smoke from both contained substantial quantities of toxicants [8]
Summary
Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. Sixty percent of boys in select regions in Sweden reported to have ever tried waterpipe, compared to 49 % of girls [13] In another national survey from 2012 on tobacco use in school children, 32 % of the boys and 30 % of girls in grade 9 had ever smoked waterpipe [14]. More than one quarter (27 %) of the Swedish population 15 years and above reported having tried water pipe, a considerably higher average than the 12 % reported for Europe in general [14] This is in contrast to the fact that regular smoking of cigarettes among Swedish adolescents are among the lowest in Europe [15]. In times of economic hardship, it is a concern that adolescents consider waterpipe products to be less expensive than cigarettes [16]
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