Abstract
BackgroundDuring 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.Methods1891 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.Results50.9% 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.ConclusionA 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.
Highlights
During the last two decades, waterpipe tobacco smoking (WTS), known as hookah, witnessed a global increase in use, especially among youth
Strengths and limitations The current study provided invaluable information on the higher prevalence of WTS compared to cigarette smoking, marking WTS as a potential public health concern among university students in the occupied Palestinian territory (oPt)
WTS seems to be a context, gender and region-specific phenomenon and it differs from the individualistic nature of cigarette smoking
Summary
During the last two decades, waterpipe tobacco smoking (WTS), known as hookah, witnessed a global increase in use, especially among 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. Data from the Global Youth Tobacco Survey among adolescents (13–15 years old) reported that the highest past 30-days prevalence of WTS was in Lebanon (36.9%), followed by the West Bank in the occupied Palestinian territory (oPt) (32.7%) and Latvia (22.7%) [13]. The National Youth Tobacco Survey among U.S students (11– 18 years old) reported an increase in the prevalence of WTS from 4.1% to 9.4% over the period 2011–2014 [14]. Current WTS prevalence among university students reached 23.5% (vs. 10.9% for cigarette smoking) in Syria (2006–07), 29.5% (vs. 26.3% for cigarette smoking) in Lebanon (2009–10) and 30.0% (vs. 29.0% for cigarette smoking) in Jordan (2010) [15,16,17,18,19]
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