Harm Perception, Attitudes and Predictors of Waterpipe(Shisha) Smoking among Secondary School Adolescents in Al-Hassa, Saudi Arabia

Objectives: This study aimed to determine the prevalence and social determinants of waterpipe (WP)smoking among secondary school students in Al-Hassa, Saudi Arabia and to assess their health related knowledgeand attitudes toward WP. Subjects and
Methods: A cross-sectional study was conducted with 1,652 Saudisecondary school students of both genders aged between 15-19 years selected by multistage sampling method.A self-administered anonymous Arabic version of Global Youth Tobacco Survey modified with items dedicatedto WP smoking and to assess perception of health related hazards and attitudes towards WP was employed fordata collection.
Results: Prevalence of current smokers ‘all forms’ was 30.3% among males (C.I= 27.5- 33.2%)and 8.5% in females (C.I= 6.6-10.9%). WP was used by 53.9% of the current tobacco users, significantly higheramong older age students. Of the regular WP smokers, 20.7% smoked WP on daily basis, 23.8% weekly, 64.2%stated using flavored “Muassel” tobacco. Primary motives for WP smoking were outings with friends, company,boredom and wasting time. Of the total, 49.7% of students stated that WP smoking is less harmful than cigarettes,60.5% believed that harmful substances were purified through water filtration, with non-addictive propertiesin 67.8%. Knowledge about health hazards of WP smoking was low, irrespective of student’s smoking status.WP smoking is more socially acceptable than cigarettes (52.1%), represents a good opportunity for gathering offriends and family (33.8%), and smoking of WP can relieve stress and tensions (37.8%). Hierarchical regressionanalysis showed that socializing motives, cigarette smoking, smoking among close family and friends, male genderand increasing age were positive predictors for WP smoking.
Conclusion: Social acceptability, poor knowledgeof WP health related hazards and certain socio demographics are favoring the increasing current trend of WPuse among adolescents in Al Hassa, Saudi Arabia.