Factors associated with Hookah pipe smoking among undergraduate students at the University of the Witwatersrand, Johannesburg

Naidoo, Kuban Dhasaradha
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Introduction Hookah pipe smoking has experienced a prodigious growth in popularity during the past two decades resulting in the adoption of this centuries old practice by scores of new, and often young, smokers. This exposes more young people to the risk of developing tobacco-related diseases. This study aimed to explore hookah pipe smoking in young adults in a South African setting. Methods In this cross sectional study conducted at the University of the Witwatersrand, Johannesburg, 824 undergraduate students were enrolled from randomly selected classes. Students completed a 40 item self-administered questionnaire exploring participants‟ demographics, smoking behaviours, and knowledge, attitudes and practices relating to hookah pipe smoking. Univariate and multivariate analysis of factors associated with hookah pipe smoking behaviour were conducted. Results More than half the students (54.2%) had “ever” smoked a hookah pipe, while 14.7% were “current” (each of the past 3 months) smokers. On multivariate analysis, statistically significant factors associated with increased likelihood of “ever” using a hookah pipe were: being “White” (odds ratio [OR] 3.08, 95% confidence interval [95% CI] 1.83-5.18) or “Indian” (OR 2.00, 95% CI 1.07-3.72), previous cigarette use (OR 9.36, 95% CI 6.05-14.50), having a family member (OR 3.22, 95% CI 1.98-5.26) or friends (OR 7.16, 95% CI 3.96-12.92) who had smoked a hookah pipe and holding the following false beliefs regarding the adverse health effects associated with hookah pipe smoking: hookah pipes are not dangerous (OR 3.60, 95% CI 1.18-10.93), hookah pipes are not addictive (OR 7.39, 95% CI 3.84-14.23) and the second hand smoke produced by hookah pipes is not harmful to other people (OR 2.19, 95% CI 1.02-4.72). “Current” hookah pipe smokers demonstrated poorer knowledge of the adverse health effects of hookah pipe smoking and held more positive attitudes of the practice compared to other students. Usage of hookah pipes tended to be intermittent with only 11.8% of students reporting daily use. The majority of “current” hookah pipe smokers (57.1%) smoked on the university campus. Adding alcohol and/or marijuana to hookah pipes was reported by just over half of the “current” hookah pipe users. Conclusion Hookah pipe smoking was prevalent among undergraduate students at this university. The study identified several factors associated with hookah pipe use, enabling the development of better targeted strategies to arrest this problem.