Knowledge, Attitudes, and Practices Towards Water-pipe Smoking among Medical and Non-Medical University Students

Section: Original Articles
Issue
Vol. 12 No. 1 (2024): Volume 12 Issue 1
Published
Jan 12, 2024
Pages
167-178

Abstract

Background: Waterpipe smoking is becoming a more popular method of tobacco consumption and is associated with short- and long-term health effects. WPS is rising worldwide, especially among university students. Thus, this study examined medical and nonmedical university students' waterpipe smoking knowledge, attitudes, and practices.Methods: A cross-sectional study was conducted at the University of Duhok, Duhok city, Kurdistan region, Iraq, from June 4th, 2023, to October 5th, 2023. The study included a sample of 200 medical and non-medical students. The selection of participants was carried out using a convenience sampling technique. A structured and validated self-administered questionnaire was utilized to collect data. The collected data were then analyzed using SPSS version 23, with a significance level set at p-value 0.05.Results: The study revealed that 59% of students aged 2123, with males comprising the majority (71%), Medical students demonstrated more excellent knowledge about the increased risks of cancer (p 0.000), respiratory diseases (p 0.000), cardiovascular hazards (p 0.000), water pipe infection transmission (p 0.003), the effect on spermatozoa characteristics (p 0.000), and parenteral WPS and low birth weight (p 0.008). Despite non-significant differences in WPS attitudes between medical and non-medical ones, 56% of students considered WPS more socially acceptable than cigarettes, with 60% feeling it relaxed and 55.5% helping manage stress. The majority of students practice WPS at cafes or restaurants (41%), with friends (74%), every week (61%), and express an intention to quit (60.5%). Non-medical students exhibit a higher frequency of weekly WPS use and monthly smoking compared to medical students (p 0.009).Conclusions: The results demonstrate WPS practices among both medical and non-medical students. Urgent action is necessary to address this issue through heightened awareness efforts and the implementation of anti-smoking policies.

References

  1. Abu-Rmeileh, N. M. E., Alkhuffash, O., Kheirallah, K., Mostafa, A., Darawad, M., Al-Farsi, Y., Yusufali, A., Thomas, J., Salama, M., Hamadeh, R. R., Nakkash, R., & Salloum, R. G. (2018). Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study. Tobacco induced diseases, 16, 20. https://doi.org/10.18332/tid/89966
  2. Afifi, R. A., Yeretzian, J. S., Rouhana, A., Nehlawi, M. T., & Mack, A. (2010). Neighbourhood influences on narghile smoking among youth in Beirut. European journal of public health, 20(4), 456462. https://doi.org/10.1093/eurpub/ckp173
  3. Akl, E. A., Gunukula, S. K., Aleem, S., Obeid, R., Jaoude, P. A., Honeine, R., & Irani, J. (2011). The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health, 11(1). doi:10.1186/1471-2458-11-244
  4. Akl, E. A., Jawad, M., Lam, W. Y., Co, C. N., Obeid, R., & Irani, J. (2013). Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm reduction journal, 10, 12. https://doi.org/10.1186/1477-7517-10-12
  5. Akl, E. A., Ward, K. D., Bteddini, D., Khaliel, R., Alexander, A. C., Lotfi, T., Afifi, R. A. (2015). The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally.Tobacco Control,24(Suppl 1), i13i21. doi:10.1136/tobaccocontrol-2014-051906
  6. Al-Sawalha, N. A., Almomani, B. A., Al-Shatnawi, S. F., & Almomani, B. N. (2021). Attitudes and Knowledge of the Harmful Effects of Waterpipe Tobacco Smoking among university students: A study from Jordan. Environmental science and pollution research international, 28(32), 4372543731. https://doi.org/10.1007/s11356-021-13888-5
  7. Alhawsawi, E. M. F., Alahmadi, J. R., Alhawsawi, E. M. F., Assaqaf, D. M., Judah, A. H., Alghanemi, A. G., & Alhawsawi, A. M. F. (2019). Knowledge, attitudes and practices regarding waterpipe smoking among health science students at king Abdulaziz university, 2016: A cross-sectional study. Saudi Journal of Internal Medicine, 9(1), 2128. doi:10.32790/sjim.2019.9.1.4
  8. Almogbel, Y. S., Aladhadh, T., Alammar, A., Aloraini, A., Alghofaili, S., Almutairi, A., & AlAmri, A. (2021). Predictors of waterpipe smoking among university students in the Qassim region, Saudi Arabia. Tobacco induced diseases, 19, 67. https://doi.org/10.18332/tid/140092
  9. AlQahtani, J. (2017). Knowledge, attitude and practice of tobacco smoking among health colleges students at Najran University, Saudi Arabia: A cross-sectional descriptive study. Journal of Health Specialties, 5(1), 35. doi:10.4103/2468-6360.198801
  10. Arshad, A., Matharoo, J., Arshad, E., Sadhra, S. S., Norton-Wangford, R., & Jawad, M. (2019). Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review. BMC public health, 19(1), 439. https://doi.org/10.1186/s12889-019-6680-x
  11. Asfar, T., Ward, K. D., Eissenberg, T., & Maziak, W. (2005). Comparison of patterns of use, beliefs, and attitudes related to waterpipe between beginning and established smokers. BMC public health, 5, 19. https://doi.org/10.1186/1471-2458-5-19
  12. Awan, K. H., Alrshedan, A., Al Kahtani, M., & Patil, S. (2016). Waterpipe smoking among health sciences university students: Knowledge, attitude and patterns of use. The Saudi dental journal, 28(4), 189193. https://doi.org/10.1016/j.sdentj.2016.05.001
  13. Awan, K. H., Siddiqi, K., Patil, S., & Hussain, Q. A. (2017). Assessing the effect of waterpipe smoking on cancer outcome - a systematic review of current evidence. Asian Pacific Journal of Cancer Prevention: APJCP, 18(2), 495502. doi:10.22034/APJCP.2017.18.2.495.
  14. Babar BA. (2016).Knowledge, attitude and practice regarding smoking among medical students in Pakistan(Master's thesis, It-Suomen yliopisto). Available from: http://urn.fi/urn:nbn:fi:uef-20161049 .
  15. Bahri, A. A., Gosadi, I. M., Mahfouz, M. S., Albasheer, O. B., Mawkili, Y. H., Mawkili, H. A., Jabbari, O. M. (2018). Waterpipe smoking: prevalence and associated factors among Jazan University students, Kingdom of Saudi Arabia. International Journal of Community Medicine and Public Health, 5(12), 5008. doi:10.18203/2394-6040.ijcmph20184725 .
  16. Bali, E., Chinmaya, B. R., Chand, S., Tandon, S., Prasad, S., Sahu, D., & Handa, S. (2015). An emerging trend: Hookah smoking among youth smokers in Gurgaon, Haryana. Journal of Indian Association of Public Health Dentistry, 13(3), 244. doi:10.4103/2319-5932.165240. http://dx.doi.org/10.4103/2319-5932.165240
  17. Braun, R. E., Glassman, T., Wohlwend, J., Whewell, A., & Reindl, D. M. (2012). Hookah use among college students from a Midwest University. Journal of community health, 37(2), 294298. https://doi.org/10.1007/s10900-011-9444-9
  18. Chaouachi K. (2006). A critique of the WHO TobReg's "Advisory Note" report entitled: "Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators". Journal of negative results in biomedicine, 5, 17. https://doi.org/10.1186/1477-5751-5-17
  19. Dehdari, T., Jafari, A., & Joveyni, H. (2012). Students perspectives in Tehran University of Medical Sciences about factors affecting smoking hookah. Razi Journal of Medical Sciences, 95.
  20. Ghafouri, N., Hirsch, J. D., Heydari, G., Morello, C. M., Kuo, G. M., & Singh, R. F. (2011). Waterpipe smoking among health sciences university students in Iran: perceptions, practices and patterns of use. BMC research notes, 4, 496. https://doi.org/10.1186/1756-0500-4-496
  21. Haddad, L., Kelly, D. L., Weglicki, L. S., Barnett, T. E., Ferrell, A. V., & Ghadban, R. (2016). A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes. Tobacco use insights, 9, 1328. https://doi.org/10.4137/TUI.S39873
  22. Harakeh, Z., & Vollebergh, W. A. (2012). The impact of active and passive peer influence on young adult smoking: an experimental study. Drug and alcohol dependence, 121(3), 220223. https://doi.org/10.1016/j.drugalcdep.2011.08.029
  23. Jaam, M., Al-Marridi, W., Fares, H., Izham, M., Kheir, N., & Awaisu, A. (2016). Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey. Public health action, 6(1), 3843. https://doi.org/10.5588/pha.15.0054
  24. Jawad, M., Abass, J., Hariri, A., Rajasooriar, K. G., Salmasi, H., Millett, C., & Hamilton, F. L. (2013). Waterpipe smoking: prevalence and attitudes among medical students in London [Short communication]. The International Journal of Tuberculosis and Lung Disease: The Official Journal of the International Union against Tuberculosis and Lung Disease, 17(1), 137140.http://dx.doi.org/10.5588/ijtld.12.0175
  25. Jradi, H., Wewers, M. E., Pirie, P. P., Binkley, P. F., & Ferketich, A. K. (2013). Cigarette and waterpipe smoking associated knowledge and behaviour among medical students in Lebanon. La Revue de Sante de La Mediterranee Orientale [Eastern Mediterranean Health Journal], 19(10), 861868. doi:10.26719/2013.19.10.861
  26. Kandela P. (2000). Nargile smoking keeps Arabs in Wonderland. Lancet (London, England), 356(9236), 1175. https://doi.org/10.1016/s0140-6736(05)72871-3
  27. Kargar, S., & Ansari-Moghaddam, A. (2023). Prevalence of cigarette and waterpipe smoking and associated cancer incidence among adults in the Middle East.La Revue de Sante de La Mediterranee Orientale [Eastern Mediterranean Health Journal],29(9), 749756. doi:10.26719/emhj.23.077
  28. Khabour, O. F., Alzoubi, K. H., Eissenberg, T., Mehrotra, P., Azab, M., Carroll, M. V., Afifi, R. A., & Primack, B. A. (2012). Waterpipe tobacco and cigarette smoking among university students in Jordan. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 16(7), 986992. https://doi.org/10.5588/ijtld.11.0764
  29. Khodadost, M., Maajani, K., Abbasi-Ghahramanloo, A., Naserbakht, M., Ghodusi, E., Sarvi, F., Hajebi, A. (2020). Prevalence of hookah smoking among university students in Iran: A meta-analysis of observational studies. Iranian Journal of Public Health.http://dx.doi.org/10.18502/ijph.v49i1.3045
  30. Knishkowy, B., & Amitai, Y. (2005). Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116(1), e113e119. https://doi.org/10.1542/peds.2004-2173
  31. Labib, N., Radwan, G., Mikhail, N., Mohamed, M. K., Setouhy, M. E., Loffredo, C., & Israel, E. (2007). Comparison of cigarette and water pipe smoking among female university students in Egypt. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 9(5), 591596. https://doi.org/10.1080/14622200701239696
  32. Mandil, A., Hussein, A., Omer, H., Turki, G., & Gaber, I. (2007). Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005. La Revue de Sante de La Mediterranee Orientale [Eastern Mediterranean Health Journal], 13(6), 14491458. http://dx.doi.org/10.26719/2007.13.6.1449
  33. Maziak W. (2013). The waterpipe: an emerging global risk for cancer. Cancer epidemiology, 37(1), 14. https://doi.org/10.1016/j.canep.2012.10.013
  34. Maziak, W. (2011). The global epidemic of waterpipe smoking. Addictive Behaviors, 36(12), 15. doi:10.1016/j.addbeh.2010.08.030
  35. Miri-Moghaddam, M., Shahrakipour, M., Nasseri, S., & Miri-Moghaddam, E. (2019). Higher prevalence of water pipe compared to cigarette smoking among medical students in Southeast Iran. Central European journal of public health, 27(3), 188194. https://doi.org/10.21101/cejph.a5615
  36. Mohammed, H. R., Zhang, Y., Newman, I. M., & Shell, D. F. (2010). Waterpipe smoking in Kuwait. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 16(11), 11151120.
  37. Momenabadi, V., Iranpour, A., Khanjani, N., & Mohseni, M. (2015). Effect of educational intervention on water pipe behaviour of students in dormitories of Kerman Medical University: BASNEF Model. Journal of Health Promotion Management, 4(3), 1222. Available from: http://jhpm.ir/article-1-474-en.html
  38. Montazeri, Z., Nyiraneza, C., El-Katerji, H., & Little, J. (2017). Waterpipe smoking and cancer: systematic review and meta-analysis. Tobacco control, 26(1), 9297. https://doi.org/10.1136/tobaccocontrol-2015-052758
  39. Nasser, A. M. A., & Zhang, X. (2019). Knowledge and factors related to smoking among university students at Hodeidah University, Yemen. Tobacco induced diseases, 17, 42. https://doi.org/10.18332/tid/109227
  40. Neergaard, J., Singh, P., Job, J., & Montgomery, S. (2007). Waterpipe smoking and nicotine exposure: A review of the current evidence. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 9(10), 987994. doi:10.1080/14622200701591591
  41. Nuzzo, E., Shensa, A., Kim, K. H., Fine, M. J., Barnett, T. E., Cook, R., & Primack, B. A. (2013). Associations between hookah tobacco smoking knowledge and hookah smoking behavior among US college students. Health education research, 28(1), 92100. https://doi.org/10.1093/her/cys095
  42. Othman, N., Kasem, A. O., & Salih, F. A. (2017). Waterpipe Smoking among University Students in Sulaimaniyah, Iraqi Kurdistan: Prevalence, Attitudes, and Associated Factors. Tanaffos, 16(3), 225232.
  43. Rahim BIH, Ibrahim AM, Kamal NM. (2018). Knowledge, attitudes and practices of waterpipe smokers in Sulaimani city/ Kurdistan region of Iraq. Kurdistan Journal of Applied Research, 7279. http://dx.doi.org/10.24017/science.2018.2.12
  44. Rami, K., Makvana, B., & Thakor, N. (2015). Knowledge, attitude and practices of hookah smoking among medical students in Gujarat, India: a cross sectional study. International Journal of Advances in Medicine, 397400. http://dx.doi.org/10.18203/2349-3933.ijam20151017
  45. Sabahy, A. R., Divsalar, K., Bahreinifar, S., Marzban, M., & Nakhaee, N. (2011). Waterpipe tobacco use among Iranian university students: correlates and perceived reasons for use. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 15(6), 844847. https://doi.org/10.5588/ijtld.10.0744
  46. Salameh, P., Salam, J., Waked, M., Barbour, B., Zeidan, N., & Baldi, I. (2014). Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMJ open, 4(2), e004378. https://doi.org/10.1136/bmjopen-2013-004378
  47. Shalaby, S. F., & Soliman, M. A. (2019). Knowledge, attitude, and practice of medical students regarding smoking and substance abuse, Cairo University, Egypt. The Journal of the Egyptian Public Health Association, 94(1), 11. https://doi.org/10.1186/s42506-019-0011-z
  48. Tofighi Niaki, M., Hasan Sheikhha, M., Ali Khalili, M., Fesahat, F., Nabi, A., Izadi, M., Ghasemi Esmailabad, S., & Reza Talebi, A. (2023). Possible Harmful Effects of Smoking Hookah on Sperm DNA Fragmentation Index and Protamine Genes Expression in Normozoospermic Men. Substance abuse : research and treatment, 17, 11782218221144547. https://doi.org/10.1177/11782218221144547
  49. Waziry, R., Jawad, M., Ballout, R. A., Al Akel, M., & Akl, E. A. (2017). The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. International journal of epidemiology, 46(1), 3243. https://doi.org/10.1093/ije/dyw021
  50. World health organization (2016). World health statistics 2016: monitoring health for the SDGs, sustainable development goals. (2016, May 1). Retrieved January 2, 2024, from Who.int website: https://www.who.int/publications/i/item/9789241565264
  51. Zieliska-Danch W. (2019). The prevalence of waterpipe tobacco smoking among Polish youths. Archives of medical science : AMS, 17(3), 731738. https://doi.org/10.5114/aoms.2019.84487

Authors

Dilkhosh Shamal Ramadhan
ORCID
Rebar Yahya abdullah

Community health Nursing deo.college of Nursing.University of duhok.Duhok

ORCID
Alaa Noori Sarkees

Department of Nursing, Shekhan Technical University, Duhok Polytechnic University, Kurdistan Region, Iraq. E-mail: [email protected]

Arazoo Issa Tahir

Department of Adult Nursing, College of Nursing, University of Duhok, City of Duhok, Kurdistan Region, Iraq. E-mail: [email protected]

Sara Jawad Kadhim

Identifiers

Download this PDF file
PDF

Statistics