Prevalence of Hookah Smoking and Its Related Factors Among Students of Tehran University of Medical Sciences, 2012 - 2013

The Burden and Correlates of Waterpipe (Hookah) Smoking among Adolescents and Youth: A Systematic Review

BACKGROUND

This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations.

METHODS

PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10-24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982).

RESULTS

A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10-24 years age group was noted to be 18.16% (95% CI, 18.03-18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34-6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers.

CONCLUSION

Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.

Risk-Taking Behaviors Considering Internet Gaming Disorder among Iranian University Students: A Latent Class Analysis

BACKGROUND

Dangerous behaviors adversely affect the health of adolescents and young adults. This study aimed to identify the subgroups of college students based on the parameters of risky behavior and analyze the impact of demographic factors and internet gaming disorder (IGD) belonging to each class.

STUDY DESIGN

A cross-sectional study.

METHODS

The study was conducted on 1355 students through a multi-stage random sampling method in 2020. A survey questionnaire was used to collect data, and all students completed 1294 sets of questionnaires. The data were analyzed using t test and latent class analysis (LCA) through SPSS and PROC LCA in SAS 9.2 software.

RESULTS

Three latent classes have been identified as low-risk (75%), tobacco smoker (8%), and high-risk (17%). There was a high possibility of risky behavior in the third class. Marital status (being single) (OR = 2.28, 95% CI: 1.19-4.37), unemployment (having no job) along with education (OR = 1.56, 95% CI: 1.04-2.33), and IGD (OR = 1.06, 95% CI: 1.04-1.09) increased the risk of inclusion in the tobacco smoker class. Moreover, unemployment (having no job) along with education (OR = 1.43, 95% CI: 1.11-1.84) increased the chance of being in the high-risk class.

CONCLUSION

According to the findings of this study, 25% of the students were tobacco smokers or were in the high-risk class. The results of this study may help develop and evaluate preventive strategies that simultaneously take into account different behaviors.

Hookah Smoking among Brazilian University Students: An Exploratory Survey on the Prevalence and Perceptions of Addiction and its Harmfulness

Background

This study aimed to determine the prevalence, beliefs, attitudes, and perceptions of hookah use in a population of undergraduate students at a large public university in Brazil.

Methods

The sample consisted of 1348 undergraduate students aged over 18-year-old. They completed structured questionnaires on demographic information and close-ended questions on the past and current experiences of smoking hookah. The data underwent descriptive analysis and binary logistic regression.

Findings

Finally, 1298 valid survey forms were obtained from printed and digital questionnaires. More than half (53.9%) of participants reported having tried hookah at least once, however, only 10.8% reported they had experienced it within the last 30 days. The majority of the studied population presented acceptable beliefs about the harmfulness and addictive capacity of hookah smoking. However, when comparing the perceptions of those who had smoked and those who had never smoked hookah, and also, the perceptions of users and non-users, significant differences were observed. Students who were users or had already tried hookah showed a tendency to underestimate the deleterious effects of this type of smoking.

Conclusion

It could be concluded that hookah smoking was common among Brazilian university students. In addition, preoccupying misperceptions of hookah's harmfulness and addictive capacity were found. The results showed that the epidemic of hookah smoking, especially among young people, has spread far beyond the Arab world and the Persians. Accordingly, preventive measures must be taken if this population is to be protected from addiction and other serious health problems.

Geographic distribution and time trends of water-pipe use among Iranian youth and teenage students: A meta-analysis and systematic review

Water-pipe tobacco smoking is harmful to health, yet its rate of prevalence remains uncertain. Recent evidence has shown that the prevalence of water-pipe smoking among students is higher than in the general population. In this study, a systematic review of related literature on water-pipe use was conducted, and for this purpose, 76 articles were examined in the study. In this vein, geographic distribution and time trends of water-pipe consumption in Iran were considered. The results of this study showed that lifetime, last-year, and last-month prevalence of water-pipe smoking use among Iranian students were 28.78 (25.07-32.49), 20.84 (16.01-25.66), and 16.36 (11.86-20.85), respectively. The results also showed a wide variation by the region and sex in Iran. This study has shown the importance of addressing public prevention and alerting programs in schools and universities.

Predictors of hookah smoking frequency among women in the South of Iran: A cross-sectional study

The prevalence of hookah smoking has grown over the past decades in Iran especially in the south of the country. This study aimed to determine the behavioral and socio-demographic predictors of the hookah smoking frequency among women in southern Iran. This research was conducted on 400 women hookah smokers selected through multi-stage sampling method. Data were collected from October 2018 to September 2019 using a questionnaire guided by literature. Ordinal logistic regression analysis was run to determine the influential behavioral and socio-demographic predictors involved in the frequency of hookah smoking. Variables with a P-value of less than 0.05 in the final fitting model were associated with the outcome variable (frequency of hookah smoking per day1 = once a day, 2 = twice a day, 3 = three times a day, 4 = more than three times a day). We found that the longer duration of hookah smoking, family usage of hookah smoking, beginning to smoke hookah with peers, absence of either parent in family (single-parent families and a lack of prior intention to cease smoking), ever-married women and low socio-economic status (SES) predicted the frequency of hookah smoking. To prevent the behavior and make effective interventions to reduce hookah smoking, policy-makers should stay focused on factors other than internal motivations. Focus on the companies surrounding women smokers, quitting the habit of hookah smoking and effective interventions to decrease one's intention to smoke hookah can help reduce such unhealthy behaviors.

A Qualitative Study of Factors Influencing the Onset of Hookah Smoking among Iranian Men with Turkmen Ethnicity

Introduction: Hookah smoking has grown considerably among Iranian Turkmen in the past two decades. The reasons for this increase in the consumption of hookah are unclear. Therefore, this study was conducted with the aim of determining the factors related to the start of hookah smoking in men with Turkmen ethnicity.

Methods: This qualitative study was conducted between February 2018 and June 2018 in Turkmen cities of Golestan provinces in Iran. The study participants included 26 male Turkmen water pipe smokers with various ages, occupation, and education level. Study data were collected through semi-structured individual interview and the results were analyzed in August 2018 by content analysis. Data management was done by software, MAXQDA version 10.

Results: In this study, 26 hookah smoker men with the age range of 20–45 years were interviewed. The age of the participants at the time of starting hookah consumption varied from 14 to 25 years. On the basis of qualitative data, the reasons for the start of hookah smoking in male Turkmen were classified into three main categories: (1) individual (curiosity and sense of adulthood, fewer perceived risks compared with other substances and hookah’s sensory attractions); (2) interpersonal (hookah-smoking friends and consumption of hookah by family members); and (3) societal (blaming unemployed people in small neighborhoods, cultural influence, more social acceptance compared with other substances, and easy access to hookah).

Conclusion: Individual, interpersonal, and societal factors play important role in the start of hookah smoking among male Turkmens. Developing health policies based on the above factors can be effective in adopting hookah prevention and control strategies. Moreover, future studies could be developed with the goal of discovering ways to solve the problem of unemployment and plan for developing recreational activities in this area to prevent initiation of hookah smoking especially among youth.

Prevalence of Hookah Smoking among University Students in Iran: A Meta-Analysis of Observational Studies

BACKGROUND

The rise in popularity of waterpipe smoking among younger people cause increase its deleterious effects on health in recent years. The aim of this study was to estimate the pooled prevalence of water-pipe smoking in university students in Iran.

METHODS

We performed the literature search from 1946 to January 21, 2019, in several international and national databases such as Medline/PubMed, Web of Science, Scopus, Google Scholar, Magiran, Iranmedex, and IranPsych. To investigate the between-study heterogeneity we used the chi-squared test and I² index. We used a random-effects model to estimate the pooled prevalence of water-pipe smoking. The potential source of heterogeneity was assessed by subgroup analysis and meta-regression.

RESULTS

According to the eligibility criteria, we included 37 relevant studies in our meta-analysis. The pooled prevalence of lifetime water-pipe smoking was 25% (95% CI: 22-29) and in male and female subgroups was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively. The pooled prevalence of water-pipe smoking in last year was 21% (95%CI: 16-25) and in last month was 8% (95%CI: 5-11). Results of meta-regression analysis showed that there was not any significant association between suspected variables and the prevalence of water-pipe smoking.

CONCLUSION

The higher prevalence rate of water pipe smoking among university students indicates the emergency need for planning preventive program.

Substance abuse behaviors among university freshmen in Iran: a latent class analysis

OBJECTIVES

Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup.

METHODS

Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students' socio-demographic characteristics on membership in each specific subgroup.

RESULTS

The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1.

CONCLUSIONS

Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.

The role of sociodemographic factors associated with waterpipe smoking among male adolescents in western Iran: A cross-sectional study

INTRODUCTION

Waterpipe smoking (WPS) is an increasingly popular leisure activity among young people in Iran. The purpose of this study was to identify the role of sociodemographic factors associated with WPS among male adolescents in Iran.

METHODS

The study used a cross-sectional design. It included 730 high school male students (Grades 10–12) recruited through multistage random sampling conducted in 2017 in Hamadan city, western Iran. The self-administered questionnaires included information on demographic variables and behavioral risk factors related to WPS. Descriptive statistics and multinomial logistic regression modeling were conducted using SPSS.

RESULTS

The student mean age, and standard deviation (SD), and age at WPS initiation were 16.41 (0.84) and 13.31 (2.43) years, respectively. The percentages of never, former and current WPS were 37.3%, 36.4% and 26.3%, respectively. We found that ever cigarette smoking (OR=5.14, 95% CI: 2.56–10.32) and WPS family (OR=2.55, 95% CI: 1.40–4.64) were significantly associated with former WPS. Furthermore, being 18 years, studying in technical fields, reporting ever and current smoking of cigarettes and family usage of WP were significantly associated with current WPS. Friends with WPS (OR= 0.50, 95% CI: 0.34–0.72) however played a protective role on former WPS.

CONCLUSIONS

The results indicate that the prevalence of former and current WPS was high in Hamadan city. Thus, designing and implementing interventions for increasing students’, friends’ and family’s awareness regarding the harms of WPS and cigarette smoking are necessary to facilitate behavior change.

Clustering and Combining Pattern of High-Risk Behaviors among Iranian University Students: A Latent Class Analysis

Background: High-risk behaviors are increasing among young adults worldwide. We aimed to identify university students’ subgroups on the basis of high-risk behaviors and to assess the role of age, living alone, religious beliefs, and parental support in the membership of specific subgroups.

Study design: A cross-sectional study

Methods: The study was conducted in Bushehr (the south of Iran) from November to December 2016. The sample included 977 university students selected through random sampling. The data were collected using a self-administered questionnaire. Then, latent class analysis was used to classify the students.

Results: Totally, five latent classes were identified as follows: low risk, high risk, somewhat low risk, hookah user, and very high risk. Notably, 7.7% and 2.5% of the students belonged to high risk and very high risk classes, respectively. The results suggested the protective effect of familial support and religiosity on high-risk behaviors.

Conclusions: This study indicated the co-occurrence of high-risk behaviors. The findings can be used to plan and evaluate interventions by considering risk factors and protective factors in universities.

Factors Associated with Hookah Use among Male High School Students: The Role of Demographic Characteristics and Hookah User and Non-User Prototypes

BACKGROUND

As students' hookah use has become a widespread problem in the developing countries, it is time to understand the cognitive determinants of students' decisions to do so. This study aimed to investigate the roles of psychological and demographic factors associated with hookah use among male high school students.

METHODS

This descriptive-analytical study was performed among 601 high school male students, recruited through multistage sampling method in the Kermanshah City, west of Iran in 2016. The data-gathering tool consisted of a self-administered questionnaire with questions about hookah use behavior and demographic, behavioral and psychological variables. Data were analyzed using SPSS-18 software using chi-square and logistic regression.

RESULTS

36.1% of the participants reported ever hookah use and 17.1% mentioned using hookah in the past month. Pleasure (28.1%) and sensation seeking (22.5%) were common reasons of hookah use. In comparison to non-users, hookah users evaluated a typical hookah user as more clever, less immature, more popular, more attractive, more self-confident, more independent, and less selfish (P<0.001).

CONCLUSIONS

The results revealed the importance of psychological factors when examining students' hookah use status. Thus, design and implementation of interventions might be effective in prevention of hookah use among students.

Subgrouping of risky behaviors among Iranian college students: a latent class analysis

BACKGROUND

Risky behaviors may interrupt development or cause considerable morbidity or mortality. This study's purpose was to determine subgroups of students based on risky behaviors and assess the prevalence of risky behaviors in each of the subgroups.

PARTICIPANTS AND METHODS

This anonymous cross-sectional study was carried out in October 2015 and November 2015, with 1,777 students from Tabriz University of Medical Sciences, through multistage random sampling method. The data were analyzed by latent class analysis.

RESULTS

The prevalence rates of cigarette smoking (more than or equal to ten cigarettes), hookah use (≥1 time/month), and alcohol consumption (≥1 time/month) during the last year were 12.4% (95% confidence interval [CI]: 10.9-14.0), 11.6% (95% CI: 10.0-13.1), and 4.9% (95% CI: 3.8-5.9), respectively. The prevalence rates of illicit opioids (1.8%, 95% CI: 1.2-2.5), cannabis (1.2%, 95% CI: 0.7-1.7), methamphetamine (1.1%, 95% CI: 0.6-1.6), methylphenidate (2.5%, 95% CI: 1.7-3.2), and extramarital sex (5.5%, 95% CI: 4.5-6.6) over the last year were also estimated. Three latent classes were determined: 1) low risk; 2) cigarette and hookah smoker; and 3) high risk. It is worth mentioning that 3.7% of males and 0.4% of females were in the high risk group.

CONCLUSION

Subgrouping of college students showed that a considerable percentage of them, especially males, were classified into the high risk and cigarette and hookah smoker groups. Appropriate preventive measures that consider multiple different risky behaviors simultaneously are needed for this part of the population.