Abstract
Objectives
To examine the prevalence of waterpipe smoking and its associated factors among adolescents in Hong Kong.
Methods
We analyzed data of the School-based Survey on Smoking among Students 2012/2013 from a representative sample of 45,857 secondary school students in Hong Kong (mean age 14.8, SD 1.9). We conducted Chi-square tests and t test to compare current (past 30 days) waterpipe users and nonusers by sociodemographic variables and other covariates. Univariate and multivariable logistic regression models were used to examine the factors associated with current waterpipe smoking.
Results
Overall, 1.2 % of students reported current waterpipe smoking, of whom 43 % reported concurrent use of cigarettes. Waterpipe was the most popular alternative tobacco product (non-cigarette) used by students. Current waterpipe smoking was associated with older age, male sex, higher self-perceived family financial status, poor knowledge about the harm of cigarette smoking, positive attitudes toward smoking, current cigarette smoking, other tobacco use, and alcohol consumption.
Conclusions
Waterpipe smoking was the most popular alternative tobacco product among Hong Kong adolescents. Despite the low prevalence, it should be routinely monitored. Education programs and cessation interventions need to address waterpipe smoking in addition to cigarette smoking.
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References
Aboaziza E, Eissenberg T (2015) Waterpipe tobacco smoking: what is the evidence that it supports nicotine/tobacco dependence? Tob Control 24:i44–i53. doi:10.1136/tobaccocontrol-2014-051910
Akl EA, Ward KD, Bteddini D, Khaliel R, Alexander AC, Lotfi T et al (2015) The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control 24:i13–i21. doi:10.1136/tobaccocontrol-2014-051906
Alvur MT, Cinar N, Akduran F, Dede C (2014) Fallacies about water pipe use in Turkish university students—what might be the consequences? Asian Pac J Cancer Prev 15:1977–1980. doi:10.7314/APJCP.2014.15.5.1977
Alzyoud S, Weglicki LS, Kheirallah KA, Haddad L, Alhawamdeh KA (2013) Waterpipe smoking among middle and high school Jordanian students: patterns and predictors. Int J Environ Res Public Health 10:7068–7082. doi:10.3390/ijerph10127068
Amrock SM, Gordon T, Zelikoff JT, Weitzman M (2014) Hookah use among adolescents in the United States: results of a national survey. Nicotine Tob Res 16:231–237. doi:10.1093/ntr/ntt160
Arrazola RA, Singh T, Corey CG, Husten CG, Neff LJ, Apelberg BJ et al (2015) Tobacco use among middle and high school students—United States, 2011–2014. MMWR 64:381–385
Aslam HM, Saleem S, German S, Qureshi WA (2014) Harmful effects of shisha: literature review. Int Arch Med 7:16. doi:10.1186/1755-7682-7-16
Barnett TE, Curbow BA, Weitz JR, Johnson TM, Smith-Simone SY (2009) Water pipe tobacco smoking among middle and high school students. Am J Public Health 99:2014–2019. doi:10.2105/AJPH.2008.151225
Baskin-Sommers A, Sommers I (2006) The co-occurrence of substance use and high-risk behaviors. J Adolesc Health 38:609–611. doi:10.1016/j.jadohealth.2005.07.010
Chan WC, Leatherdale ST, Burkhalter R, Ahmed R (2011) Bidi and hookah use among Canadian youth: an examination of data from the 2006 Canadian Youth Smoking Survey. J Adolesc Health 49:102–104. doi:10.1016/j.jadohealth.2010.11.250
Chen K-T, Chen C-J, Fagot-Campagna A, Narayan KMV (2001) Tobacco, betel quid, alcohol, and illicit drug use among 13- to 35-year-olds in I-Lan, rural Taiwan: prevalence and risk factors. Am J Public Health 91:1130–1134
Czoli CD, Leatherdale ST, Rynard V (2013) Bidi and hookah use among Canadian youth: findings from the 2010 Canadian Youth Smoking Survey. Prev Chronic Dis 10:120290. doi:10.5888/pcd10.120290
Daniels KE, Roman NV (2013) A descriptive study of the perceptions and behaviors of waterpipe use by university students in the Western Cape, South Africa. Tob Induc Dis 11:4. doi:10.1186/1617-9625-11-4
Doran N, Godfrey KM, Myers MG (2015) Hookah use predicts cigarette smoking progression among college smokers. Nicotine Tob Res. doi:10.1093/ntr/ntu343
Eissenberg T, Ward KD, Smith-Simone S, Maziak W (2008) Waterpipe tobacco smoking on a U.S. college campus: prevalence and correlates. J Adolesc Health 42:526–529
El-Zaatari ZM, Chami HA, Zaatari GS (2015) Health effects associated with waterpipe smoking. Tob Control 24:i31–i43. doi:10.1136/tobaccocontrol-2014-051908
Faeh D, Viswanathan B, Chiolero A, Warren W, Bovet P (2006) Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country. BMC Public Health 6:169. doi:10.1186/1471-2458-6-169
Grekin ER, Ayna D (2012) Waterpipe smoking among college students in the United States: a review of the literature. J Am Coll Health 60:244–249
Hakim F, Hellou E, Goldbart A, Katz R, Bentur Y, Bentur L (2011) The acute effects of water-pipe smoking on the cardiorespiratory system. Chest 139:775–781. doi:10.1378/chest.10-1833
Heinz AJ, Giedgowd GE, Crane NA, Veilleux JC, Conrad M, Braun AR et al (2013) A comprehensive examination of hookah smoking in college students: use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use. Addict Behav 38:2751–2760. doi:10.1016/j.addbeh.2013.07.009
Hong Kong Council on Smoking and Health (2014) Uniting the community for a smoke-free Hong Kong: Annual report 2013–2014, Hong Kong
Jaber R, Madhivanan P, Veledar E, Khader Y, Mzayek F, Maziak W (2015) Waterpipe a gateway to cigarette smoking initiation among adolescents in Irbid, Jordan: a longitudinal study. Int J Tuberc Lung Dis 19:481–487. doi:10.5588/ijtld.14.0869
Jawad M, Wilson A, Lee JT, Jawad S, Hamilton FL, Millett C (2013) Prevalence and predictors of water pipe and cigarette smoking among secondary school students in London. Nicotine Tob Res 15:2069–2075. doi:10.1093/ntr/ntt103
Jawad M, Lee JT, Millett C (2015a) Waterpipe tobacco smoking prevalence and correlates in 25 Eastern Mediterranean and Eastern European countries: cross-sectional analysis of the Global Youth Tobacco Survey. Nicotine Tob Res. doi:10.1093/ntr/ntv101
Jawad M, Nakkash RT, Mahfoud Z, Bteddini D, Haddad P, Afifi RA (2015b) Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon. Public Health 129:370–376. doi:10.1016/j.puhe.2015.01.011
Jensen PD, Cortes R, Engholm G, Kremers S, Gislum M (2010) Waterpipe use predicts progression to regular cigarette smoking among Danish youth. Subst Use Misuse 45:1245–1261. doi:10.3109/10826081003682909
Kadhum M, Sweidan A, Jaffery AE, Al-Saadi A, Madden B (2015) A review of the health effects of smoking shisha. Clin Med 15:263–266. doi:10.7861/clinmedicine.15-3-263
Lo WS, Wang MP, Leung LT, Lin HC, Ho SY (2013) School-based Smoking Survey 2012–13: Final survey report. The University of Hong Kong, Hong Kong
Maziak W (2015) Rise of waterpipe smoking. BMJ 350:h1991. doi:10.1136/bmj.h1991
Maziak W, Taleb ZB, Bahelah R, Islam F, Jaber R, Auf R et al (2015) The global epidemiology of waterpipe smoking. Tob Control 24:i3–i12. doi:10.1136/tobaccocontrol-2014-051903
McKelvey K, Attonito J, Madhivanan P, Jaber R, Yi Q, Mzayek F et al (2014) Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis. Drug Alcohol Depend 142:307–313. doi:10.1016/j.drugalcdep.2014.06.038
Minaker LM, Shuh A, Burkhalter RJ, Manske SR (2015) Hookah use prevalence, predictors, and perceptions among Canadian youth: findings from the 2012/2013 Youth Smoking Survey. Cancer Causes Control 26:831–838. doi:10.1007/s10552-015-0556-x
Mzayek F, Khader Y, Eissenberg T, Al Ali R, Ward KD, Maziak W (2012) Patterns of water-pipe and cigarette smoking initiation in schoolchildren: Irbid longitudinal smoking study. Nicotine Tob Res 14:448–454. doi:10.1093/ntr/ntr234
Palamar JJ, Zhou S, Sherman S, Weitzman M (2014) Hookah use among US high school seniors. Pediatrics 134:227–234. doi:10.1542/peds.2014-0538
Roohafza H, Sadeghi M, Shahnam M, Bahonar A, Sarafzadegan N (2011) Perceived factors related to cigarette and waterpipe (ghelyan) initiation and maintenance in university students of Iran. Int J Public Health 56:175–180. doi:10.1007/s00038-009-0107-x
Smith SY, Curbow B, Stillman FA (2007) Harm perception of nicotine products in college freshmen. Nicotine Tob Res 9:977–982. doi:10.1080/14622200701540796
Smith JR, Novotny TE, Edland SD, Hofstetter CR, Lindsay SP, Al-Delaimy WK (2011) Determinants of hookah use among high school students. Nicotine Tob Res 13:565–572. doi:10.1093/ntr/ntr041
Smith-Simone SY, Curbow BA, Stillman FA (2008) Differing psychosocial risk profiles of college freshmen waterpipe, cigar, and cigarette smokers. Addict Behav 33:1619–1624. doi:10.1016/j.addbeh.2008.07.017
Soneji S, Sargent JD, Tanski SE, Primack BA (2015) Associations between initial water pipe tobacco smoking and snus use and subsequent cigarette smoking: results from a longitudinal study of US adolescents and young adults. JAMA Pediatr 169:129–136. doi:10.1001/jamapediatrics.2014.2697
The Government of the Hong Kong Special Administrative Region (2003) Thematic Household Survey report No. 16, The Government of the Hong Kong Special Administrative Region, Census and Statistics Department, Hong Kong
The Government of the Hong Kong Special Administrative Region (2007) Tobacco control legislation: Statutory no smoking areas. Institute. https://www.tco.gov.hk/english/legislation/legislation_sa.html. Accessed 18 June 2015
The Government of the Hong Kong Special Administrative Region (2013) Thematic Household Survey: report No. 53, The Government of the Hong Kong Special Administrative Region, Census and Statistics Department, Hong Kong
Villanti AC, Cobb CO, Cohn AM, Williams VF, Rath JM (2015) Correlates of hookah use and predictors of hookah trial in U.S. young adults. Am J Prev Med doi:10.1016/j.amepre.2015.01.010
Weglicki LS, Templin TN, Rice VH, Jamil H, Hammad A (2008) Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth. Am J Prev Med 35:334–339. doi:10.1016/j.amepre.2008.06.037
Zyoud SH, Al-Jabi SW, Sweileh WM (2014) Bibliometric analysis of scientific publications on waterpipe (narghile, shisha, hookah) tobacco smoking during the period 2003–2012. Tob Induc Dis 12:7. doi:10.1186/1617-9625-12-7
Acknowledgments
We are grateful for Dr. Lai Ming Ho for advice on statistical analysis.
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The School-based Survey on Smoking among Students was commissioned by the Food and Health Bureau, the Government of the Hong Kong Special Administrative Region of the People’s Republic of China.
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The authors declare no conflict of interest.
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Jiang, N., Ho, S.Y., Wang, M.P. et al. Waterpipe smoking among secondary school students in Hong Kong. Int J Public Health 61, 427–434 (2016). https://doi.org/10.1007/s00038-016-0796-x
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DOI: https://doi.org/10.1007/s00038-016-0796-x