RESEARCH PAPER
Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study
 
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1
Institute of Community and Public Health, Birzeit University, Occupied Palestinian Territories
2
Statistic Department, Hacettepe University, Ankara, Turkey
3
Department of Public Health, Medical School, Jordan University of Science and Technology, Irbid, Jordan
4
Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
5
The University of Jordan, Amman, Jordan
6
Sultan Qaboos University, Muscat, Oman
7
Dubai Medical College, Dubai, United Arab Emirates
8
Zayed University, Abu Dhabi, United Arab Emirates
9
Mansoura University, Mansoura, Egypt
10
College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
11
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
12
Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, United States
Publish date: 2018-05-15
 
Tob. Induc. Dis. 2018;16(May):20
KEYWORDS:
TOPICS:
ABSTRACT:
Introduction:
Waterpipe tobacco smoking (WTS) continues to be very common in the Eastern Mediterranean Region (EMR), partially because of cultural acceptance but also because of misconceptions of its harm. This paper aimed to describe the beliefs towards waterpipe harm of university students who smoked waterpipe in five EMR countries.

Methods:
This study was conducted in 2016 across five EMR countries: Egypt, Jordan, Occupied Palestinian Territories, Oman and United Arab Emirates (UAE). Participants were recruited from among university students in each country. Students’ characteristics, smoking behavior, flavor preference and knowledge of WTS harm were collected using an internet-based survey. Participants were included if they were ever waterpipe tobacco smokers and between 18 and 29 years of age. Bivariate analyses assessed variations in student-perceived WTS harm across the countries. Linear regression analysis was used to assess WTS perceived harm differences between students in the different countries.

Results:
A total of 2 544 university students participated from the five countries. Among ever smoking students, 66% reported WTS in the past 30 days, with the highest proportions (40%) from Occupied Palestinian Territories (OPT) and (41%) Jordan. Dual smoking of waterpipe and cigarettes was highest among students from Egypt. Most participants from the five countries had high level of perceived harm related to WTS during pregnancy. Less than 50% of the students believed that WTS could lead to the death of the smoker, can be harmful for non-smokers and have an addictive effect. Female students, those older than 22 years, and those who didn’t smoke waterpipe in the last 30 days significantly had a higher level of WTS perceived harm. Participating students believed that cigarettes are more addictive and contain more nicotine compared to waterpipe.

Conclusions:
Misperceptions of waterpipe harm are common among university students in the five EMR countries. Immediate public health action is needed, including enforcement of waterpipe tobacco control regulations along with awareness campaigns.

CORRESPONDING AUTHOR:
Niveen M.E. Abu-Rmeileh   
Institute of Community and Public Health, Birzeit University, Occupied Palestinian Territories
 
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