Almost half of the students in the study group had tried smoking waterpipe at least once, and it was established that approximately one-third still smoked. These findings show that waterpipe smoking is substantially wide-spread among university students.
In a study performed in England among university students, the rate of steady waterpipe smokers was 2.8%; this rate was 19% among waterpipe users in the USA (8
). In a study performed in Syria the rates of waterpipe smoking were 25.5% among male students, 4.9% among female students, and the rates of daily waterpipe use were 1.8% among male students. In another study performed in Syria, the rates of daily waterpipe use among café customers were 24% (10
). In East Mediterranean countries, waterpipe is second to cigarette smoking among the types of steady tobacco consumption. The social acceptance of smoking waterpipe, especially the fact that cigarette smoking is seen as shameful for girls whereas waterpipe smoking is not, is also a factor in the steady increase of the smoking rate (5
). Also it can be seen as a reason for the increase in waterpipe cafés. The increase in waterpipe use in the last years and especially among young people in the East Mediterranean countries is a known fact (2
In the multi-centre study Global Youth and Tobacco Investigation, in its Lebanon part, it was found that among Lebanese youth the cigarette smoking rate had decreased between 2001 and 2005, whereas use of other tobacco methods had increased (13
In Turkey, which could be thought of as a bridge between the East Mediterranean countries and Europe, and in which the waterpipe is widely used, waterpipe use is expected to be at a lower rate than in the East Mediterranean countries. But on the contrary, in our study we found that the casual use of waterpipe among girls and boys is not low at all.
Although waterpipe use is common among female students, it has been established that the possibility of using waterpipe among male students is twice as high. In a study performed in adolescents in Lebanon, it was found that cigarette smoking alone or together with waterpipe use is much higher in males than in females (5
). The study result of the Lebanon 2005 Global Youth Tobacco Investigation has shown that smoking and the use of tobacco other than cigarettes is higher in males than in females (13
). However, differing from European countries, in East Mediterranean countries waterpipe smoking is socially accepted, therefore waterpipe use is common in girls living in these countries.
In England, in a study performed with students from the British University, it was found that experiencing waterpipe and its steady use was higher in males (8
). In different studies performed in Lebanon in 2001 and in Syria in 2003, in university students, similar results were obtained. In studies performed in Iran and the United States, waterpipe use was found to be higher in boys than in girls (4
There are studies that show that, related to the cultural differences between societies, the presence of someone using tobacco products in the family increases the tendency of cigarette smoking in boys and waterpipe smoking in girls. In East Mediterranean countries, waterpipe has been used traditionally for centuries, and among women it is accepted as a less shameful event compared to cigarette smoking. Therefore, waterpipe use is more common in women compared to cigarette smoking. Waterpipe smoking is considered natural among parents, and some parents even smoke it together with their children (5
Although waterpipe use was slightly higher in the third-grade students of the faculties, the difference between classes was not significant. This can be explained by the fact that students with a tendency for waterpipe smoking usually do it before university or in the first grade. As a matter of fact the mean age for starting smoking waterpipe was found to be 17. On the other hand, there are studies showing that the rate of smoking waterpipe increased in the higher classes (8
It is known that smoking cigarettes serves as a pioneer for waterpipe smoking, and vice versa (12
). In our study we found that the prevalence of waterpipe smoking was nine times greater in students with the habit of cigarette smoking. A similar study, showing that cigarette smoking has an effect upon trying and steadily smoking waterpipe, was done in a British University (8
In Syria, in a study in which university students and regular café customers were evaluated, the prevalence of waterpipe smokers was found to be higher in cigarette smoking individuals (11
). Again in Syria, in a study performed with medical faculty students, similar to our study, waterpipe smoking was found to be ten times more frequent in cigarette smokers compared to non-smokers (15
The presence of a family member or friend that smokes waterpipe increases substantially the possibility of the student smoking waterpipe as well. In a study performed in the USA, it was found that the presence of a family member smoking waterpipe increases the smoking in other individuals by 6.5 times (12
). In our study this value was found to be approximately five times. On the other hand, the presence of a friend smoking waterpipe increases the prevalence by three times. There are many studies showing the important effect of family members and friends upon waterpipe use (1
Most of the students smoke waterpipe less than once a week, and the preferred places to smoke are cafés. Only one student stated that he smoked every day. In a study performed in Ankara, it was found that the preferred smoking sequence was once in a while and not daily (7
A total of 91% of the waterpipe users did not see themselves as addicted. These findings are similar to the results of two different studies performed in the United States of America (USA). In these studies and in ours, the fact that waterpipe was smoked once in a while by the majority is remarkable. Not seeing themselves as addicts, and the feeling that they can quit whenever they want to, is a common perception among waterpipe users (9
Most of the students were smoking waterpipes with their friends, and collective use was common. In a study from Syria, in which students and café customers were evaluated, it was established that people preferred to smoke with their friends. In the same study, 96.5% of the students and 43.8% of the café customers stated that they smoked the waterpipe collectively (11
Only 21% of the students in the study group were considering quitting smoking waterpipe. In two different studies performed in the USA (12.2%) and in Turkey (11.0%), the rate of considering quitting was similarly low (7
). On the other hand in a study performed in Egypt this rate was found to be over 50% (16
). The fact that the intensity of waterpipe smoking is low in Turkey and USA, the perception of it as a means of entertainment among friends, and the rejection of its addictive features may all be factors affecting the thoughts of individuals regarding quitting.
The majority of the students in our study who did not smoke waterpipe had no clue about the harmful effects of waterpipe use. The perception that waterpipe use was less addictive compared to cigarette smoking among students smoking waterpipe was significantly higher than in the students not smoking. On the other hand, the fact that most of the students smoking waterpipe thought that it was more harmful to themselves and to the environment compared to cigarette smoking and that this rate was higher than in non-smokers was an interesting finding. This may be due to the fact that the smokers observed more effectively the harmful effects of waterpipe smoking on themselves and on the environment, compared to the non-smokers. In two studies from Syria, performed in university students and café customers, the rate of considering waterpipe smoking as more harmful than cigarette smoking was also high (10
). On the other hand, there are some studies showing that cigarette smoking is considered to be more harmful compared to waterpipe smoking (8