# Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study

## TL;DR

This study finds that waterpipe smoking dependence is common among Palestinian university students and is linked to factors like dual smoking, peer approval, and frequent use.

## Contribution

The study identifies specific social, behavioral, and economic factors contributing to waterpipe smoking dependence in a Palestinian university student population.

## Key findings

- 69.4% of current waterpipe smoking university students showed high dependence.
- Peer approval and morning waterpipe sessions were strongly associated with higher dependence.
- Dual cigarette smoking and higher frequency of waterpipe use increased dependence risk.

## Abstract

Waterpipe smoking (WPS) has been associated with a variety of adverse health effects, consequences, and symptoms of nicotine dependence. This study aims to determine the prevalence of WPS dependence among Palestinian university waterpipe smoking students, their normative beliefs about WPS, and their relationship to dependence.

A cross-sectional study of current WPS university students at five major Palestinian universities was conducted from September to December 2022. Participants were recruited using convenient sampling, and data collection was carried out via an interviewer-administered questionnaire. We assessed students’ WPS dependence using the Lebanese Waterpipe Dependence Scale. We used the Poisson regression model with robust variance to analyze factors independently associated with high WPS dependence.

The study included 746 current WPS university students. Results revealed a high prevalence of WPS dependence, with 69.4% (95%CI: 66.0-72.7%) exhibiting high dependence. Factors contributing to high WPS dependence included dual cigarette smoking (aPR: 1.18; 95%CI: 1.12–1.25), studying medical sciences (aPR: 1.13; 95%CI: 1.10–1.18), friends’ approval of WPS (aPR: 1.25; 95%CI: 1.17–1.34), daily WPS frequency (aPR: 1.98; 95%CI: 1.39–2.23), spending more than 50% of daily allowance on WPS (aPR: 1.37; 95%CI: 1.10–1.64), and morning WPS sessions (aPR: 1.97; 95%CI: 1.31–2.27). The study highlighted the influence of social factors, such as peers’ approval and perceived prevalence, on WPS dependence.

WPS dependence is prevalent among university students, and it is associated with morning WPS, dual smoking, and increased WPS frequency. Notably, peer and cultural factors are essential primary motivators. As a result, it is critical to incorporate WPS considerations into Palestine’s antismoking health promotion program. Therefore, it is vital to incorporate WPS into the Palestinian antismoking health promotion policy, and the health education of adolescents regarding the dangers of WPS should coincide with antismoking initiatives.

The online version contains supplementary material available at 10.1186/s12909-024-05156-0.