EurAsian Journal of BioSciences Eurasia J Biosci 14, 2061-2068 (2020) Prevalence of smoking hookah (shisha) among students of Salahaddin University F.A. Shalaw 1, Jangy Esmail Abdulla 2, Ahmed Farhan Shallal 3*, Titi Rahmawati Hamedon 4 1 Surgical Specialist Hospital-Cardiac Center, Ministry of Health-Kurdistan Region, Erbil, IRAQ 2 College of Nursing, University of Raparin, Ranya, KGR, IRAQ 3 Medical Laboratory Science department, College of Science, University of Raparin, Ranya, KGR, IRAQ 4 Department of Community Health, Faculty of Medicine and Health Sciences, UPM, 43400 UPM Serdang Selangor, MALAYSIA *Corresponding author: [email protected] Abstract The objective of this study was to determine the prevalence of smoking shisha and evaluate the socio-demographic associates of smoking among Salahaddin University (SU) students in Erbil city. Respondents were selected randomly and 378 students who met the inclusion criteria participated in this study. A self-administered questionnaire was used to collect information on socio-demographic and individual characteristics. The prevalence of smoking shisha among SU students (21.2%, n=80) was higher than that of cigarette smoking (12.4%, n = 47) and the highest prevalence of shisha smokers were much higher in males than females 70 (60.5%). Chi square test shows that 4 factors were significantly associated with smoking shisha; gender (χ2=7.723, df=1, p<0.005), age (χ2=37.674, df=2, p<0.001), BMI (χ2=18.901, df=3, p<0.001), cigarette smoking status (χ2=159.097, df=2, p<0.001). Multiple logistic regression test has showed that the most significant risk factors for smoking shisha were age (OR=5.585, 95%CI: 2.016-15.461), and cigarette smoking status (OR=74.060, 95%CI: 23.623-232.179). Among SU students, the overall prevalence of smoking shisha was high and significantly associated with age, gender, body mass index and cigarette smoking status. Effective prevention strategies are required in order to reduce the risk of smoking shisha among SU students. Keywords: shisha, smoking, students, Salahaddin University, Erbil Shalaw FA, Abdulla JE, Shallal AF, Hamedon TR (2020) Prevalence of smoking hookah (shisha) among students of Salahaddin University. Eurasia J Biosci 14: 2061-2068. © 2020 Shalaw et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License. INTRODUCTION restaurants is increased in Erbil city center. Though the Kurdistan parliament banned smoking in public places, There are massive numbers of public and private Shisha consumption has risen since 2007 (EKurd Daily, institutes, colleges and universities around the world 2019). It is expected that increasing the number of which are still getting increased. That is, they are shisha cafes, bars and restaurants will lead to the rise in standing for the higher education sector where both the the consumption of Shisha. staff and the students are exposed to various risks and As far as the terminology is concerned, more than a hazards in this seemingly safe setting (Shalaw and term is used when it comes to the process of smoking Rahmawati, 2016). Kurdistan region has witnessed a Shisha. The people here mainly mention shisha smoking growth in the higher education sector like other sectors while shisha, water pipe and hookah smoking are used in public and private especially since 2003 (Dream City in other places. Smoking shisha was popular in the Erbil: real stat to investment LTD, 2020). In the capital of Middle East and Asia in the past and it is where it comes Kurdistan, there are several public and private from (Chaouachi, 2007). It has recently developed most universities such as Cihan Private, Lebanese French widely in the UK and other European Union countries Private Universities and Hawler Medical, Salahaddin basically among young people (Kadhum et al., 2015). It Public Universities (Universities in Kurdistan: Ministry of is usually believed that smoking shisha and shisha are Higher Education and Scientific Research, 2020). not as much risky as the cigarettes, but the truth is that Salahaddin University –Erbil is one of the public and the oldest university which is located in the capital of the Iraqi Kurdistan Region, Erbil city. SU has 23 thousand Received: December 2019 students for 2019 academic year (Salahaddin Accepted: March 2020 University, 2019). The number of cafes, bars and Printed: June 2020 2061 EurAsian Journal of BioSciences 14: 2061-2068 (2020) Shalaw et al. one hour shisha is nearly equal to 100 cigarettes MATERIALS AND METHODS (Hendrick, 2020; Sun, and Yang, 2014), or 50 to 60 Study Design and Study Population cigarettes, and a two to three-hour period of smoking A cross-sectional study design was used to shisha is equal to smoking 25 cigarettes (Hamad determine the prevalence of Smoking shisha and its Medical Corporation, 2020). Interestingly, shisha associated factors. This study was conducted on 378 commonly contains tobacco that is sometimes blended randomly selected students in the Salahaddin with natural products or molasses sugar and specials University. Notably, Salahaddin University – Hawler is types of fruits like apricot, apple, strawberry, mint and one of the biggest and oldest university and is located in cola (Young, 2020). Further, smoking shishahas the capital of Iraqi Kurdistan Region - Erbil. become progressively available mostly because of a Materials growing number of shisha-serving and cheaper prices in Data was collected using pre-tested self- the venues. Despite this, there are many kinds of shisha administered questionnaire, which was directly that differ in content and shape, which indicates that distributed to the respondents. Both English and Kurdish shisha smokers are at risk, and experience the same languages were used in the questionnaire. Reliability of health complications as cigarette smokers such as heart the pre-tested questionnaire showed the internal disease, respiratory problem, infection and cancer consistency of assessment using the Cronbach’s alpha, (Islami et al., 2013; Habib et al., 2001; Tamim et al., which was found to be 0.841 for the reliability of the 2008; Awan et al., 2017). Shisha like other kinds of questionnaire. The questionnaire is divided into various tobacco contains nicotine which has the ability of getting sections. Section A collect information on socio- the smokers addicted. That is, smoking shisha is demographic background, such as gender, age, race, significantly related to several long-term health effects; body mass index and marital states. Individual infection, cardiovascular damage, respiratory problem characteristics are collected in Section B, which collects and cancer (Islami et al., 2013; Habib et al., 2001; Awan information on the type of shisha smoked, companion at et al., 2017). Much of the mortality and morbidity the beginning, frequency of shisha smoking, smoking significantly associated with smoking shisha can be shisha location, smoking time and cigarette smoking attributed to the hurt of the cardiovascular system, status. The last section, Section D, contained details of respiratory system, infection and cancer (Aslam et al., the knowledge of various aspects of shisha smoking, 2014). Many studies in different countries showed that and it includes shisha smoking have health hazard, the prevalence of smoking hookah among university increased risk of heart conditions, infection, cancer and students has increased such as United States, respiratory diseases. European countries, Saudi Arabia and Pakistan (Maziak Data Collection et al., 2015; Shafagoj and Mohammed, 2002; Warren et Questionnaire was distributed to respondents in al., 2009; Aurangzeb et al., 2012). Though smoking October 2019. The respondents were informed about shisha is one of the serious issue, it is rising among the purpose of the study and those participating in this university students in the world (Sutfin et al., 2011). study were on a voluntary basis. Besides, the Smoking shisha basically occurs among friends in public respondents were made sure that their answers would settings such as private place, or in café and restaurants be kept confidential and would only be used for research that offer ready-to-smoke shisha to customers (Joveini purpose. After the respondents have finished answering et al., 2016). Further, different studies also evaluated the questions, the questionnaires were collected demographic variables associated with shisha smoking immediately. for instance age, and male gender (Primack et al., 2010; Data Analysis Eissenberg et al., 2008). In general, it is believed that Data was analyzed by using the IBM Statistical smoking shisha among university students is less Package of Social Sciences (SPSS) version 21. Initially addictive or harmful than cigarettes. That is, in Malaysia, the data was analyzed descriptively using frequency, a study among medical students revealed that percentage, means and standard deviations, as well as significant respondents assumed which shisha smoke median, and interquartile range. All numerical data were does not harmfully affect health (Redhwan Ahmed and tested for normality. Inferential analysis (Chi-square Saghir, 2011; Bazzi, 2015). The aims of this study are to test) was used to determine the association between determine the prevalence of shisha smoking and its smoking shisha and the independent variables (socio- associated factors among the respondents and to demographic, and individual factors). Finally, a determine the association between smoking shisha