Waterpipe Smoking among Herat University Students: Prevalence, Attitudes, and Associated Factors

Background: Waterpipe tobacco smoking (WTS) is an ancient type of smoking that has become a global phenomenon. This study aimed to identify the prevalence of waterpipe smoking and its relation to socio-demographic characteristics in Herat University students in western Afghanistan. Methods: In this cross-sectional study, a structured self-administered questionnaire containing 53 items in 3 subscales was distributed between July and December 2018, to examine the use of waterpipe among Herat University students. Data were evaluated in SPSS. Chi-square test was used to observe differences between categorical variables. All important variables were separately evaluated for men and women in logistic regression models. A P-value less than 0.05 was considered statistically significant. Findings: The prevalence of ever waterpipe use in male and female students was 54.1% and 81.8%, respectively. Parents’ higher education and family economic status were associated with higher rates of ever waterpipe use in both sexes. On the other hand, marital status and parents’ employment were not associated with waterpipe use. Ever waterpipe use was associated with having smoking friends or family members in both sexes. Male and female waterpipe users believed that cigarette smoke had more nicotine than waterpipe. While more male waterpipe users believed that cigarette was more addictive than waterpipe, more female users believed otherwise. Conclusion: The prevalence of ever waterpipe use is higher in male students at Herat University. Having a smoking friend and family member positively influences waterpipe use among both sexes. Most users believed that waterpipe smoking was less hazardous than cigarette smoking.