Waterpipe Smoking among University Students in Sulaimaniyah, Iraqi Kurdistan: Prevalence, Attitudes, and Associated Factors

BACKGROUND: Waterpipe smoking is increasingly becoming the most common method of tobacco use among adolescents in the Eastern Mediterranean Region. This study was undertaken in Iraqi Kurdistan to estimate its prevalence among students and investigate attitudes and factors associated with it. MATERIALS AND METHODS: In a cross-sectional survey at Sulaimani Polytechnic University, 1160 students were approached in a two-stage design using a self-administered questionnaire. Data was entered into Epidata and analysis was done in Stata. RESULTS: Prevalence of cigarette smoking was 10% and waterpipe smoking was 28% (male 49%, female 10%). Waterpipe smoking was initiated prior to joining the university in 74% of the cases and 22% of waterpipe smokers smoked every day. The most common place for smoking was coffee shops (52%) and 71% of smokers shared the pipe. The significant risk factors were smoking cigarettes (OR 10.3, 95% CI 7.0–15.0), male gender (OR 5.7, 95% CI 3.9–8.2), non-Kurdish ethnicity (OR 3.0, 95% CI 1.6–15.9), city residence (OR 1.5, 95% CI 1.0–2.1), and use of alcohol and other substances (OR 2.8 95% CI 1.4–5.6). CONCLUSION: Waterpipe smoking is highly prevalent among students in Iraqi Kurdistan, especially among males, and is becoming a public health problem. Tobacco control interventions should be designed specifically to address this problem among adolescents and the youth.