Hookah smoking among a sample of Iraqi male high school students:  Awareness and understanding

Background: The use of hookah smoking device is increasing at large scale distributing from Eastern Mediterranean region reaching Western countries. Hookah smoke users exposed to a lot of chemical compounds and to several chronic diseases. The purpose of this study is to confirm the prevalence of hookah use among a sample of male high school students in Iraq, and to provide a better understanding of cessation-related behaviors and cognitions of hookah only users. Methods: A descriptive cross-sectional study was conducted among students in three high schools (for males only) at Karkh District, Baghdad. The study period was from Oct. 2017 till Jan. 2019 including a total of 847 male students. A structured KAP questionnaire was used to identify their knowledge and use of hookah smoking. Analysis of data was carried out using the available statistical package of SPSS-25. Results: the overall prevalence of hookah smoking among high school male students was high (46%). More than two-thirds (70.6%) of them think that water pipe smoking is acceptable socially more than cigarette smoking. More than half of participants (55%) first heard about hookah smoking from friends and close to two-thirds (65.2%) who smoke hookah from those surround students were also friends. Almost half of respondents think hookah smoking is not encouraged in the faith of Islam (47.3%) and less than quarter (20.9%) think it’s completely forbidden in Islam. Conclusions: Hookah smoking is increasing among high school students and becoming a socially acceptable behavior that needs more public and adolescent education about its harmful effect.