Factors associated with shisha smoking: a cross-sectional telephone-based survey among general population adults in Nigeria

ABSTRACT Background This is the first national-level study to identify factors associated with shisha smoking among general population adults in Nigeria where high prevalence rates have been reported. Methods We conducted a telephone-based, cross-sectional survey between 28th July and 11th September 2022 in 12 states. We performed logistic regression analysis, with adjusted odds ratios (aORs) and 95% confidence intervals (CI) as the measures of association. Findings We surveyed 1278 individuals: 611 who currently smoked shisha and 667 who did not. The following increased the likelihood of being a person who currently smokes shisha: being a person who currently smokes cigarettes (aOR=5.54, 95% CI 2.57 to 11.90) or consumes alcohol (aOR=3.46, 95% CI 1.91 to 6.28); and having a family member (aOR=2.32, 95% CI 1.23 to 4.40), or one (aOR=22.81, 95% CI 9.99 to 52.06) or more (aOR=78.85, 95% CI 22.50 to 276.33) close friends who smoke shisha. The following reduced the likelihood of being a person who currently smokes shisha: being older (aOR=0.92, 95% CI 0.89 to 0.95) and screening positive for possible generalised anxiety disorder (aOR=0.60 95% CI 0.41 to 0.88). The following did not have an effect on current shisha smoking status: sex, level of education, employment status, household wealth, religion, rural/urban residence, perceived stress score, and screening positive/negative for possible major depressive disorder. Conclusions Strategies to curb shisha smoking need to account for the associated social and behavioural factors, including age, cigarette smoking, alcohol consumption, and having family members or close friends who smoke shisha. KEY MESSAGES What is already known on this topic Shisha smoking is a growing public health threat worldwide, including in Africa, but there is a lack of general population, national-level studies that identify the factors associated with shisha smoking in this context. What this study adds The study suggests that the following increase the likelihood of being a person who smokes shisha: being a person who smokes cigarettes or drinks alcohol, having family members or close friends who smoke shisha, and being a younger adult. Females seem to be as likely to smoke shisha as their male counterparts in this context. However, there are potential sex differences in the factors associated with shisha smoking, for example, the effects of household wealth, employment status, having family members who smoke shisha, and mental health The relationship between shisha smoking and mental health might be different from that which is well-known between smoking other tobacco products such as cigarettes and mental health. How this study might affect research, practice or policy Interventions to curb shisha smoking need to account for the factors associated with the behaviour, sex differences, as well as differences that might exist between shisha smoking behaviour and the smoking of other tobacco products.