Knowledge, Attitude, and Harm Perception Towards Water Pipe Tobacco Smoking (Shisha Smoking)
Chapter One
Aim of the study
To study the Knowledge, attitude, and practice of adults in Port Harcourt toward Water pipe tobacco smoking.
Specific objectives of the study:
- To find out the prevalence of water pipe tobacco smoking among adults at in Port Harcourt.
- To study sociodemographic characteristics of smokers.
- To compare knowledge, attitudes, and practices of Water pipe tobacco smoking among male and female adults.
- To find out the factors related to Water pipe tobacco smoking at first step towards modeling tobacco dependence (reasons of smoking).
CHAPTER TWO
REVIEW OF LITERATURE
Water-Pipe Smoking and Health impact
Smoking is one of the causes of death that can be avoided. It can result in over 443,000 fatalities each year and $96.8 billion in productivity losses (Adhikari, Kahende, Malrcher, & Asman, 2009). Conventional cigarettes (CC) or non-cigarette tobacco (NCT) products like water pipe tobacco and e-cigarettes are currently rising in popularity throughout the world (Warren et al., 2008). Almost a billion individuals worldwide are aware of waterpipe smoking. There are 100 million waterpipe smokers worldwide, according to estimates (Wolfram, Chehne, Oguogho, & Sinzinger, 2003).
Smoking poses health hazards to people, including those from heart disease, lung cancer, and respiratory illnesses (Akl et al., 2010).
Smoking a waterpipe has similar consequences to smoking cigarettes. It can increase heart rate and blood pressure (Eissenberg & Shihadeh, 2009). After waterpipe tobacco smoking (WTS) sessions, it is known to elevate heart rate and blood pressure similarly to regular smoking (Kim, Kabir, & Jahan, 2016). The heart can be negatively impacted by tobacco products, increasing the risk of acute myocardial infraction (Teo et al., 2006). Smoking a waterpipe (WPS) can affect vascular function by lowering blood flow and raising vascular resistance (Alomari, Khabour, Alzoubi, Shqair, & Stoner, 2015). Acute coronary disease incidence is correlated with waterpipe smoking exposure duration. Compared to nonsmokers, one study from the American University of Beirut found that lifetime exposure of more than 40 WP-years was associated with a tripled risk of developing significant coronary artery stenosis (Sibai et al., 2014). Another in vitro study explaining the effects of waterpipe smoking on endothelial cell function was conducted by researchers. Waterpipe smoking causes vascular diseases by causing oxidative stress, inflammation, and endothelial dysfunction as well as by impairing the endothelial vasodilatory function of repair mechanisms (Rammah, Dandachi, Salman, Shihadeh, & El-Sabban, 2013). Smoking a waterpipe can result in 1.7 times the amount of nicotine being exposed to than smoking a cigarette (exposure length of 45 minutes versus 5 minutes) (Eissenberg & Shihadeh, 2009).
Smoking through a waterpipe might harm the respiratory system. It can induce an acute aggravation of asthma in individuals, an increase in respiratory rate, changes to the way the lungs normally work, and chronic obstructive pulmonary disease (COPD) (El-Zaatari, Chami, & Zaatari, 2015). Smoking over a waterpipe can interfere with lungs’ normal spirometry. In one study, 110 shisha smokers were enrolled, and Ben-Saad et al. (2009) discovered that 36% of the participants had static hyperinflation, 14% had minor obstructive ventilatory defects, and 6% had significant obstructive ventilatory defects. El- Zaatari et al. (2015) added that the Borg scale at mid- to peak activity revealed an increase in dyspnea following exposure to waterpipe smoking. Smoking a waterpipe can result in polycythemia and raise carboxyhemoglobin levels higher than smoking cigarettes (El-Zaatari et al., 2015).
Moreover, research conducted in Syria, the United Arab Emirates, China, and Lebanon revealed a link between waterpipe smoking and COPD (El-Zaatari et al., 2015). It may worsen lung inflammation, oxidative stress, and airway resistance (El-Zaatari et al., 2015).
Smoking water pipes can double the chance of developing lung cancer, according to a comprehensive assessment of six trials (OR = 2.12, 95% CI 1.32-3.42). (Fakhreddine, Kanj, & Kanj, 2014). Another study conducted in Kashmir discovered that smoking from a waterpipe was linked to a six-fold increased incidence of compared to nonsmokers (Koul et al., 2011). According to Al-Amad, Awad, and Nimri’s (2014) research, regular waterpipe use was associated with a 16.44-year reduction in diagnosis age on average when compared to nonsmokers (95% CI, -26.33 to -6.55). The average age of diagnosis for occasional waterpipe users was 11.79 years younger than that of nonsmokers (95% CI, -23.29 to -0.27). Another cohort study from Iran found a link between smoking waterpipes and stomach cancer (OR = 3.4, 95% CI 1.7 to 7.1). (El-Zaatari et al., 2015).
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
For this study, a descriptive cross-sectional study design was selected to conduct at four Universities in Port Harcourt, Rivers state, Nigeria from February to March 2023.
Study sample
Sampling procedure
According to the study’s objectives. The selection of number of enrolled colleges and departments were proportionate with total university students’ number see (table 2.1). The colleges and departments are selected by simple random sampling method.
If a college consist of many departments, one to two of them were selected by simple random sampling method. All students for all stages in the selected departments were included in the study.
Inclusion and Exclusion criteria
All available students in the selected colleges and departments during the researcher’s visit to the hole of students lectures and those agreed to participate in the study are included, while all those who refused to participate or did not fill in out the questionnaire forms completely are excluded.
Response rate
About 2600 questionnaire forms were distributed but only 2225 forms were filled out completely. The response rate was 85.57%. The study sample represent 10% of all four universities.
Pilot study
For testing the prepared questionnaire, a pilot survey was conducted before the study to assess the feasibility and applicability of the questionnaire. After conducting the pilot study, minor changes were done on the questionnaire by adding question about knowledge and it was:
Did you think smoking cause any of the following diseases?
CHAPTER FOUR
ANALYSIS AND RESULTS
Prevalence of the studied students according to smoking (cigarette/ WP), and universities
Of the total studied students 14.2% (121) were cigarette smokers. Students of CU had higher percentage (16.3) followed by Uniport (15.2%), RSU (13.7%) and NU (12%). Up to 38 %( 330) of students had history of WPS. Students of NU showed the higher percentage (42.8) followed by RSU (41.2%), Uniport (36.6%) and CU (31.3%). There was no significant statistical association between the universities and history of Smoking (Cigarette/ WP) (table 3.1).
Table 3.1: Distribution of smoking (cigarette/ WP) among studied students according to their universities.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Conclusion
According to the findings of the present study it has been concluded that: 1- Up to ¼ of university students’ at Port Harcourt are cigarette smokers and ⅓ are WP smokers.
Water pipe tobacco smoking are more prevalent among males than females.
Single students are more prone to smoke than married students.
Most of cigarette smokers were WP smokers and there was highly significant association between Water pipe tobacco smoking.
Most of students in this study were not well aware about most of harmful effects of the smoking.
There is no significant statistical association between prevalence of Water pipe tobacco smoking, and type of universities (nor Public Neither Private).
Half of participants were willing to quit smoking and the main cause for quitting is health adverse effects of smoking.
There was a significant association between those have a family smoker member it makes them more prone to smoking.
Cafes are the most common place that used by students for WPS practice.
Most frequent reasons for smoking were to relieve anger and frustration, enjoy taste, enjoy smell, spend time out and share with other friends.
Recommendations:
Inclusion of a detailed and separate course in university curriculum regarding tobacco control and effects of smoking on health. This course must be like three lectures added to English debate or English language at the first year in governmental and private universities.
Sensitization on the dangers of tobacco should be continuously carried out through the mass media in order to increase the knowledge level of students regarding the dangers of smoking.
The government should increase the taxes on cigarettes and other tobacco products to ensure that they significantly increase in price in turn be unaffordable for most of students, or lead to decrease consumption of tobacco products.
Establishing strict rules for opening new WPS places (cafes), and preventing practicing WPS in other unlicensed public places.
Health care providers and university authorities should be offering culturally appropriate cessation products and services to encourage to quit WPSs.
Further research is needed to identify the factors that increase or decrease the tendency of launching WPS in order to develop guided prevention strategies.
A wide surveillance should be applied to identify the extent of WPS spread among adults in Port Harcourt.
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