An Emerging Problem of Shisha Smoking among High School Students in Ethiopia
Abstract
:1. Background
2. Methods
2.1. Study Design and Setting
2.2. Study Population and Sample Size Calculation
2.3. Sampling Procedures
2.4. Survey Instruments and Data Collection
2.5. Data Processing and Analysis
3. Results
3.1. Socio Demographic Characteristics
3.2. Shisha Use Practice and Perception about Shisha Smoking
3.3. High School Students’ Parents and Friends’ Shisha Smoking Practice
3.4. School Environments and Shisha Smoking
3.5. School and Individual Level Factors for Ever Use of Shisha
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AOR | Adjusted odds ratio |
APC | Article Processing Charge |
CI | Confidence interval |
GYTS | Global Youth Tobacco Survey |
ICC | Intra-cluster correlation coefficient |
IRB | Institutional review board |
SNNPR | Southern Nations, Nationalities, and Peoples’ Region |
SPH | School of Public Health |
OR | Odds ratio |
UKRI | UK Research and Innovations |
VIF | Variance inflation factor |
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Variable | Category | Frequency | Percentage (%) |
---|---|---|---|
Sex (n = 3319) | Female | 1804 | 53.9 |
Male | 1515 | 45.3 | |
Age (n = 3321) | 13–14 | 99 | 3.0 |
15 | 689 | 20.6 | |
16 | 1055 | 31.5 | |
17 | 755 | 22.6 | |
18 | 502 | 15.0 | |
19–20 | 190 | 5.7 | |
>20 | 31 | 0.9 | |
Religion (n = 3313) | Orthodox Christian | 2203 | 65.8 |
Muslim | 367 | 11.0 | |
Protestant | 654 | 19.6 | |
Catholic | 51 | 1.5 | |
Other | 38 | 1.1 | |
Living area (n = 3347) | Addis Ababa | 458 | 13.7 |
Adama | 586 | 17.5 | |
Bahir Dar | 875 | 26.2 | |
Hawassa | 561 | 16.8 | |
Mekelle | 867 | 25.9 | |
School type (n = 3347) | Private | 729 | 21.8 |
Government | 2618 | 78.2 | |
Total number of grade 9 and 10 students in the school) (n = 36) | 108–350 | 9 | 25.0 |
408–980 | 7 | 19.4 | |
1038–1600 | 9 | 25.0 | |
1604–2273 | 6 | 16.7 | |
≥2677 | 5 | 13.9 | |
Student grade level (n = 3347) | Grade 9 | 1685 | 50.3 |
Grade 10 | 1662 | 49.7 | |
Parents living area (n = 3310) | Rural | 1185 | 35.4 |
City | 2125 | 63.5 | |
Source of income (n = 3328) | Parents | 3004 | 90.4 |
Work for myself | 257 | 7.7 | |
Other | 67 | 2.0 |
Variable | Frequency (%) | p-Value | ||
---|---|---|---|---|
Never Shisha Users | Ever/Current Shisha Users | |||
Ever used shisha by regions | Total | 3245 (97.4) | 86 (2.6) | <0.001 |
Addis Ababa | 432 (95.2) | 22 (4.8) | ||
Adama | 568 (97.4) | 15 (2.6) | ||
Bahir Dar | 870 (99.8) | 2 (0.23) | ||
Hawassa | 520 (92.9) | 40 (7.1) | ||
Mekelle | 855 (99.2) | 7 (0.8) | ||
Ever used shisha | Male | 1441 (95.6) | 67 (4.4) | <0.001 |
Female | 1776 (98.9) | 19 (1.1) | ||
Current use of shisha by regions | Total | 3311 (99.4) | 20 (0.6) | <0.001 |
Addis Ababa | 445 (98) | 9 (2.0) | ||
Adama | 580 (99.5) | 3 (0.5) | ||
Hawassa | 554 (98.9) | 6 (1.1) | ||
Bahir Dar | 872 (100) | 0 (0) | ||
Mekelle | 860 (99.8) | 2 (0.2) | ||
Is shisha smoking harmful to health? | No | 60 (84.5) | 10 (14.1) | <0.001 |
Yes | 2677 (97.6) | 55 (2) | ||
I do not know | 486 (96) | 19 (3.7) | ||
Is shisha smoking less harmful than tobacco smoking? | No | 357 (94) | 23 (6) | <0.001 |
Yes | 1250 (97.3) | 35 (2.7) | ||
I do not know | 1590 (98.4) | 26 (1.6) |
Variable | Categories | Frequency (%) |
---|---|---|
Any of your friend’s smoke shisha (n = 3347) | No | 2588 (77.3) |
Yes | 205 (6.1) | |
I am not sure | 168 (5) | |
I do not know | 358 (10.7) | |
Missing | 28 (0.84) | |
How often do your friends smoke shisha (n = 205) | Every day | 32 (15.6) |
Weekly | 47 (22.9) | |
Sometimes | 71 (34.6) | |
I am not sure | 21 (10.2) | |
I do not know | 21 (10.2) | |
Missing | 13 (6.3) | |
Do any of your friends smoke shisha by region (n = 205) | Addis Ababa | 90 (43.9) |
Adama | 44 (21.5) | |
Hawassa | 29 (14.2) | |
Bahir Dar | 33 (16.1) | |
Mekelle | 9 (4.4) | |
Father smokes shisha (n = 3347) | Yes | 11 (0.3) |
No | 3041 (90.9) | |
I do not know | 126 (3.8) | |
Not relevant for me | 135 (4) | |
Missing | 34 (1) | |
Mother smokes shisha (n = 3347) | Yes | 15 (0.45) |
No | 3119 (93.2) | |
I do not know | 101 (3) | |
Not relevant for me | 67 (2) | |
Missing | 45 (1.3) |
Variable | Category | Frequency (%) |
---|---|---|
Any shop for shisha smoking within 100 m radius from the school compound (students’ responses) (n = 3347) | Yes | 251 (7.5) |
No | 1311 (39.2) | |
I do not know | 1754 (52.4) | |
Missing | 31 (0.93) | |
Students in the school smoke in these shisha shops (students’ responses) (n = 251) | Yes | 113 (45.2) |
No | 25 (10) | |
I do not know | 106 (42) | |
Missing | 7 (2.8) | |
Any shop house for shisha smoking within 100 m radius from the school (school director response) (n = 36) | Yes | 16 (44.4) |
No | 20 (55.6) | |
Grade 9 and 10 teachers from this school who smoke Shisha (school director response) (n = 36) | Yes | 2 (5.6) |
No | 34 (94.4) |
Variables | Ever Used Shisha (%) n = 86 (2.6%)) | Model-1 OR (95% CI) | Model-2 AOR (95% CI) | |
---|---|---|---|---|
Age | 13–16 | 27 (31.4) | Reference | Reference |
17 and above | 59 (68.6) | 0.7 (0.3–1.6) | 0.8 (0.32–1.8) | |
Sex | Male | 67 (77.9) | Reference | Reference |
Female | 19 (22.1) | 0.5 (0.19–1.1) | 0.5 (0.19–1.2) | |
Parent’s residence | Rural | 25 (29.1) | Reference | Reference |
City | 59 (68.6) | 0.9 (0.3–2.4) | 0.9 (0.31–2.5) | |
Source of income from parents | No | 25 (29.1) | Reference | Reference |
Yes | 61 (70.9) | 3.3 (1.2–9.2) * | 3.1 (1.1–8.8) * | |
Ever use of khat | No | 29 (33.7) | Reference | Reference |
Yes | 57 (66.3) | 4.4 (1.9–10.4) * | 4.2 (1.9–10.4) * | |
Ever use of smokeless tobacco | No | 50 (58.1) | Reference | Reference |
Yes | 35 (40.7) | 3 (1.1–8.0) | 3.1 (1.1–8.4) | |
Ever drink of alcohol | No | 24 (27.9) | Reference | Reference 1 |
Yes | 62 (72.1) | 1.4 (0.6–3.2) * | 1.4 (0.61–3.4) * | |
Ever use of marijuana | No | 54 (62.8) | Reference | Reference |
Yes | 29 (33.7) | 3.8 (1.4–11.0) * | 3.9 (1.4–11.1) * | |
Ever smoked cigar rete | No | 34 (39.5) | Reference | Reference |
Yes | 52 (60.5) | 9.2 (3.8–22.1) * | 8.2 (3.4–19.8) * | |
Any of your friend smoke shisha | No | 19 (22.1) | Reference | Reference |
Yes | 49 (57) | 16.7 (6.5–42.8) * | 16.8 (6.4–44.3) * | |
Is shisha smoking less harmful than cigarette smoking | No | 23 (26.7) | Reference | Reference |
Yes | 35 (40.7) | 1.3 (0.43–4) | 1.5 (0.5–4.5) | |
I do not know | 26 (30.2) | 1.1 (0.31–3.4) | 1.1 (0.34–3.8) | |
School type | Government | 64 (74.4) | 1 | |
Private | 22 (25.6) | 3.9 (0.71–21.2) | ||
Teachers in the school who smoke shisha | 1 | |||
4.7 (0.5–43.4) | ||||
Shisha houses within 100 m radius | 1 | |||
0.3 (0.07–1.3) | ||||
Number of students in the school | 1 (0.99–1) |
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Hirpa, S.; Fogarty, A.; Addissie, A.; Bauld, L.; Frese, T.; Unverzagt, S.; Kantelhardt, E.J.; Getachew, S.; Deressa, W. An Emerging Problem of Shisha Smoking among High School Students in Ethiopia. Int. J. Environ. Res. Public Health 2021, 18, 7023. https://doi.org/10.3390/ijerph18137023
Hirpa S, Fogarty A, Addissie A, Bauld L, Frese T, Unverzagt S, Kantelhardt EJ, Getachew S, Deressa W. An Emerging Problem of Shisha Smoking among High School Students in Ethiopia. International Journal of Environmental Research and Public Health. 2021; 18(13):7023. https://doi.org/10.3390/ijerph18137023
Chicago/Turabian StyleHirpa, Selamawit, Andrew Fogarty, Adamu Addissie, Linda Bauld, Thomas Frese, Susanne Unverzagt, Eva Johanna Kantelhardt, Sefonias Getachew, and Wakgari Deressa. 2021. "An Emerging Problem of Shisha Smoking among High School Students in Ethiopia" International Journal of Environmental Research and Public Health 18, no. 13: 7023. https://doi.org/10.3390/ijerph18137023