Waterpipe smoking among adolescents in Hong Kong

Abstract

BACKGROUND AND AIMS: Waterpipe smoking has increased rapidly among adolescents worldwide. We examined the prevalence of current waterpipe smoking and its associated factors among adolescents in Hong Kong. METHODS: We analyzed data of 2012/13 School-based Survey on Smoking from a representative sample of 45,857 secondary school students in Hong Kong (US grades 7-12; mean age: 14.8, SD=1.9). We conducted chi-square tests and t-test to compare current (past 30-day) waterpipe smoking with regard to sociodemographic factors and other covariates, and conducted multivariable logistic regression to examine factors associated with current waterpipe smoking. RESULTS: 1.2% (95% confidence interval [CI]: 1.1-1.4) of students reported current waterpipe smoking, of whom 43% reported dual use of cigarettes within the past 30 days. Waterpipe was the most popular tobacco product after cigarettes. Current waterpipe smoking was associated with older age (adjusted odds ratio [AOR]=1.17 per year, 95% CI: 1.06-1.28), male sex (AOR=1.52, 95% CI: 1.09-2.11), higher self-perceived family financial status (AOR=1.55, 95% CI: 1.04-2.32), poor knowledge about cigarette smoking (AOR=1.97, 95% CI: 1.30-2.98), positive attitudes toward cigarette smoking (AOR=2.71, 95% CI: 1.66-4.44), current cigarette smoking (AOR=2.64, 95% CI: 1.66-4.19), other tobacco use (AOR=4.12, 95% CI: 2.66-6.38), and alcohol consumption (AOR=1.92, 95% CI: 1.17-3.15 for <1 day/month; AOR=5.25, 95% CI: 3.43-8.01 for ≥1 day/month). CONCLUSIONS: Despite the low prevalence, waterpipe smoking should be routinely monitored. Education programs and cessation interventions should address the use of multiple tobacco products and alcohol consumption. Counter-marketing campaigns deglamorizing waterpipe smoking may help prevent adolescents from using waterpipe. Funding: The Government of the Hong Kong Special Administrative Region of the People’s Republic of China, the Food and Health Bureau Corresponding Author: Nan Jiang, School of Public Health, University of Hong Kong, Hong Kong, nanjiang@hku.hk