Knowledge, attitudes and practices of shisha smoking among youths in Kampala, Uganda

Abstract

Tobacco use in various forms is the leading preventable cause of death worldwide and so is exposure to secondhand smoke. Despite the various strategies put in place to control cigarette smoking, alternative methods of tobacco use such as Shisha smoking have been left out. Globally, there are approximately over 100 million people who smoke tobacco using Shisha daily, majority of who are youths. In spite of being viewed as a safe alternative to cigarette smoking, studies have revealed that Shisha smoking has the more or the same adverse health effects as cigarette smoking. However, such considerations are usually neglected by Shisha smokers. This study therefore aimed to establish knowledge, attitudes, practices and factors associated with Shisha smoking among youths in two divisions of Kampala, Uganda. Methods: A cross-sectional survey was conducted between April and May 2014 among 640 youths systematically selected from bars. Interviewer administered questionnaires were used to collect information on knowledge, attitudes, practices and factors associated with Shisha smoking. Key informant interviews were used to collect qualitative data. Data analyzed using STATA 12.0. Odds Ratios were used for statistical associations at 95% level of confidence and p- values ≤ 0.05 were taken to be statistically significant. Qualitative data was summarized according to themes. Ethical clearance and informed consent were obtained. Results: Of all (530) the participants, 86.4% (458/530) had low knowledge and 69.2% (367/530) had negative attitudes towards Shisha smoking. Participants that smoked Shisha were 36.4% (193/530) with an average age of initiation reported at 23.0 + 3.3 years. Shisha smoking was mainly practiced on weekly 37.6% (75/193) basis, smoking flavored and sweetened tobacco 75.7% (146/193) and the most frequent venue for this practice was in the bars, restaurants and cafes 93.8% (181/193). Majority of Shisha smokers smoked in the company of friends 92.8% (179/193) who mostly shared a Shisha pipe 91.2% (176/193). Nearly two thirds, 62.7% (121/193) of those who smoked Shisha smoked cigarettes as well. Factors that were found to be significantly associated with Shisha smoking included; smoking cigarettes (OR: 5.89, 95% CI: 3.85-9.01, p<0.001); attitude (positive) (OR: 3.99, 95% CI: 2.55-6.24, p<0.001); age (25-30 years) (OR: 1.72, 95% CI: 1.13-2.62, p=0.012) and knowledge (no knowledge) (OR: 0.49 CI: 0.28-0.87, p=0.014). Key Informants indicated that Shisha smoking was not harmful to health if it is smoked exclusively. Conclusions and recommendations: There was high prevalence of Shisha smoking among youths attending bars and low knowledge regarding the health effects. Therefore, there is a need to create awareness on the health effects associated with Shisha smoking as well as subject Shisha smoking and its products to policies applicable to cigarette smoking and other tobacco products.