title: Harm perception, attitudes and predictors of waterpipe (shisha) smoking among secondary school adolescents in Al-Hassa, Saudi Arabia.
abstract: OBJECTIVE
  This study aimed to determine the prevalence and social determinants of waterpipe (WP) smoking among secondary school students in Al-Hassa, Saudi Arabia and to assess their health related knowledge and attitudes toward WP.
  
  
  METHODS
  A cross-sectional study was conducted with 1,652 Saudi secondary school students of both genders aged between 15-19 years selected by multistage sampling method. A self-administered anonymous Arabic version of Global Youth Tobacco Survey modified with items dedicated to WP smoking and to assess perception of health related hazards and attitudes towards WP was employed for data collection.
  
  
  RESULTS
  Prevalence of current smokers 'all forms' was 30.3% among males (C.I= 27.5- 33.2%) and 8.5% in females (C.I= 6.6-10.9%). WP was used by 53.9% of the current tobacco users, significantly higher among older age students. Of the regular WP smokers, 20.7% smoked WP on daily basis, 23.8% weekly, 64.2% stated using flavored " Muassel " tobacco. Primary motives for WP smoking were outings with friends, company, boredom and wasting time. Of the total, 49.7% of students stated that WP smoking is less harmful than cigarettes, 60.5% believed that harmful substances were purified through water filtration, with non-addictive properties in 67.8%. Knowledge about health hazards of WP smoking was low, irrespective of student's smoking status. WP smoking is more socially acceptable than cigarettes (52.1%), represents a good opportunity for gathering of friends and family (33.8%), and smoking of WP can relieve stress and tensions (37.8%). Hierarchical regression analysis showed that socializing motives, cigarette smoking, smoking among close family and friends, male gender and increasing age were positive predictors for WP smoking.
  
  
  CONCLUSIONS
  Social acceptability, poor knowledge of WP health related hazards and certain socio demographics are favoring the increasing current trend of WP use among adolescents in Al Hassa, Saudi Arabia.
authors.affiliation: Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. amin55@myway.com
authors.forename: Tarek Tawfik
authors.initials: TT
authors.lastname: Amin
authors.forename: Mostafa Abdel Monem
authors.initials: MA
authors.lastname: Amr
authors.forename: Burhan Omar
authors.initials: BO
authors.lastname: Zaza
authors.forename: Wassem
authors.initials: W
authors.lastname: Suleman
mesh_terms: D000293:Adolescent; D000328:Adult; D001290:Attitude; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012529:Saudi Arabia / Q000453:epidemiology; D012574:Schools; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D012931:Social Environment; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult