Article Text

Download PDFPDF

Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study
  1. P Salameh1,
  2. J Salamé2,
  3. M Waked3,
  4. B Barbour4,
  5. N Zeidan4,
  6. I Baldi5
  1. 1Clinical & Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
  2. 2Charité—Universitätsmedizin University Hospital, Berlin, Germany
  3. 3Pulmonology Department, Saint Georges Hospital & Faculty of Medicine, Balamand University, Beirut, Lebanon
  4. 4Faculty of Public Health, Lebanese University, Fanar, Lebanon
  5. 5Laboratoire Santé Travail Environnement, Université Bordeaux Segalen, Bordeaux, France
  1. Correspondence to Professor Pascale Salameh; psalameh{at}


Objectives The objective of this study was to measure the correlates, including normative beliefs, associated with waterpipe (WP) and cigarette smoking prevalence and dependence.

Setting A cross-sectional study was carried out using a proportionate cluster sample of Lebanese students in 17 public and private universities.

Participants Of the 4900 distributed questionnaires, 3384 (69.1%) were returned to the field worker. All available students during break times were approached, with no exclusion criteria.

Primary and secondary outcome measures sociodemographic variables, detailed active and passive smoking, in addition to items of the tobacco dependence scales were all evaluated.

Results Correlates to WP smoking were studying in a private university (adjusted OR, aOR=1.50 (1.26 to 1.79); p<0.001) and ever smoking cigarettes (aOR=1.80(1.44 to 2.26); p<0.001); friends’ and societal influence were found on smoking behaviour and dependence. Although the role of parents was not visible in decreasing the risk of smoking WP, their protective influence seemed more important on WP dependence (β=−1.09(−1.79 to −0.28); p<0.001), a behaviour that is considered more deleterious for health. Parents’ and friends’ disagreement with smoking had a protective effect on cigarette smoking and dependence (aOR<1; p<0.01), while thinking that idols and successful people smoke increased the risk of both cigarette smoking and dependence (aOR>1; p<0.01).

Conclusions In conclusion, WP smoking and dependence are influenced by parents’ and friends’ opinions, and idols’ smoking status. Future research is necessary to further improve our understanding of motives for WP smoking and dependence.

  • waterpipe
  • smoking
  • dependence
  • LWDS-11
  • YACD
  • peer pressure
  • parental guidance
  • normative belief

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.