Prevalence of hookah pipe smoking in high-school learners in Johannesburg, South Africa

Background. Hookah pipe (HP) smoking has become popular globally, especially among young adults and adolescents. There are misperceptions regarding the safety of HP smoking, relative to cigarettes. Objectives. To assess the prevalence of HP use in grade 8 and 12 students and the factors associated with use in the different age groups. Methods. A cross-sectional study was conducted in grade 8 and 12 high-school students from six randomly selected public schools in Johannesburg, South Africa. A self-administered structured questionnaire was completed by students after consent had been obtained from parents and students. The questionnaire focused on knowledge and awareness of HP smoking. Data were analysed using Stata/SE version 15. A p-value <0.05 was considered significant. Results. A total of 347 grade 8 and 232 grade 12 students participated in the study. Of the sample, 26% in grade 8 and 70% in grade 12 had ever smoked an HP. In both grades a higher proportion of males smoked. Eleven percent of students in grade 8 and 37% in grade 12 were currently smoking the HP. Approximately 47% and 51% of grade 8 and grade 12 students, respectively, first started smoking at parties. The mean age of initiation was 8 and 12 years in grade 8 and 12, respectively. Grade 12 students had greater awareness of the risks of HP smoking. Having a family member who smoked an HP was significantly related to HP use in grade 8 students. Overall, factors associated with increased odds of smoking the HP were being in grade 12, not being aware of health effects, and seeing the health warnings on hookah tobacco package labels. Conclusions. HP smoking increased significantly between grades 8 and 12. Increasing knowledge and awareness of the risks involved in HP smoking in children at an early age is recommended. One of the factors influencing uptake of HP smoking in young students was having a family member smoking it; adult anti-smoking and anti-HP campaigns are therefore also important.