Prevalence of Hookah Smoking and its Associated Factors among Undergraduate Engineering Students of Khwopa College of Engineering, Nepal

Research Article

J Fam Med. 2023; 10(2): 1330.

Prevalence of Hookah Smoking and its Associated Factors among Undergraduate Engineering Students of Khwopa College of Engineering, Nepal

Yuba Raj Baral1; Suraj Jyakhwo1; Amrit Bist2*; Sabina Jyakhwo3; Nikesh Duwal4

1Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal

2Patan Academy of Health Sciences, Lalitpur, Nepal

3Florence College of Nursing, Rajiv Gandhi University, India

4LA Trobe University, Australia

*Corresponding author: Amrit Bist School of Public health, Patan Academy of Health Sciences, Lalitpur, Nepal. Tel: +977-9848836723 Email: [email protected]

Received: April 21, 2023 Accepted: May 30, 2023 Published: June 06, 2023


Background: Hookah smoking, also known as water pipe smoking, is an emerging trend that is gaining popularity globally, especially among youth and college students. It has been referred to as a global tobacco epidemic by public health officials and identified as an emerging threat to public health.

Methodology: A descriptive cross-sectional study with systematic sampling was conducted. A self-administered questionnaire was used to collect the data. Collected data were entered, and analysis was done using SPSS IBM version 26.

Results: The overall prevalence of hookah smoking was found to be 38.7%, with a mean age of 17.92 years. The analysis indicated that sex and faculty of respondents were significantly associated with hookah smoking. In this study, male participants were 2.44 times more likely to be involved in hookah smoking compared to female participants (OR=2.449, 95% CI=1.026–0.848). Participants in the electrical engineering faculty were 4.84 times more likely to smoke hookah than participants in the computer engineering faculty (OR=4.844, 95% CI), and participants in the civil engineering faculty were 2.58 times more likely to smoke hookah than participants in the computer engineering (OR=2.583, 95% CI).

Conclusion: The cross-sectional study with systematic sampling conducted among undergraduate engineering students at Khowpa College of Engineering revealed that hookah smoking was more prevalent among male participants than female participants. Hence, an awareness program is needed to be planned and implemented among engineering students, with a special focus on male students.

Keywords: Hookah smoking; Prevalence; Associated factors; Undergraduate engineering students


Smoking refers to the action of inhaling and exhaling fumes from burning tobacco in cigars, cigarettes, and hookahs. According to the Center for Disease Control and Prevention (CDC), hookahs are water pipe apparatuses that are used to smoke specially made tobacco that comes in different flavors such as apple, mint, cheery, chocolate, watermelon, strawberry, etc. and are typically practiced in groups with the same mouthpiece passed from person to person. Hookah is also called narghile, waterpipe, and shisha. Hookahs vary in shape and size. A hookah has a head, a body, a water bowl, and a flexible hose with a mouthpiece. Hookah smoking is also known as water pipe smoking and is gaining popularity globally, especially among young people and college students [1]. Hookah smoking is the second-most prevalent form of alternative tobacco product. The rapid increase in hookah smoking is due to the misconception that hookah smoking is less harmful and less addictive than cigarette smoking [2]. Hookah users perceived hookah as less harmful, less addictive, and socially and parentally acceptable [3]. Hookah smoking is generally done in groups, with the same mouthpiece being passed from person to person, which can increase the risk of the transfer of infectious oral diseases. The expansion of cafés and hookah bars has rapidly increased hoo kah smoking [4]. The physical appearance of a hookah and the taste of flavored tobacco have rapidly attracted new hookah users. Hookah smoking has been promoted by factors such as the misperception of less harm, socially and parentally acceptable and curiosity, higher socioeconomic status, curiosity, and being easily available and accessible. Globally, about 1 billion people are familiar with hookah, and more than 100 million people use hookah on a daily basis. The sweet taste of flavored tobacco contributes to attracting hookah users, who are generally young adults and beginner hookah smokers [5].

Hookahs generate smoke that is similar to cigarette smoke, which contains nicotine, tar, carbon monoxide, heavy metals, and other toxicants and also poses a risk for the same diseases caused by cigarette smoking [3]. The volume of smoke from hookahs is ten times higher than cigarette smoke. The burning temperature of tobacco in a hookah is about 900 degrees Celsius, which could produce different types of harmful chemicals and toxicants [6]. Non-cigarette smokers viewed hookah as an alternative way of smoking flavored tobacco and misperceived it as less harmful, less addictive, socially acceptable, and a way to socialize with friends. Generally, in a 1-hour hookah smoking session, a hookah smoker inhales 90,000mL of smoke [4]. Hookah smoking is rapidly increasing and has become an emerging threat to public health. Adolescents who smoke either hookah or cigarettes are associated with health problems and may increase the risk of health problems during adulthood. In order to reduce the health threat caused by tobacco, the World Health Organization (WHO) has set a target of a 30% decrease in the prevalence of tobacco usage among people older than 15 years until 2025 [7].

Curiosity and susceptibility were the major reasons for experimenting with hookah smoking. Curiosity refers to an interest in tobacco products, and susceptibility is the development of beliefs about future tobacco use behaviors. The diversification of the tobacco product has contributed to changes in patterns of use of tobacco products. Since 2011, use of novel tobacco products such as hookah and electronic cigarettes has increased, while conventional tobacco products such as cigarettes are declining [8].


A descriptive cross-sectional study was conducted among undergraduate engineering students of Khwopa College of engineering. It was calculated using the formula:

where the prevalence of 13%, 95% confidence interval, and 5% margin of error were taken. Semi-structured, self-administered questionnaires were used to assess the prevalence and associated factors of hookah smoking. Systematic sampling was used as the sampling technique for the collection of data. Ethical approval was received from IRC, and approval for data collection was received from the respective municipality. The data were entered and analyzed using IBM SPSS Statistics version 25.0. Based on the distribution and variance, appropriate statistical tests were used for analysis. Descriptive analysis was used to describe background characteristics. A chi-square test was used to test the difference between the categorical variables, and p <0.05 was considered statistically significant.


The mean age of the respondents was 20.83, with minimum and maximum ages of 18 and 24 years, respectively. The majority of students were from the Hindu religion (96.1%), followed by Buddhism (1.9%) and Christianity (1.9%). More than two-thirds of participants were male (78.1%), while few of the respondents were female (21.9%). The majority of the respondents were from Janajati (45.2%), followed by Brahmin (30.3%), and Chhetri (20.6%). More than two-thirds of students (81.9%) were from nuclear families; while very few (18.1%) were from joint families. More than half of the sample students were from the civil engineering faculty (51.6%), followed by the computer faculty (25.2%), and the electrical faculty (23.2%). More than two-thirds of respondents (77.4%) were from urban areas, while only 22.6% of respondents lived in rural areas (Table 1).