Cigarette and nargila (water pipe) use among Israeli Arab high school students: prevalence and determinants of tobacco smoking.

Cigarette smoking is a popular habit among Arab Israelis. Over the past decade, smoking tobacco using nargila, a water pipe, has become a popular and accepted behavior among teenagers in Israel. Although the use of a water pipe (nargila) is an old habit among Middle Eastern adult males, its emergence among youth is a new finding. A representative sample of high school students in Tayibe, Israel is the subject of this survey. The sample represents data from 326 adolescents (boys 52.5% and girls 47.5%), ages 15-18, studying in one of the largest high schools in the Arab region of Israel. Our results show that a third of the sample smoked either cigarettes (36.2%) or nargila (37.1%). The gender difference among youths smoking cigarettes was 24.8% (48.0% for boys and 23.3% for girls), in contrast to 37.6% (55.0% for boys and 17.4% for girls) for nargila. There was a statistically significant correlation between cigarette and nargila smoking in populations where there is low religious inclination, increased parental smoking, and low student academic achievement. Students' perceptions of low academic achievement (OR 4.51, p < 0.001), students' mothers who smoke (OR 3.57, p < 0.001), and student's fathers who smoke (OR 2.75, p < 0.01) increase the youths' chances of using nargila. Our conclusions are that smoking cigarettes and nargila are equally popular, and patterns of smoking cigarettes and nargila parallel each other. Causes that influence cigarette smoking also influence nargila smoking. Educational efforts are needed as a public health intervention.