Waterpipes Use among High School Students in Jakarta Ridhwan Fauzi1,2 Chitlada Areesantichai3 1Faculty of Medicine and Health University of Muhammadiyah Jakarta 2Tobacco Control Support Center, Indonesian Public Health Association 3College of Public Health Sciences, Chulalongkorn University Yogyakarta 2016

Introduction “The hookah’s origin dates back to the fifteenth century, has been used extensively in the Middle East in recent decades has become a global phenomenon” The waterpipe involves the passage of charcoal-heated air through a perforated aluminium foil and across the flavoured tobacco to become smoke that bubbles through the water before inhalation by the smoker Maziak et all 2014

Tobacco Epidemic in Indonesia Contains addictive and pathogenic substances such as nicotine carbon monoxide, formaldehyde, acetaldehyde, acrolein. Considered a risk factor of chronic obstructive pulmonary disease (COPD), cancer, hemodynamic alterations, vascular disease, infectious diseases. Lead to addiction. Blachman, 2014

Tobacco Epidemic in Indonesia Cigarettes Vs Waterpipes Smoking Prevalence in Gulf Countries El-Awa F, 2010

Tobacco Epidemic in Indonesia Age-related waterpipe use patterns among college students in the USA Primack BA 2013

Tobacco Smoking Among Young Adult The Most Vulnerable Group Huge leaps in brain development  Physical and emotional* Source: US Surgeon General 2012

Although Indonesia regularly conducted household survey, further analysis of the survey published in peer review is scarce

Objectives This study aims to examine factor associated with waterpipes smoking behavior among High School Students in Jakarta

Cross Sectional School Based Survey Methods Cross Sectional School Based Survey General school (SMA) The sampling Technique: Multistage cluster random sampling with total sample were 1.318 studets. Subject: All male and female aged 15-19 years old Data Analysis: Chi Square Test and Binary Logistic Regression Variables: Independent Variables: Sociodemographic: Gender, School Location, parent’s education, parent’s working situation Social Influence: Smoking status of father, mother, sibling, close friend Accessibility: affordability, availability, ads exposure Outcome Variables: Cigarette Smoking (ever used)

Results & Discussions

Cigarettes Smoking Proportion Total Experimental: 16.9% Current: 5.7% Non Smoker: 77.4% Experimental: 23.4% Current: 8.4% Non Smoker: 68.2% In Male Experimental: 10.7% Current: 3.1% Non Smoker: 86.2% In Female N=1,318, female: 581, male: 439

Sociodemographic Sociodemographic Waterpipes Smoking p value No Yes Gender   Female 581 (86.1) 94 (13.9) <0.001* Male 439 (68.2) 205 (31.8) Age (years) 0.359 15-16 710 (78) 200 (22) 17-19 309 (75.7) 99(24.3) School location Suburban 653 (84) 124 (16) Downtown 367 (67.8) 174 (32.2) Parents education 0.009* ≤ Primary 35 (81.4) 8 (18.6) Secondary 534 (80.5) 129 (19.5) Higher 450 (73.5) 162 (26.5) Father working situation 0.608 Not Working 81 (79.4) 21 (20.6) Working 938 (77.2) 277 (22.8) Mother working situation 0.414 640 (78) 180 (22) 379 (76.1) 119 (23.9)

Social Influences Waterpipes Smoking Social Influences p value No Yes Parents Smoking   0.001 Neither of them 510 (82) 112 (18) Either Father or Mother 485 (73.5) 175 (26.5) Both of Them 25 (69.4) 11 (30.6) Sibling Smoking <0.001 872 (79.3) 227 (20.7) 147 (67.4) 71 (32.6) Close Friend Smoking 284 (93.1) 21 (6.9) 736 (72.7) 277 (27.3)

Accessibility Waterpipes Smoking Accessibility p value No Yes n (%) Availability   <0.001 528 (89.3) 63 (10.7) 492 (67.6) 236 (32.4) Affordability 654 (87.2) 96 (12.8) 366 (64.4) 202 (35.6) Exposure to Ads 0.029 857 (78.5) 235 (21.5) 163 (71.8) 64 (28.2)

Multivariate Analysis Being male were almost three times (AOR: 2.989, 95% CI: 2.197-4.066) more likely to become shisha smoker than female. Those who thought shisha was affordable and available were 2 times and more likely smoke shisha The odds of ever use shisha were higher among those who have parents, sibling and close friend smoking.

Discussions This study reported a total of 16.9% Jakarta students had ever tried shisha smoking at least one time in a life, another 5.7% were considered as current user (past 30 days). This rate is slightly higher than Vietnam’s study, prevalence of young adult (19-24 years old) who smoked shisha in past 30 days were 3% The relationship between shisha with parent’s smoking history is widely available. Parents smoking history were statistically significant different with shisha smoking (p<0.01). Friends also have significant influence to decision of smoking shisha (p<0.001). Limitation: Under reporting & only covered general type school owned by government.

Conclusions and Recommendations The prevalence for shisha smoking is quite high The stronger regulation to control non-cigarette smoking is needed Peer education program should be expanded to non-cigarette smoking Longitudinal research should be carried out to find out causal relationship of dual use and even triple use of tobacco smoking.

Acknowledgement The authors would like to express our gratitude for The 90th years anniversary of Chulalongkorn University Scholarship (Ratchadaphisek sompho Endowment Fund) for supporting this study.