1. 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

2. 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

3. 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

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

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

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

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

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

9. 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 studets.
Subject: All male and female aged 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)

10. Results & Discussions

11. 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

12. 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)

13. 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)

14. 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)

15. Multivariate Analysis
Being male were almost three times (AOR: 2.989, 95% CI: ) 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.

16. 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.

17. 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.

18. 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.