Factors associated with the use of waterpipe and other tobacco products among students, Brazil, 2015

Malta, Deborah Carvalho; Hallal, Ana Luiza Curi; Machado, Ísis Eloah; Prado, Rogério Ruscitto do; Oliveira, Patrícia Pereira Vasconcelos de; Campos, Maryane Oliveira; Souza, Maria de Fátima Marinho de

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 (suppl 1) • 2018 • https://doi.org/10.1590/1980-549720180006.supl.1 copy

Factors associated with the use of waterpipe and other tobacco products among students, Brazil, 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To identify the frequency and factors associated with the use of waterpipe and other tobacco products among Brazilian students.

Methods:

This is a cross-sectional study based on data from the National Adolescent Student Health Survey. The sample consisted of 9th-grade students from elementary school. We conducted a descriptive analysis of the use of tobacco products in 2012 and 2015. To explore the relationship between the use of other tobacco products and factors such as sociodemographic characteristics, family, mental health, and life habits, we calculated the adjusted odds ratio.

Results:

The use of other tobacco products increased from 4.8% (95%CI 4.6 - 5.0) in 2012 to 6.1% (95%CI 5.7 - 6.4) in 2015, with a higher proportion among boys. Waterpipe was the most commonly used product in 2015 (71.6%; 95%CI 68.8 - 74.2), especially among girls. Factors positively associated with the use of other tobacco products were: attending private school, living with father/mother, working, not having friends, suffering domestic violence, skipping classes, consuming cigarettes and alcohol, experimenting drug, having had sex, having smoker parents or guardians, and seeing people smoking. The protective factors were: female gender, increasing age, multiracial or indigenous people, having meals with a guardian, family supervision, and practicing physical activity.

Conclusion:

The use of other tobacco products was high and has been increasing in recent years, particularly waterpipe. It is important to raise awareness of the risks and monitor the use of these products, as well as improve public policies of tobacco control in the country.

Keywords:
Tobacco use disorder; Adolescents; Smoking water pipes; Health promotion; Tobacco products; Health surveys

Use of other tobacco products	Total		Male		Female
Use of other tobacco products	%	95%CI	%	95%CI	%	95%CI
Hookah (waterpipe)	71.6	(68.8 - 74.2)	51.8	(47.7 - 55.8)	67.5	(64 - 70.7)
Hand-rolled cigarettes (straw or paper)	13.5	(11.6 - 15.6)	12.9	(10.8 - 15.2)	9.3	(7.2 - 11.9)
Clove cigarettes (Bali cigarettes)	4.6	(3.7 - 5.7)	4.2	(3.2 - 5.5)	3.4	(2.4 - 4.8)
Electronic cigarette (e-cigarette)	3.2	(2.4 - 4.4)	3.3	(2.3 - 4.8)	2	(1.2 - 3.4)
Chewing tobacco	2.4	(1.8 - 3.3)	2.7	(1.9 - 3.9)	1.2	(0.7 - 2.2)
Cigars, small cigars	2	(1.4 - 2.9)	2.6	(1.7 - 3.9)	0.7	(0.4 - 1.2)
Cigarillos	1.4	(0.9 - 2.0)	1.8	(1.2 - 2.9)	0.4	(0.2 - 0.7)
Indian cigarettes (beedis)	1.3	(0.8 - 1.9)	1.5	(1.0 - 2.2)	0.6	(0.3 - 1.1)
Other	17.3	(14.9 - 19.9)	19.2	(16 - 22.9)	15.1	(12.7 - 17.8)

Variable	%	95%CI	OR_na	95%CI	p-value	OR_a	95%CI	p-value
Total	6.1	(5.9 - 6.2)
Age (years)
< 13	4.8	(3.1 - 7.3)	1.0	(0.6 - 1.6)	0.98	1.6	(0.9 - 2.8)	0.096
13	4.7	(4.3 - 5.2)	1.0	-	-	1.0	-	-
14	5.3	(4.9 - 5.7)	1.1	(1.0 - 1.2)	0.004	0.7	(0.7 - 0.8)	< 0.001
15	8.2	(7.6 - 8.9)	1.8	(1.7 - 2.0)	< 0.001	0.6	(0.5 - 0.7)	< 0.001
16 and older	7.9	(7.4 - 8.4)	1.7	(1.6 - 1.9)	< 0.001	0.4	(0.3 - 0.4)	< 0.001
Gender
Male	6.5	(6.2 - 6.9)	1.0	-	-	1.0	-	-
Female	5.6	(5.4 - 5.8)	0.9	(0.8 - 0.9)	< 0.001	0.8	(0.8 - 0.9)	< 0.001
Ethnicity/skin color
White	6.4	(5.5 - 7.4)	1.0	-	-	1.0	-	-
Black	6.8	(5.9 - 8)	1.1	(1 - 1.2)	0.047	0.9	(0.8 - 1.0)	0.139
Asian	5.6	(4.7 - 6.8)	0.9	(0.8 - 1.0)	0.069	0.9	(0.7 - 1.0)	0.097
Multiracial	5.6	(4.9 - 6.5)	0.9	(0.8 - 0.9)	< 0.001	0.9	(0.8 - 0.9)	< 0.001
Indigenous	5.4	(4.7 - 6.2)	0.8	(0.7 - 1.0)	0.029	0.7	(0.6 - 0.8)	< 0.001
School
Public	6.2	(5.8 - 6.7)	1.0	-	-	1.0	-	-
Private	5.2	(4.8 - 5.6)	0.8	(0.8 - 0.9)	< 0.001	1.1	(1.0 - 1.2)	0.037
Currently working
No	5.2	(4.9 - 5.5)	1.0	-	-	1.0	-	-
Yes	11.6	(11 - 12.1)	2.4	(2.3 - 2.5)	< 0.001	1.2	(1.1 - 1.3)	< 0.001
Paid work
No	5.3	(5 - 5.6)	1.0	-	-	-	-	-
Yes	11.6	(11 - 12.2)	2.4	(2.2 - 2.5)	< 0.001	-	-	-
Lives with mother and/or father
No	7.4	(6.7 - 8.1)	1.0	-	-	1.0	-	-
Yes	6.0	(5.8 - 6.1)	0.8	(0.7 - 0.9)	< 0.001	1.2	(1.1 - 1.4)	0.002
Has meals with a guardian
No	10.9	(10 - 11.8)	1.0	-	-	1.0	-	-
2 or less times a week	8.5	(8 - 9)	0.8	(0.7 - 0.8)	< 0.001	1.0	(0.9 - 1.1)	0.719
3 to 4 times a week	7.8	(6.9 - 8.7)	0.7	(0.6 - 0.8)	< 0.001	0.9	(0.7 - 1.1)	0.186
5 or more times a week	5.1	(4.9 - 5.2)	0.4	(0.4 - 0.5)	< 0.001	0.8	(0.7 - 0.9)	0.001
Feels lonely
No	5.3	(5.0 - 5.6)	1.0	-	-	1.0	-	-
Yes	9.7	(9.3 - 10.2)	1.9	(1.8 - 2.0)	< 0.001	1.2	(1.1 - 1.3)	0.001
Insomnia
No	5.4	(5.1 - 5.8)	1.0	-	-	-	-	-
Yes	10.6	(10.1 - 11.2)	2.1	(1.9 - 2.2)	< 0.001	-	-	-
Friends
One or more	5.9	(5.3 - 6.5)	1.0	-	-	1.0	-	-
None	9.1	(8.2 - 9.9)	1.6	(1.4 - 1.8)	< 0.001	1.2	(1.0 - 1.4)	0.033
Physical assault (by a family member)
No	4.7	(4.4 - 4.9)	1.0	-	-	1.0	-	-
Yes	13.8	(13.2 - 14.3)	3.3	(3.1 - 3.5)	< 0.001	1.4	(1.3 - 1.5)	< 0.001
Family supervision
No	10.0	(9.5 - 10.5)	1.0	-	-	1.0	-	-
Yes	4.0	(3.9 - 4.2)	0.4	(0.4 - 0.4)	< 0.001	0.8	(0.8 - 0.9)	< 0.001
Skips classes without telling the parents
No	4.2	(4 - 4.4)	1.0	-	-	1.0	-	-
Yes	12.1	(11.6 - 12.5)	3.1	(3.0 - 3.3)	< 0.001	1.3	(1.3 - 1.4)	< 0.001
Regular tobacco use
No	4.6	(4.2 - 5.0)	1.0	-	-	1.0	-	-
Yes	61.0	(59.1 - 62.9)	32.6	(30.0 - 35.5)	< 0.001	4.6	(4.2 - 5.0)	< 0.001
Drinks alcohol regularly
No	1.7	(1.6 - 1.9)	1.0	-	-	1.0	-	-
Yes	19.8	(19.3 - 20.3)	14.0	(13.1 - 14.9)	< 0.001	5.2	(4.8 - 5.6)	< 0.001
Drug experimentation
No	3.0	(2.8 - 3.1)	1.0	-	-	1.0	-	-
Yes	37.1	(36.1 - 38.2)	19.3	(18.2 - 20.4)	< 0.001	5.0	(4.7 - 5.4)	< 0.001
Sexual intercourse
No	2.9	(2.7 - 3.0)	1.0	-	-	1.0	-	-
Yes	14.3	(13.9 - 14.7)	5.6	(5.3 - 6.0)	< 0.001	1.7	(1.6 - 1.8)	< 0.001
People smoked in the student’s presence
No	2.7	(2.5 - 2.8)	1.0	-	-	1.0	-	-
Yes	9.3	(9.1 - 9.6)	3.8	(3.5 - 4.0)	< 0.001	1.6	(1.5 - 1.8)	< 0.001
Smoker parents or guardians
No	4.7	(4.5 - 5.0)	1.0	-	-	1.0	-	-
Yes	9.0	(8.7 - 9.4)	2.0	(1.9 - 2.1)	< 0.001	1.2	(1.1 - 1.2)	< 0.001
Daily physical activity
No	5.9	(5.6 - 6.3)	1.0	-	-	1.0	-	-
Yes	6.6	(6.2 - 6.9)	1.1	(1.1 - 1.2)	0.001	0.9	(0.8 - 1.0)	0.008

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[1] Corresponding author: Deborah Carvalho Malta. Avenida Alfredo Balena, 190, Santa Efigênia, CEP: 30130-100, Belo Horizonte, MG, Brasil. E-mail: dcmalta@uol.com.br