Social and Behavioral Determinants of Nargila Smoking among Israeli Youth

Background: Nargila (also known by Hookah, Hubble-Bubble, Water Pipe and
Shisha), is a device for smoking, which works by water-filtration and indirect heat. The
use of substances, such as tobacco, herbs and even hard drugs in the device, is common.
Over the past decade nargila smoking using mainly tobacco, is an accepted behavior
among teenagers in Israel. This study examines nargila smoking among teenagers in
relation to family and school problems. Also, the study examines risk behaviors, such as
cigarette smoking, alcohol use and violence, in their background.
Methods: This article presents findings from the international study data of the
HBSC (Health Behavior in School-aged Children), conducted by the World Health
Organization. The Israeli representative sample consists of data collected from 6,681, 6th,
8th and 10th grade school children. Sampling consists of data from the Jewish and Arab
state, secular and religious, school systems)
Results: This study shows a statistically significant association between nargila
smoking and involvement with other health risk behaviors. Strong predictors in the use of
nargila as a onetime experience as well as weekly use, correlate with a history of cigarette
smoking, drunkenness and violence. Nargila, use with tobacco, follows patterns
expressed in two sociological theories; "The Problem Behavior Theory" and the "The
Gateway Theory" leading to the use of more dangerous substances.
Conclusions: These findings suggest that causes that influence nargila smoking
also influence other risk behaviors, which in turn, effect this pass-time occupation. There
is need for a State prevention program and protocol that consists of educating students,
parents, teachers and public representatives about the risks of this accepted behavior and
habit.