Factors associated with shisha smoking: a cross-sectional telephone-based survey among general population adults in Nigeria

Background This is the first national-level study to identify factors associated with shisha smoking among general population adults in Nigeria where high prevalence rates have been reported. Methods We conducted a telephone-based, cross-sectional survey between 28th July and 11th September 2022 in 12 states. We performed logistic regression analysis, with adjusted odds ratios (aORs) and 95% confidence intervals (CI) as the measures of association. Findings We surveyed 1278 individuals: 611 who currently smoked shisha and 667 who did not. The following increased the likelihood of being a person who currently smokes shisha: being a person who currently smokes cigarettes (aOR=5.54, 95% CI 2.57 to 11.90) or consumes alcohol (aOR=3.46, 95% CI 1.91 to 6.28); and having a family member (aOR=2.32, 95% CI 1.23 to 4.40), or one (aOR=22.81, 95% CI 9.99 to 52.06) or more (aOR=78.85, 95% CI 22.50 to 276.33) close friends who smoke shisha. The following reduced the likelihood of being a person who currently smokes shisha: being older (aOR=0.92, 95% CI 0.89 to 0.95) and screening positive for possible generalised anxiety disorder (aOR=0.60 95% CI 0.41 to 0.88). The following did not have an effect on current shisha smoking status: sex, level of education, employment status, household wealth, religion, rural/urban residence, perceived stress score, and screening positive/negative for possible major depressive disorder. Conclusions Strategies to curb shisha smoking need to account for the associated social and behavioural factors, including age, cigarette smoking, alcohol consumption, and having family members or close friends who smoke shisha. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Bill & Melinda Gates Foundation (INV-009670). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The National Health Research Ethics Committee, Nigeria gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at Development Gateway: An IREX Adventure. (2023). Development Gateway shisha study quantitative data: a cross-sectional survey investigating factors associated with shisha use in Nigeria [Data set]. Zenodo. https://doi.org/10.5281/zenodo.7775958