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

Background: In Nigeria, there is very limited evidence on factors that influence shisha smoking, and this hinders effective tobacco control policymaking. We, therefore, aimed to identify factors associated with shisha smoking among general population adults in Nigeria. Methods: We conducted a telephone-based, cross-sectional survey between 28th July and 11th September 2022 in 12 states. Our outcome of interest was self-reported current shisha smoking status, and the independent variables included potential behavioural, biological, mental health, environmental, and social determinants of shisha smoking. 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). We found sex differences in the factors associated with shisha smoking, particularly on the effects of household wealth, employment status, having family members who smoke shisha, and mental health Conclusions: Strategies to curb shisha smoking need to account for the associated biological, social and behavioural factors, including age, cigarette smoking, alcohol consumption, and having family members or close friends who smoke shisha. They should also account for sex differences, and differences that exist between shisha smoking behaviour and the smoking of other tobacco products.