[Water-pipe tobacco smoking among school children in Israel: frequencies, habits, and attitudes]

Harefuah. 2003 Nov;142(11):736-41, 807.
[Article in Hebrew]


Background: Tobacco smoking via a water-pipe (Nargile) is a new phenomena among school children in Israel in recent years. Water-pipe tobacco has the potential for nicotine addiction, for other smoking-related damages and for drug abuse.

Goals: Our primary goal was to characterize the frequencies of water-pipe smoking among school children in Israel, its distribution according to age, gender, habits and attitudes. The secondary goal was to compare its use to cigarette smoking among these school children.

Methods: A self-reported questionnaire was distributed among 388 school children (ages 12-18 years old) in grades A, and C, of middle schools and grade B of high schools in a central region of Israel. The questionnaires were answered unanimously and the process was conducted in classes by the school teacher and by nursing school students.

Results: Among all school children in this study, 41% smoke a water-pipe at various frequencies. Of all the children, 22% smoke at least every weekend. Water-pipe smoking was 3 times more frequent than cigarette smoking and was almost equally distributed among both genders, but girls were heavier smokers than boys, of either water pipe or cigarette smoking. Six percent of water-pipe smokers add psychoactive drugs or alcohol to the tobacco. The main reasons for water-pipe smoking were the pleasure achieved and the intimacy that it adds to the youngsters' meetings. Ninety percent of all the school children believe that water-pipe smoking is not healthy, but at least 50% believes it is less harmful than cigarettes. According to school children that smoke water-pipes at least every weekend, 40% of their parents are current or ex-smokers of water-pipes, in contrast with 10% of parents to non-smoking children and about a quarter of the children who smoke also do so together with their parents.

Conclusions: Tobacco smoking via water-pipes is a very common phenomena among middle and high school children in Israel. Girls are heavier smokers and adding drugs or alcohol to water-pipe tobacco is a fact. School children and their parents perceive that tobacco smoking via water-pipe is much safer than cigarette smoking. These alarming findings call upon the need for aggressive intervention by the Ministries of Education and Health, as well as the Anti-Drug Authority. More rigorous efforts should be implemented in terms of education and dissemination of the data regarding known hazards among schoolteachers, parents and school children. Further research is also necessary in order to prevent other ominous and camouflaged modalities of nicotine addiction at an early age.

Publication types

  • Comparative Study
  • English Abstract

MeSH terms

  • Adolescent
  • Attitude to Health
  • Child
  • Female
  • Health Education
  • Humans
  • Incidence
  • Israel / epidemiology
  • Male
  • Nicotine
  • Sex Characteristics
  • Smoking / epidemiology*
  • Students, Nursing
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / prevention & control
  • Surveys and Questionnaires
  • Water


  • Water
  • Nicotine