Waterpipe smoking among public and private university students in Ankara, Turkey: an online survey | BMC Public Health


Study design, setting and participants

A cross-sectional (descriptive) online survey was conducted among university students in Ankara, the capital of Turkey, during the 2018-2019 academic year. In that year, there were 12 private universities and 7 public universities in Ankara. The number of university students in Ankara, the target population, was 26,781 men, 26,674 women in private universities and 72,627 men and 80,607 women in public universities. [12].

Survey instrument

To collect the data, a questionnaire (prepared in SurveyMonkey) was used. The questionnaire included 46 questions on socio-demographic characteristics, smoking habits and knowledge-attitudes towards smoking. (Please see additional questionnaire information.) It was developed by researchers adopting questions from internationally validated questionnaires (specifically, the World Health Organization’s Global Adult Tobacco Survey and the CDC [18]). To further validate the questionnaire, the questions were reviewed by experienced tobacco control researchers in Turkey, and a pilot test of the online survey was also conducted to ensure that the questions were clear and the survey was going smoothly. It took an average of 6 to 7 minutes to complete the questionnaire. Permission was obtained by the authors from the respective university ethics committees prior to data collection.


It aimed to obtain a representative sample of students enrolled in public and private universities in Ankara. Two private universities and one public university were invited to participate. One of the private universities was invited as it was the oldest in Ankara and had a large number of enrolments. The other two universities were invited because the researchers were associated with them. At the time of the survey, there were 11,014 (5,881 male and 5,133 female) and 5,245 (2,702 male and 2,543 female) undergraduate students at the two private universities, and 35,331 (14,894 male and 20,437 women) undergraduate students in the public university. .

Student affairs or related administrative departments of universities have been requested to send the invitation email to all registered students via the registered student email addresses. The criteria for including participants was to be an undergraduate student at one of the three universities. The invitation email included general information about the study and the link to the online questionnaire. Reminder emails were sent every 3-4 weeks. The investigation remained open for almost 3 months. The students answered the study questionnaire on a voluntary basis; they received no inducement. Informed consent was obtained from all participating students; no student was under the age of 18. The convenience sample (non-probabilistic), made up of students who participated in the survey, included 1,362 and 1,215 students in private universities and 2,731 students in the public university. Of a total of 51,590 students invited to the study, 5,308 responded, giving a response rate of 10.3%.

The measurement

WP Demographics and Usage Pattern

Data on demographic characteristics included gender and age. The status of WP use was determined on the basis of its use, relying on the question “Have you ever smoked WP?” because WP use is a major risk factor for future tobacco product use. If participants had ever smoked WP, ​​their smoking habits (i.e. surveyed.

Indicators of socio-economic status

Family income or wealth were not asked for in the survey, due to the difficulty of accurately measuring these variables in voluntary online surveys. Instead, the survey included three other questions to help assess socioeconomic status (SES): whether the student had access to a car (regardless of ownership); Student lifestyle (four categories: living in dormitory, living alone (outside dormitory), living at home with family or sharing residence with friends); and Student’s source of income (three categories: family, scholarships, work). In the analyses, the binary (indicator) variable “Has a car” and the categorical variables “Lifestyle” and “Source of income” were used as indicators of the students’ SES.

Additionally, to summarize the information in the three variables described above, an SSE index was generated. The SES index [19] was developed by calculating the first principal component of eight binary variables: has a car, lives with family, lives in a dormitory, lives alone, has one or more roommates, source of income: family support, source of income: scholarship studies and source of income: work . Using the first principal component factor scores as weights, an SES index was constructed for each student in the data set.

Statistical methods

Stata/MP 15.1 was used to perform statistical analyses. Descriptive statistics were reported for never and never smoker WPs by private and public university students. Among water pipe users, descriptive characteristics on water pipe usage patterns were presented. To test whether students at private universities had the same prevalence rate or similar characteristics as those at public universities, p-values ​​from chi-square tests were used. Binary logistic regressions, where the outcome variable always used WP, ​​were used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for associated factors (gender, age, having access to a car, lifestyle, source of income). Binary logistic regression was also estimated for the associated factors of sex, age and SES index. To compare the aORs between public and private university students, aOR equality tests were carried out. Regressions were estimated in samples of private and public university students separately, as well as in the pooled sample, where a binary (dummy) variable for being a private university student was added as another associated factor.


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