Sociocultural and Demographic Predictors of Hookah Smoking Behavior in the Eastern Province of Saudi Arabia

Abstract

Background. The prevalence of hookah smoking in Saudi Arabia is rising, particularly among young adults. In response to this public health concern, the Saudi government implemented a 100% tobacco excise tax and altered hookah lounge licensing regulations in 2019. However, the sociocultural and demographic factors influencing smoking behavior remain understudied.
Aim. This study aimed to assess the relationship between hookah lounge availability, taxation, and smoking behavior, and to explore how demographic and social factors such as gender, age, income, and peer influence affect hookah consumption in the Eastern Province of Saudi Arabia.
Methods. A cross-sectional, internet-based survey was conducted from February to March 2020 among 1,670 adults residing in the Eastern Province. The survey, based on validated tools, included questions on smoking status, preferred tools, social influence, lounge availability, and income. Descriptive statical tests were performed using SPSS with a P< 0.05 was considered statistically significant.
Results. Out of 1,670 participants, 30% were smokers, the majority of whom were males (69%) and aged 21–30 years (46%). A significant association was found between smoking status and hookah lounge availability (P< 0.001). While the 100% tax led to reduced lounge visits (P = 0.002), it did not significantly change overall smoking rates (71% reported no change in behavior). Social influence was strongly associated with smoking, with 84% of smokers reporting increased desire to smoke in the presence of peers. The monthly income level was significantly associated with lounge visitation patterns (P = 0.008), but not with perceived financial impact (P = 0.203).
Conclusion. Social acceptance and peer environments are major drivers of hookah use in Saudi Arabia. Although taxation reduced public smoking settings, it did not alter overall consumption. Effective tobacco control must extend beyond economic measures to address sociocultural determinants through peer-led, education-based, and zoning-specific interventions.