While data describing the prevalence of water pipe tobacco smoking are available to support public health policy in some EMR countries, product info those data are lacking for others. For example, Jordan is an EMR country where 48% of men and 10% of women smoke tobacco cigarettes (Shafey, Dolwick, & Guindon, 2003); however, water pipe tobacco smoking prevalence is uncertain. Clearly, public health interventions addressing smoking are appropriate, and the extent to which these interventions include water pipe tobacco smoking may depend upon the availability of reliable data demonstrating its prevalence as well as factors that may contribute to this behavior. Because water pipe tobacco smoking is common in university students in Syria, Lebanon, and the United States (Cobb et al.

, 2010), our first look at the prevalence of this behavior in Jordan focused on this population. The primary purpose of this study was to assess the prevalence of water pipe tobacco smoking among university students in Jordan. In order to determine the most appropriate populations for targeting of interventions, we also aimed to determine the association between water pipe tobacco smoking and major sociodemographic factors, such as age, gender, income, and marital status. Also in order to assist with development of future interventions, our third and final aim in this study was to assess the association between perception of harm and addiction of water pipe tobacco use and water pipe tobacco smoking among the studied population.

Methods Design, participants, and setting This cross-sectional study involved administration of a questionnaire by a trained interviewer from March to July 2008. The study was conducted at four large prominent universities in Jordan��Jordan University of Science and Technology (JUST), Yarmouk University, Irbid National University, and Jerash Private University. Of the 25 universities in Jordan, 10 are public and 15 are private. Thus, we selected similar proportions for our study sites: JUST and Yarmouk are public, while Irbid and Jerash are private. Procedures The study protocol was approved by the Institutional Review Board of JUST. Informed GSK-3 consent was obtained from all participants before all interviews. In order to select participants randomly, we used a two-stage cluster sampling strategy. In the first stage, main campus regions (a.k.a., ��yards��) were randomly selected from a list of all such yards at each participating university. Roughly one third (19 of 59 total yards) were selected. In the second stage, we utilized a systematic random sampling procedure that involved selecting every seventh student to enter the selected yard. Using this sampling strategy, 735 undergraduate students were invited to participate in the study.