An obvious change in youth tobacco use patterns worldwide to non-cigarette forms is be-ing observed; most notably water-pipe smoking (WPS). Social norms and culture have been suggested as important factors behind its spread. We aimed to assess university students' knowledge and attitudes towards WPS smoking and to examine the motivating factors behind its use. A cross-sectional study design with a random sample of 750 students was used. A pretested self-administered questionnaire was used to obtain the required data. Chi-squared test was used to assess between different groups. About 23% of the participants were classi-fied as current water-pipe smokers. The main reason reported for using it was enjoying its taste. Half of the participants agreed that their society approves it more than a cigarette, and 18% of the female students reported that their families accept their WPS. Additionally, cur-rent smokers have significantly higher percentages of incorrect information about its danger compared to non-current smokers. In conclusion, WPS appears to be more socially accepta-ble than cigarette smoking and is perceived as less harmful. Implementing intervention pro-grams to improve awareness of its harm, emphasizing on the misperceptions associated with its use, may reduce its use among university students.

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