Social determinants of health and frequency of hookah use among adults in Saudi Arabia: a cross-sectional study

Background: Hookah smoking has become increasingly popular in Saudi Arabia, particularly among young adults. Despite rising prevalence, limited research has investigated how social determinants of health (SDOH) influence the frequency of use in this context. Objective was to examine the relationship between SDOH and the frequency of hookah use among adults in Saudi Arabia. Methods: A cross-sectional study was conducted from October to December 2023 using an online questionnaire distributed in both Arabic and English. Adults aged 18 and above who reported current hookah use were included. The survey captured demographic characteristics and smoking behaviors. Descriptive statistics, chi-square tests, and ordinal logistic regression were used to analyze the data. Results: A total of 227 participants completed the survey. Most respondents were Saudi nationals (75.8%), with 54.2% being male. Daily hookah use was reported by 38.8% of participants. Statistically significant associations were found between hookah use frequency and both education level (p=0.045) and place of use (p<0.001). Home use was most common among daily users, while café use was linked to occasional use. Income, gender, marital status, and employment were not significantly associated with use frequency. Conclusions: Education level and setting of hookah use significantly influence frequency of smoking in Saudi Arabia. Findings suggest that public health policies should target specific environments and education groups to reduce hookah consumption and its associated health risks.