action that might negatively affect health, such as smoking or taking drugs 2 .Cigarette consumption continues to rise worldwide 4 , and tobacco consumption is increasing in Saudi Arabia 1,5 . In 2010, the World Health Organization (WHO) estimated that about 16% of Saudi Arabia's population smoked (approximately 3.1 million people) 6,7 . The WHO Eastern Mediterranean Region (EMRO) has the highest growth rate in the cigarette market, even though significant reductions in smoking rates have occurred in the United Kingdom, Australia, Brazil, and other countries 4 . Several studies on tobacco ABSTRACT INTRODUCTION Novel tobacco products are becoming more popular in the Middle East and especially in Saudi Arabia. We studied the prevalence of midwakh pipe (tobacco smoking pipe) use among students at Qassim University and evaluated factors associated with midwakh pipe usage. METHODS A cross-sectional study was conducted using a self-administered questionnaire to collect the data. The participants were male students from Qassim University, Al-Qassim, Saudi Arabia. Data were collected over the period from May to June 2018. A multivariable logistic regression model was used to identify sociodemographic factors and smoking history related to midwakh smoking. RESULTS A total of 316 responses were collected; 7.9% (n=25) were midwakh smokers at some point, and 3.8% (n=12) were current midwakh smokers. Multivariable logistic regression indicated that the significant predictors of midwakh smoking among male university students were having a friend who is a tobacco or midwakh smoker, and consuming other forms of tobacco other than midwakh. CONCLUSIONS Having midwakh smoking friends, having friends smoking any other form of tobacco, and being a smoker could predict the use of midwakh among university male students in Saudi Arabia. Interventions are required to control this behavior to prevent smoking-related health consequences.