How Do Waterpipe Smoking Establishments Attract Smokers? Implications for Policy

Abstract

Background: Given the unique social nature of waterpipe smoking, an important factor contributing to its popularity is the spread of waterpipe establishments. Objectives: With a focus on implications for regulations, we conducted a qualitative assessment of customers’ online reviews on Yelp.com to gain insight into their positive and negative perceptions about waterpipe establishments and products, and identify features that are most important to them. Methods: In June 2016, an online search of Yelp was conducted to identify waterpipe establishments in Miami, Florida. First, we collected information from the websites on establishments’ characteristics and their marketing practices. Then we selected customers’ water-pipe-related reviews and used an inductive qualitative method to code and identify key themes associated with positive and negative customers’ experiences. Thematic analysis was completed upon reaching saturation. The final coding scheme consisted of 32 codes within eight themes. Results: The homepage of the establishment was used to promote special discounts and events, while the online waterpipe menu was used to promote the waterpipe products. Our thematic analysis indicated that the variety of flavored tobacco was the most rated positive factor to customers, while the low-quality charcoal and high price were the most negative factors. Conclusions/Importance: Waterpipe online advertisements and promotions should be monitored and restricted. The availability of flavored tobacco, innovative device/accessories, affordable pricing, and charcoal quality are important domains for water-pipe establishments policy/regulation. Regulatory framework for waterpipe establishments should address the complex context of waterpipe including the venue (i.e., physical, website, menu), the tobacco, the device/accessories, and charcoal.

Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use

“…Attractiveness of the flavored waterpipe products that produce smoke with a mild taste and pleasant smell in contrast to the harsher taste and smell of traditional tobacco, may increase preference for product use, thereby indirectly increasing toxicity. Especially, young adults prefer the mild taste and pleasant smell of smoke from flavored waterpipe tobacco and wrongly perceive the product as a less harmful or even harmless alternative to cigarette smoking 21,24 .…”

“…Charcoal quality was recognized as an important theme for visitors that reviewed waterpipe smoking establishments on the free online platform and social networking site Yelp (Yelp.com) 21 . Visitors preferred establishments were organic and natural charcoal were used.…”

“…Visitors preferred establishments were organic and natural charcoal were used. Low quality charcoal was one of the most negative factors in reviews of establishments; visitors referred to quick-light charcoals and reported to dislike them for their chemical flavour 21 .…”

“…This prevents smoking cessation and may induce a gateway effect towards cigarette smoking. Other characteristics of WPS that increase attractiveness are the price of the tobacco product and nicotine content 21,22 . In addition, the socializing aspect of waterpipe smoking may positively influence attractiveness.…”

“…Visitors of waterpipe smoking establishments prefer the use of charcoal and even more specifically, high quality charcoal. Visitors dislike quick-light charcoal because of its chemical flavour 21 . Charcoal is a known source of CO and various toxicants associated with a range of human health effects 33 .…”