Knowledge About the Waterpipe (Hookah), a Qualitative Assessment Among Community Workers in a Major Urban Center in Canada

Abstract

Waterpipe (WP) use has surged in popularity since the introduction of flavoured shisha. It is now an increasingly popular form of smoking among youth in North America. Health professionals/educators knowledge about the WP may well be inadequate. This study, using qualitative methods, sought to explore the knowledge and attitude of leaders in the community toward the WP. Family physicians, pharmacists, tobacco counsellors, social workers and educators were invited to participate in a one-one interview using open-ended questions. A total of 27 interviews were conducted. Individuals from Eastern Mediterranean backgrounds raised doubt about the overemphasised cultural significance of the WP and perceived this as a marketing strategy by industry. Most felt that WP smokers believed the WP to be less harmful than cigarettes and that the use of flavoured tobacco was motivating people to smoke. Participants believed that education should be directed at the general public and healthcare professionals, suggesting school programs and the use of social media to inform young smokers. Most thought that the current practices regarding packaging and second hand smoke exposure are confusing. They identified the lack of knowledge, poor enforcement procedures, "so called cultural aspects" and the economic impact of banning the WP on small businesses as barriers to change. Despite the awareness of an increase in WP use, our participants recognized that little has been done to curb this problem. Our findings emphasize the need for further education and better legislation to regulate WP use and availability.

Perceptions and Experiences with Flavored Non-Menthol Tobacco Products: A Systematic Review of Qualitative Studies

“…Ten studies examined flavors in waterpipe or hookah (hereafter referred to as hookah), most of which were studies from Western countries (Scotland, Canada, UK, U.S.) (see Table 2) [18,19,20,21,22,23,24,25,26,27] . In all ten studies, participants spoke about flavors as appealing and/or tasty; in five of the studies, participants also spoke positively about the widespread availability of different flavors and the ability to mix flavors [18,22,24,26,27].…”

“…In two studies from Canada and Lebanon, adult users and non-users of hookah said that flavors were a reason why younger people used hookah [21,24], and in one study among young adults in Canada, flavors were mentioned as the reason for initiating use of hookah: “I think it had to do with the flavor that got me to smoke it. It has a lot of variety” [20].…”

“…In one study among young adults in the UK, users described being addicted to hookah, in part because of flavors [22]. Lastly, in a study with 27 adults in Canada, most participants felt that there should be additional restrictions on flavored hookah [21]. …”

“…Thus, our findings point to regulation of all flavored tobacco products, including e-cigarettes, since they are heavily marketed to youth and may be detrimental to brain development and for future tobacco product use. Furthermore, in two studies included in our review (one involving adults’ opinions of hookah; one involving adolescents’ opinions of e-cigarettes), individuals reported favorable attitudes toward regulation of flavored hookah and e-cigarettes as a way to deter youth initiation of tobacco [21,32]. These findings may be useful to tobacco regulatory agencies as further evidence regarding the importance of regulation of flavored non-menthol tobacco products, as well as the acceptability of potential regulation.…”

Factors Influencing Hookah Smoking in High School Students

“…The size, shape and tobacco used in the nargile vary in different regions (7). The most commonly used form of nargile nowadays consists of the head, body, bowl (usually made out of glass), hose, and mouthpiece (7)(8)(9). This type of nargile and its use refer to the consumption of nargile containing flavored tobacco (apple, watermelon, strawberry, cappuccino, etc.)…”