The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally

Abstract

ObjectiveThe objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review.Data sourcesThe following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms.Study selectionArticles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years.Data extractionArticles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results.Data synthesisThe review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels.ConclusionsThe review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.

Young adult waterpipe tobacco users’ perceived addictiveness of waterpipe tobacco

“…Responses could include multiple themes so counts within these groups are not mutually exclusive. Participants' responses to the closed-ended items are consistent with research indicating young adults do not perceive WTS to be addictive and believe they can easily quit 21 . Although research indicates WTS is influenced by a number of factors, such as social use and product features like appealing flavorings, studies have consistently shown that such WTS perceptions are associated with waterpipe tobacco initiation and current use [54][55][56][57][58][59] .…”

“…Open-ended items. Open-ended questions were developed for this study based on prior research on waterpipe tobacco use behavior, perceptions, and addiction 13,20,21 . These questions probed at perceptions of the addictiveness of WTS, thoughts on what it means to be addicted to WTS, and feedback on what message content may be effective to convey the addictiveness of WTS.…”

“…Despite evidence to the contrary, many young adults maintain the belief that WTS is less addictive than cigarettes [20][21][22] . However, much of the evidence on young adults' WTS beliefs and perceptions comes from population surveillance surveys [20][21][22] .…”

“…However, much of the evidence on young adults' WTS beliefs and perceptions comes from population surveillance surveys [20][21][22] . There is limited research on the potential reasons underlying the perception that WTS is less addictive than cigarette smoking among young people [23][24] .…”

Waterpipe smoking among secondary school students in Hong Kong

“…Of the few studies on adolescents, most, if not all, have been based on Western (e.g., Canada, the US and UK) or Middle East populations (Akl et al 2015;Zyoud et al 2014). Cigarette smoking is the most important predictor of waterpipe use among adolescents (Barnett et al 2009;Jawad et al 2015a, b;Minaker et al 2015;Palamar et al 2014;Smith et al 2011;Weglicki et al 2008).…”