title: Comparison of patterns of use, beliefs, and attitudes related to waterpipe between beginning and established smokers.
abstract: BACKGROUND
  To compare patterns of use, beliefs, and attitudes related to waterpipe smoking between university students (beginning smokers) and cafe customers (established smokers) in Aleppo Syria, in order to explore the evolution of this smoking method.
  
  
  METHODS
  Two cross-sectional surveys were conducted among representative samples of university students (total 587, 48.4% men, mean age 22 years), and waterpipe users among cafe' customers (total 268, 60% men, mean age 30 years) in Aleppo, Syria. We used interviewer-administered questionnaire inquiring about pattern of waterpipe smoking (initiation, frequency), situational characteristics of use (partner, place, sharing), beliefs related to waterpipe smoking (harmful/addictive properties of waterpipe), attitudes related to waterpipe smoking (confidence in quitting, will to quit, motivation for quitting, past year quit attempt), and cigarette smoking.
  
  
  RESULTS
  Daily and regular patterns of smoking become more prevalent with increased duration of smoking, but intermittent smoking remains the predominant pattern of waterpipe use. Women seem to be drawn later to the habit, which seem to escape the usual taboo against women's cigarette smoking. Patterns and context of waterpipe use tend to change with progress of the practice affecting frequency, setting, and sharing of waterpipe. Unlike beginners, established waterpipe smokers seem more smoking-method oriented, more hooked on the habit, less willing to quit, and less likely to foresee challenges to quitting.
  
  
  CONCLUSIONS
  Use patterns and attitudes related to waterpipe smoking evolve to accommodate the change in dependence and life circumstances of the smoker. Most of use features, beliefs, attitudes, as well as time-course seem unique to this smoking method requiring novel approach to intervention.
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria. taghrid@scts-sy.org
authors.forename: Taghrid
authors.initials: T
authors.lastname: Asfar
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.forename: Thomas
authors.initials: T
authors.lastname: Eissenberg
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D015995:Prevalence; D012147:Restaurants; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology*; D012938:Social Perception; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D013593:Syria / Q000453:epidemiology; D013997:Time Factors; D014495:Universities; D014867:Water
chemical_list: D014867:Water
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