An observational study of group waterpipe use in a natural environment.
BACKGROUND
To date research on tobacco smoking with a waterpipe (hookah, narghile, and shisha) has focused primarily on the individual user in a laboratory setting. Yet, waterpipe tobacco smoking is often a social practice that occurs in cafés, homes, and other natural settings. This observational study examined the behavior of waterpipe tobacco smokers and the social and contextual features of waterpipe use among groups in their natural environment.


METHODS
Trained observers visited urban waterpipe cafés on multiple occasions during an 8-month period. Observations of 241 individual users in naturally formed groups were made on smoking topography (puff frequency, duration, and interpuff interval [IPI]) and engagement in other activities (e.g., food and drink consumption, other tobacco use, and media viewing).


RESULTS
Most users were male in group sizes of 3-4 persons, on average, and each table had 1 waterpipe, on average. The predominant social features during observational periods were conversation and nonalcoholic drinking. Greater puff number was associated with smaller group sizes and more waterpipes per group, while longer IPIs were associated with larger group sizes and fewer waterpipes per group. Additionally, greater puff frequency was observed during media viewing and in the absence of other tobacco use.


CONCLUSIONS
Overall, the results suggest that waterpipe smoking behavior is affected by group size and by certain social activities. Discussion focuses on how these findings enhance our understanding of factors that may influence exposure to waterpipe tobacco smoke toxicants in naturalistic environments.
Department of Psychology, Center for Neuroscience, West Virginia University, Morgantown, WV;
Melissa D
MD
Blank
Kirk Warren
KW
Brown
Robert J
RJ
Goodman
Thomas
T
Eissenberg
D000328:Adult; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis; D008297:Male; D012907:Smoking; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data
D014028:Tobacco Smoke Pollution