title: Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region.
abstract: Waterpipe tobacco smoking (WTS) is on the rise globally, particularly among vulnerable populations such as youth and women. Increasing knowledge about toxicant yield from waterpipe tobacco and deleterious health effects points to the potential for a health epidemic. WTS is often viewed as a safe alternative to cigarette smoking. Though the original objective of the research was to explore the social norms and attitudes that lead to waterpipe being a more acceptable form of tobacco smoking for women than cigarettes in the Eastern Mediterranean Region, the use of a qualitative research methodology resulted in rich data that helped to understand more generally the phenomenon of waterpipe smoking. Both focus group discussions (FGDs) and key informant interviews were used. Participants were recruited to represent genders, various age groups, socioeconomic status, waterpipe smoking status, and residents of urban and rural areas. A total of 81 FGDs and 38 in-depth interviews were conducted in 2007. Thematic analysis was used to analyze the transcripts. A total of ten themes emerged: socio-cultural norms, gender differences, motivation to smoke, sensory characteristics of waterpipe, metaphors, consumerism, indicators of dependence, comparison between cigarettes and waterpipe, health effect of smoking, and intervention. Results indicated that WTS has socio-cultural dynamics associated with it that are far more pronounced than health considerations. An increased socio-cultural acceptability, the perceived reduced harm and the advent of the fruity Moassel tobacco are among the many reasons for WTS acceptability. Findings point to the need for a unified strategy to address this health issue at all levels of the ecological framework and have important implications for future policy and practice.
authors: Department of Health Promotion and Community Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors: Rima
authors: R
authors: Afifi
authors: Department of Health Promotion and Community Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors: Joanna
authors: J
authors: Khalil
authors: Syrian Center for Tobacco Studies, Aleppo, Syria.
authors: Fouad
authors: F
authors: Fouad
authors: Department of Anesthesiology and Pain Medicine, University of Alberta, Alberta, Canada.
authors: Fadi
authors: F
authors: Hammal
authors: Egyptian Smoking Prevention Research Institute, Egypt.
authors: Yara
authors: Y
authors: Jarallah
authors: Department of Health Promotion and Community Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
authors: Hala
authors: H
authors: Abu Farhat
authors: Sociology Department, Faculty of Social Sciences, Brown University, RI, United States.
authors: Maha
authors: M
authors: Ayad
authors: Department of Health Promotion and Community Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. Electronic address: rn06@aub.edu.lb.
authors: Rima
authors: R
authors: Nakkash
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001290:Attitude; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D036301:Qualitative Research; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D012938:Social Perception; D055815:Young Adult
keywords: Addiction; Egypt; Lebanon; Palestine; Smoking; Social norms; Syria; Waterpipe