title: Knowledge, attitudes and beliefs towards waterpipe tobacco smoking and electronic shisha (e-shisha) among young adults in London: a qualitative analysis.
abstract: Introduction Waterpipe tobacco smoking (WTS), known in the United Kingdom as shisha, is popular among adolescents worldwide. Some electronic cigarettes are marketed in the United Kingdom as 'electronic shisha' (e-shisha). This study aimed to understand how WTS users view e-shisha and whether it could be used as a harm-reduction or cessation aid.
  
  
  METHODS
  In-depth face-to-face interviews were conducted with 16 young adults recruited by snowball sampling in London, UK. Recurrent themes were derived iteratively through thematic analysis.
  
  
  RESULTS
  WTS is a socially acceptable activity, carried out at home or in a café. Peer influence and flavour play a key role in its use. Participants were aware of some health risks of WTS, although many accepted this risk and reported a need for more health-related WTS information. Although participants were familiar with e-shisha, there was no evidence of its use as a harm-reduction or cessation product. E-shisha tasted different to flavoured waterpipe tobacco and removed the positive social attributes typically ascribed to WTS. Waterpipe users felt e-shisha may encourage non-users to initiate cigarettes or WTS.
  
  
  CONCLUSIONS
  Opinions of reduced risk in using WTS may be due to the lack of available information, misconceptions and its easy accessibility. E-shisha does not appear to play a role in WTS harm reduction or cessation. On-going research efforts should test educational interventions addressing the adverse health impacts of WTS in this population group.
authors: 1Department of Primary Care and Population Health,University College London,London,UK.
authors: Shrinal
authors: S
authors: Kotecha
authors: 2Department of Primary Care and Public Health,Imperial College London,Hammersmith,London,UK.
authors: Mohammed
authors: M
authors: Jawad
authors: 1Department of Primary Care and Population Health,University College London,London,UK.
authors: Steve
authors: S
authors: Iliffe
mesh_terms: D000293:Adolescent; D066300:Electronic Nicotine Delivery Systems / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D036301:Qualitative Research; D012907:Smoking / Q000523:psychology*; D014867:Water; D055815:Young Adult; D014026:Nicotiana
chemical_list: D014867:Water
keywords: prevention; qualitative research; substance use; tobacco industry; treatment and intervention; youth tobacco use