title: Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional.
abstract: BACKGROUND
  When asserting the right of individuals to be free to smoke a hookah (waterpipe [WP]) in public places, the "cultural" importance of the practice is often cited. The purpose of this study was to explore the cultural significance of WP smoking.
  
  
  METHODS
  Qualitative methods were used to elicit the views of groups of WP smokers from different cultural backgrounds.
  
  
  RESULTS
  Sixteen group discussion sessions with a total of 75 WP smokers aged between 18 and 30 were conducted. A few participants saw culture as a factor supporting WP smoking initiation and maintenance. The vast majority indicated that WPs being perceived as "healthier" than cigarettes, and the availability of flavored shisha as important factors in their initiation and ongoing use. Most started smoking before the age of 18 calling it a "high school thing" and admitted that they had easy access to WP cafés. Many indicated that they did not know if they were smoking tobacco or a "herbal" substance.
  
  
  CONCLUSIONS
  Peer influence, availability of flavored products and facile access to WP cafés are major factors in WP initiation. Ethno-cultural traditions play only a minor role. The assertion that cultural traditions and practice are inherent in WP smoking as implied by media and marketing was not supported by our findings. Contemporary use of WP is spreading among new non-traditional users. Lack of knowledge about the harms of WP smoking indicates a need for education and regulation to require packaging and health warning labels and restrictions on access, especially to minors.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada;
authors.forename: Fadi
authors.initials: F
authors.lastname: Hammal
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada;
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada;
authors.forename: Candace
authors.initials: C
authors.lastname: Nykiforuk
authors.affiliation: Calgary Chinese Community Services Association, Calgary, AB, Canada.
authors.forename: Khadija
authors.initials: K
authors.lastname: Abdullahi
authors.affiliation: Calgary Chinese Community Services Association, Calgary, AB, Canada.
authors.forename: Dawit
authors.initials: D
authors.lastname: Mussie
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada; bfinegan@ualberta.ca.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Finegan
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000208:ethnology; D003469:Culture; D005260:Female; D017144:Focus Groups / Q000379:methods; D006801:Humans; D008297:Male; D012907:Smoking / Q000208:ethnology* / Q000523:psychology / Q000639:trends*; D016540:Smoking Cessation / Q000208:ethnology / Q000379:methods; D055815:Young Adult