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.

Conclusion: 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.

Figure 1

Family attitude towards participants (café customers, university students) waterpipe smoking showing more tolerant attitude for women's waterpipe smoking compared to men's. This unique observation marks the first incident in this region where a smoking method by women is more tolerated than by men.

Figure 2

Self-perceived dependence among waterpipe smokers according to their frequency of waterpipe use (café customers compared to students). It shows that dependence is related to frequency of use, and that at comparable level of use, established smokers among café customers are more likely to perceive themselves as being hooked on the waterpipe compared to students.