Policy-Relevant Context of Waterpipe Tobacco Smoking among University Students in Six Countries Across the Eastern Mediterranean Region: A Qualitative Study

Document Type : Research Articles


1 Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.

2 Institute of Community and Public Health, Birzeit University, Birzeit, Palestine.

3 College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.

4 Department of Natural Science and Public Health, College of Sustainability Sciences and Humanity, Zayed University, Abu Dhabi, United Arab Emirates.

5 Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

6 Dubai Medical College, Dubai, United Arab Emirates.

7 Department of Public Health and Community Medicine, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

8 Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

9 Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.

10 Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan.


Background: Waterpipe tobacco smoking rates in the Eastern Mediterranean region are some of the highest worldwide, especially among young people. This study aimed to improve our knowledge of the policy-relevant context of waterpipe smoking among six countries in the Eastern Mediterranean region. Methods: In-depth interviews were conducted in Bahrain, Egypt, Jordan, Lebanon, Palestine, and the United Arab Emirates. Participants were young adult university students (18-29 years) from both genders who had ever smoked the waterpipe, recruited from universities participating in this study. Directed content analysis was used to analyze the transcripts. Results: A total of 53 in-depth interviews were conducted in Arabic in 2016. Findings were organized around 5 themes: waterpipe product characteristics; patterns of waterpipe smoking; the waterpipe café setting; perceived health consequences; and health warning labels. Waterpipe smoking was commonly perceived as a safe alternative to cigarettes. Waterpipe tobacco was reported to be widely accessible and affordable to young participants. There is a lack of knowledge among waterpipe smokers about the associated health effects. Warning labels are effective at communicating health risks associated with waterpipe smoking. Conclusions: Regulatory frameworks for waterpipe tobacco smoking should be developed and enforced, including waterpipe-specific health warning labels that elucidate the harmful effects of waterpipe smoking.


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