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Policy-relevant context of waterpipe tobacco smoking among university students in six countries across the Eastern Mediterranean region: A qualitative study
Asian Pacific Journal of Cancer Prevention
  • Ramzi G. Salloum, University of Florida
  • Niveen Abu-Rmeileh, Birzeit University
  • Randah Hamadeh, Arabian Gulf University
  • Justin Thomas, Zayed University
  • Aya Mostafa, Ain Shams University, Faculty of Medicine
  • Afzalhussein Yusufali, Dubai Medical College
  • Khalid A. Kheirallah, Jordan University of Science and Technology
  • Mark M. Macauda, University of South Carolina
  • Ryan P. Theis, University of Florida
  • Lama El Kadi, American University of Beirut
  • Evan J. Johnson, University of Florida
  • Muhammad W. Darawad, The University of Jordan
  • Rima Nakkash, American University of Beirut
Document Type
Publication Date

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.

Asian Pacific Organization for Cancer Prevention
  • Eastern Mediterranean,
  • Hookah,
  • Policy,
  • Qualitative,
  • Shisha,
  • Waterpipe
Scopus ID
Indexed in Scopus
Open Access
Citation Information
Ramzi G. Salloum, Niveen Abu-Rmeileh, Randah Hamadeh, Justin Thomas, et al.. "Policy-relevant context of waterpipe tobacco smoking among university students in six countries across the Eastern Mediterranean region: A qualitative study" Asian Pacific Journal of Cancer Prevention Vol. 18 Iss. 9 (2017) p. 2533 - 2540 ISSN: <a href="" target="_blank">1513-7368</a>
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