Knowledge About the Waterpipe (Hookah), a Qualitative Assessment Among Community Workers in a Major Urban Center in Canada

Waterpipe (WP) use has surged in popularity since the introduction of flavoured shisha. It is now an increasingly popular form of smoking among youth in North America. Health professionals/educators knowledge about the WP may well be inadequate. This study, using qualitative methods, sought to explore the knowledge and attitude of leaders in the community toward the WP. Family physicians, pharmacists, tobacco counsellors, social workers and educators were invited to participate in a one-one interview using open-ended questions. A total of 27 interviews were conducted. Individuals from Eastern Mediterranean backgrounds raised doubt about the overemphasised cultural significance of the WP and perceived this as a marketing strategy by industry. Most felt that WP smokers believed the WP to be less harmful than cigarettes and that the use of flavoured tobacco was motivating people to smoke. Participants believed that education should be directed at the general public and healthcare professionals, suggesting school programs and the use of social media to inform young smokers. Most thought that the current practices regarding packaging and second hand smoke exposure are confusing. They identified the lack of knowledge, poor enforcement procedures, "so called cultural aspects" and the economic impact of banning the WP on small businesses as barriers to change. Despite the awareness of an increase in WP use, our participants recognized that little has been done to curb this problem. Our findings emphasize the need for further education and better legislation to regulate WP use and availability.