Waterpipe tobacco smoking: What's so sexy?

Background: Waterpipe tobacco smoking is re-emerging in the Eastern Mediterranean region and in the West as a popular mode of smoking tobacco particularly among women and youth. As a result, waterpipe tobacco smoking prevalence is increasing worldwide. Of major concern is that waterpipe tobacco smokers often have little knowledge about its detrimental health effects.

Objectives: To explore the social norms and attitudes associated with waterpipe smoking in Lebanon.

Methods: A total of 34 focus group discussions and in-depth interviews were conducted in Lebanon during the summer of 2007. Data was collected from waterpipe and non-waterpipe smokers across gender, age groups, urban/rural regions and socio-economic, marital, and employment status. The interviews and focus groups were transcribed in Arabic and thematic analysis was conducted.

Results: The findings indicated a deep rooted socio-cultural dimension to waterpipe tobacco smoking. One of the main themes that emerged from the findings was how waterpipe tobacco smoking conveys various sexual connotations. The messages are mainly expressed by the smoker's body language and the way they hold the hose, vent the smoke, etc. Moreover, waterpipe smokers have developed their own language and set of smoking etiquette.

Conclusion: The social attributes and dimensions of waterpipe tobacco smoking need to be taken into consideration while developing tailored prevention and cessation interventions.