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Title: Policy-relevant context of waterpipe tobacco smoking among university students in six countries across the Eastern Mediterranean Region: a qualitative study
Authors: Salloum, Ramzi G. 
Abu-Rmeileh, Niveen M. E. 
Hamadeh, Randah Ribhi 
Thomas, Justin 
Mostafa, Aya 
Yusufali, Afzalhussein 
Kheirallah, Khalid A. 
Macauda, Mark M. 
Theis, Ryan P. 
El Kadi, Lama 
Johnson, Evan J. 
Darawad, Muhammad W. 
Nakkash, Rima 
Keywords: College students - Tobacco use - Eastern Mediterranean Region;College students - Hookahs use - Eastern Mediterranean Region;College students - Health and hygiene - Eastern Mediterranean Region
Issue Date: 2017
Abstract: 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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