{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T05:39:28Z","timestamp":1793338768975,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Waterpipe tobacco smoking is becoming increasingly popular in the West among young people. Given the associated health risks of this behaviour, we aimed to investigate why young adults take up waterpipe tobacco smoking and their attitudes to the associated risks. Methods: This was a qualitative study, with a phenomenological perspective. Focus groups and face-to-face semi-structured interviews were conducted among waterpipe smokers aged 20\u201330 years living in London, UK. Transcripts were analysed using constant comparison and cycling between the data and analysis. Data collection continued until thematic saturation was achieved. Results: Sixteen smokers attended focus groups and face-to-face interviews. Seven main themes emerged encompassing four main dimensions relating to: lack of knowledge, perceived risk, affordability, and social addiction. Waterpipe was perceived to be safer than cigarette smoking due to the pleasant odour, fruity flavours, and belief that water filtered the toxins. The waterpipe had become a \u201csocial addiction\u201d enhancing group atmosphere, was cheap and did not have the dangers of violence or hallucinations associated with other addictions like alcohol and drugs. Because of their intermittent smoking patterns and the lack of statutory warnings, none felt they were not at risk of any adverse side effects. Conclusions: Waterpipe smoking is a growing public health problem; the social environment associated with its use is perceived to be a positive outlet by smokers who do not consider it harmful to their health. These perceptions need to be addressed urgently by anti-smoking policies.<\/jats:p>","DOI":"10.3390\/dj8040134","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T08:59:34Z","timestamp":1607590774000},"page":"134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Perceptions of Waterpipe Smoking among Young Adults: A Phenomenological Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-113X","authenticated-orcid":false,"given":"Amraj.","family":"Dhillon","sequence":"first","affiliation":[{"name":"Heart Centre, The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Doran","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York YO10 5DD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal.","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"School of Dentistry, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"key":"ref_1","unstructured":"WHO Study Group on Tobacco Product Regulation (TobReg) (2015). Advisory Note: Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators, WHO Press."},{"key":"ref_2","first-page":"CD003439","article-title":"Impact of Tobacco Advertising and Promotion on Increasing Adolescent Smoking Behaviours","volume":"10","author":"Lovato","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.5588\/ijtld.12.0175","article-title":"Waterpipe Smoking: Prevalence and Attitudes among Medical Students in London","volume":"17","author":"Jawad","year":"2013","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jawad, M., Choaie, E., Brose, L., Dogar, O., Grant, A., Jenkinson, E., McEwen, A., Millett, C., and Shahab, L. (2016). Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146799"},{"key":"ref_5","first-page":"32","article-title":"The Effects of Waterpipe Tobacco Smoking on Health Outcomes: An Updated Systematic Review and Meta-Analysis","volume":"46","author":"Waziry","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3546","DOI":"10.1016\/j.fct.2008.09.007","article-title":"Volatile Aldehydes in the Mainstream Smoke of the Narghile Waterpipe","volume":"46","author":"Shihadeh","year":"2008","journal-title":"Food Chem. Toxicol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.fct.2004.12.013","article-title":"Polycyclic Aromatic Hydrocarbons, Carbon Monoxide, \u201ctar\u201d, and Nicotine in the Mainstream Smoke Aerosol of the Narghile Water Pipe","volume":"43","author":"Shihadeh","year":"2005","journal-title":"Food Chem. Toxicol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4137\/TUI.S39873","article-title":"A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes","volume":"9","author":"Haddad","year":"2016","journal-title":"Tob. Use Insights"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sadeghi, R., Mahmoodabad, S.S.M., Fallahzadeh, H., Rezaeian, M., Bidaki, R., and Khanjani, N. (2019). A Systematic Review about Educational Interventions Aimed to Prevent Hookah Smoking. Int. J. Ayurvedic Med., 14\u201321.","DOI":"10.47552\/ijam.v10i1.1180"},{"key":"ref_10","first-page":"718","article-title":"Alternative Forms of Tobacco Use","volume":"12","author":"Prignot","year":"2008","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13027-018-0178-5","article-title":"Prevalence of Human Papillomavirus Infection among Iranian Women Using COBAS HPV DNA Testing","volume":"13","author":"Jamdar","year":"2018","journal-title":"Infect. Agents Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/ije\/dyq002","article-title":"The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review","volume":"39","author":"Akl","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1477-7517-10-12","article-title":"Motives, Beliefs and Attitudes Towards Waterpipe Tobacco Smoking: A Systematic Review","volume":"10","author":"Akl","year":"2013","journal-title":"Harm Reduct. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Jackson, D., and Aveyard, P. (2008). Waterpipe Smoking in Students: Prevalence, Risk Factors, Symptoms of Addiction, and Smoke Intake. Evidence from One British University. BMC Public Health, 8.","DOI":"10.1186\/1471-2458-8-174"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1477-7517-7-10","article-title":"Narghile (Water Pipe) Smoking among University Students in Jordan: Prevalence, Pattern and Beliefs","volume":"7","author":"Bakri","year":"2010","journal-title":"Harm Reduct. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12160-008-9047-6","article-title":"Prevalence of and Associations with Waterpipe Tobacco Smoking among U.S. University Students","volume":"36","author":"Primack","year":"2008","journal-title":"Ann. Behav. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Arshad, A., Matharoo, J., Arshad, E., Sadhra, S.S., Norton-Wangford, R., and Jawad, M. (2019). Knowledge, Attitudes, and Perceptions Towards Waterpipe Tobacco Smoking amongst College or University Students: A Systematic Review. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6680-x"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ghafouri, N., Hirsch, J.D., Heydari, G., Morello, C.M., Kuo, G.M., and Singh, R.F. (2011). Waterpipe Smoking among Health Sciences University Students in Iran: Perceptions, Practices and Patterns of Use. BMC Res. Notes, 4.","DOI":"10.1186\/1756-0500-4-496"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1617-9625-11-4","article-title":"A Descriptive Study of the Perceptions and Behaviors of Waterpipe Use by University Students in the Western Cape, South Africa","volume":"11","author":"Daniels","year":"2013","journal-title":"Tob. Induc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1617-9625-5-16","article-title":"Perceptions of Hookah Smoking Harmfulness: Predictors and Characteristics among Current Hookah Users","volume":"5","author":"Aljarrah","year":"2009","journal-title":"Tob. Induc. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1080\/14622200701591591","article-title":"Waterpipe Smoking and Nicotine Exposure: A Review of the Current Evidence","volume":"9","author":"Neergaard","year":"2007","journal-title":"Nicotine Tob. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1111\/add.12265","article-title":"To What Extent Should waterpipe Tobacco Smoking Become a Public Health Priority?","volume":"108","author":"Jawad","year":"2013","journal-title":"Addiction"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Roskin, J., and Aveyard, P. (2009). Canadian and English Students\u2019 Beliefs About Waterpipe Smoking: A Qualitative Study. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-10"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nakkash, R.T., Khalil, J., and Afifi, R.A. (2011). The Rise in Narghile (Shisha, Hookah) Waterpipe Tobacco Smoking: A Qualitative Study of Perceptions of Smokers and Non Smokers. BMC Public Health, 11.","DOI":"10.1186\/1471-2458-11-315"},{"key":"ref_25","unstructured":"Rice, P.L., and Ezzy, D. (1999). Qualitative Research Methods: A Health Focus. Chronic Diseases in Canada, Oxford University Press."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13011-017-0128-z","article-title":"Licit and Illicit Substance Use Patterns among University Students in Germany Using Cluster Analysis","volume":"12","author":"Schilling","year":"2017","journal-title":"Subst. Abus. Treat. Prev. Policy."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Committee on Improving the Health Sf, and Well-Being of Young Adults, Board on Children Yu, and Families, Medicine Io, Council NR (2015). Investing in the Health and Well-Being of Young Adults. J. Adolesc. Health, 56, 127\u2013129.","DOI":"10.1016\/j.jadohealth.2014.11.012"},{"key":"ref_28","unstructured":"British Heart Foundation Media Release (2014, March 01). \u2018Rise in \u2018Shisha Bars\u2019 Prompts Warning on Dangers of Waterpipe Smoking\u2019. Available online: https:\/\/www.bhf.org.uk\/default.aspx?page=14417."},{"key":"ref_29","unstructured":"World Health Organisation (2011). Tobacco Questions for Surveys. A Subset of Key Questions from the Global Adult Tobacco Survey (GATS), Centre for Disease Control and Prevention. [2nd ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/08870449608400256","article-title":"Beyond the Divide between Cognition and Discourse: Using Interpretative Phenomenological Analysis in Health Psychology","volume":"11","author":"Smith","year":"1996","journal-title":"Psychol. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1136\/tc.2007.020529","article-title":"A Pleasure among Friends: How Narghile (Waterpipe) Smoking Differs from Cigarette Smoking in Syria","volume":"17","author":"Hammal","year":"2008","journal-title":"Tob. Control"},{"key":"ref_32","unstructured":"Glaser, B.G., and Strauss, A.L. (2000). The Discovery of Grounded Theory: Strategies for Qualitative Research, Aldine Transaction."},{"key":"ref_33","first-page":"103","article-title":"Comparing Harm Beliefs and Risk Perceptions among Young Adult Waterpipe Tobacco Smokers and Nonsmokers: Implications for Cessation and Prevention","volume":"7","author":"Lipkus","year":"2018","journal-title":"Addict. Behav. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1002\/cncr.29992","article-title":"The Potential Impact of Prophylactic Human Papillomavirus Vaccination on Oropharyngeal Cancer","volume":"122","author":"Guo","year":"2016","journal-title":"Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/tobaccocontrol-2011-050350","article-title":"Indoor Air Quality in Virginia Waterpipe Cafes","volume":"22","author":"Cobb","year":"2013","journal-title":"Tob. Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.puhe.2016.12.028","article-title":"Waterpipe Tobacco Smoking Prevalence and Illegal Underage Use in Waterpipe-Serving Premises: A Cross-Sectional Analysis among Schoolchildren in Stoke-on-Trent","volume":"146","author":"Jawad","year":"2017","journal-title":"Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"18","DOI":"10.26719\/2020.26.1.18","article-title":"Self-Reported Addiction to and Perceived Behavioural Control of Waterpipe Tobacco Smoking and Its Patterns in Egypt: Policy Implications","volume":"26","author":"Mostafa","year":"2020","journal-title":"East. Mediterr. Health J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"i13","DOI":"10.1136\/tobaccocontrol-2014-051906","article-title":"The Allure of the Waterpipe: A Narrative Review of Factors Affecting the Epidemic Rise in Waterpipe Smoking among Young Persons Globally","volume":"24","author":"Akl","year":"2015","journal-title":"Tob. Control"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"440","DOI":"10.5993\/AJHB.38.3.13","article-title":"Understanding Psychosocial Aspects of Waterpipe Smoking among College Students","volume":"38","author":"Sharma","year":"2014","journal-title":"Am. J. Health Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3399\/bjgp12X625030","article-title":"Shisha Guidance for GPs: Eliciting the Hidden History","volume":"62","author":"Jawad","year":"2012","journal-title":"Br. J. Gen. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"E165","DOI":"10.5888\/pcd9.120082","article-title":"Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States","volume":"9","author":"Morris","year":"2012","journal-title":"Prev. Chronic Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1136\/tc.2009.031773","article-title":"Health Warning Labelling Practices on Narghile (Shisha, Hookah) Waterpipe Tobacco Products and Related Accessories","volume":"19","author":"Nakkash","year":"2010","journal-title":"Tob. Control"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/8\/4\/134\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:43:18Z","timestamp":1760179398000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/8\/4\/134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,10]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["dj8040134"],"URL":"https:\/\/doi.org\/10.3390\/dj8040134","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,10]]}}}