Water pipe tobacco smoking among youth: a study of social determinants, attitudes and perceptions of smokers in Kinondoni municipality, Dar es Saalaam region

Abstract

Background: The prevalence of water pipe tobacco smoking in developing nations like Tanzania and worldwide is increasing. Globalization and migration which have been acting like powerful engines in the spread and the rise of water pipe smoking have eventually brought the dangerous habit in Tanzania which is popularly known as Shisha. Since Water pipe smoking is emerging as serious problem of public health importance globally, there is dire need to study critically its positive predictors, patterns of smoking and health effects and disseminate the findings to guide formulation of interventions to address this emerging global public health issue. Objective: The objective of this study was to gain an in depth understand of the factors related to water pipe tobacco among the youth of Kinondoni municipality. That is, to study how social determinants, local beliefs, attitudes, perceptions and the attached social, cultural and functional meanings of that type of smoking are influencing the initiation (the uptake),maintenance and even the cessation (quitting) of the water pipe tobacco smoking. Methodology: The type of study is Phenomenology and data from study participants was collected through semi structured interviews. The participants (interviewees) were picked by using one of the types of Purposive Sampling which is known as Maximum Variation Sampling. The collected data was analyzed using constant comparative analysis which is a process whereby data collection and analysis are done on ongoing basis. Findings: A total of 44 (32 males and 12 females) study participants were interviewed. A majority, 69% percent of participants were below 25 years .Almost a third of these participants were students, very few participants have permanent employment and majority are either unemployed or self employed with small business activities. Again, the majority have secondary school education and low income individuals. The dominant themes which emerged from the interviews were peer pressure, availability, affordability, fashionable trend, relaxation, addiction, lack of knowledge, health problems, cultural and social context, and the water pipe tobacco smoking in relation to Cigarettes and Marijuana smoking. The local beliefs related to water pipe tobacco among young smokers are centered on addiction, contents, harmfulness and the danger of the water pipe tobacco vis-à-vis Cigarette and Marijuana smoking. In turn beliefs, perceptions and misconceptions are responsible in informing the positive and favorable attitudes of young smokers towards water pipe tobacco. Social determinants in terms of education level, monthly income, employment status, occupation and social relations seem to have a direct influence in smoking behavior. The water pipe tobacco smoking behavior is attached to various social, cultural and functional meanings. Conclusion and Recommendations: The smoking of water pipe tobacco or Shisha is increasingly becoming popular among young men and young women in most cities and major towns of the country. The reasons for the growing popularity of this type of tobacco smoking are many but prominent among them are misguided beliefs, attitudes, perceptions, poor knowledge of the contents and health effects of Shisha smoking, the rising availability and economic accessibility of the water pipe tobacco, a lenient tobacco control policy and lack of health information. Before water pipe tobacco smoking can become a serious problem of public health importance in the country, evidence-based public health and policy strategies are required to equip the youth and the whole public to make informed decisions about water pipe tobacco smoking. The recommended measures are formulation of comprehensive tobacco control policy, high taxation on Shisha products, graphic health warnings on water pipes and water pipe tobacco and implementing FCTC policies and strategies. To address the issues of knowledge, beliefs, attitudes and perceptions, educational interventions are required. And lastly, more studies are required on water pipe tobacco smoking especially epidemiological studies on the health problems experienced by the water pipe tobacco smokers and country wide quantitative studies to establish the estimated number of smokers and the gravity of the situation.