Water-pipe tobacco epidemic in tobacco naive communities: Experience from Ethiopia*

Water-pipe tobacco (WPT) is a public health threat of the 21st century. As a fashion, it swiftly spreads to all corners of the world in no more than two decades. It is a new phenomenon for Ethiopiain general and for Amhara National Regional Statein particular. The major objective of this study was to gain in-depth baseline information about water-pipe tobacco smoking practice in Bahir Dar City, 2012. An explorative study was conducted at Bahir Dar City—capital of Amhara National Regional State. It is home for one of the largest universities in the country with more than 40,000 students. Of the total 50 WPT lounges, six were identified based on their customer variety, and loaded by the help of police officers who had ample experience in fighting the expansion of WPT smoking in the city. A total of 115 people participated in this study. In-depth interviews and focus group discussions (FGD) were conducted, and the tape recorded data were thematically analyzed. More than 80% of the study participants were below 40 Years, and more than 30% of the total study participants were students. The profession of the remaining participants ranges from daily laborers to university instructors. Females accounted for 37.39%. The following factors were found to be pertinent for rapid increment of water-pipe tobacco smoking: geographic and economic accessibility, peer pressure, deceiving characteristics of WPT-non-irritant and aromatic, lack of knowledge, and absence of effective policy. The most outstanding findings of this study were the following: almost all of the study participants were tobacco naive and really unaware of the contents WPT; but about 94% of them had been khat chewers before they started with WPT smoking. In this region, khat had until recently been used by the Muslims only. WPT smoking is an even more recent phenomenon. “Khat stimulates, and WPT calms down,” said study participants. That means by using the later as an antidote for the former, people start ruining their health with substances containing chemicals proven to be notorious to human health. This combination of deadly addictions seems to be peculiar to Ethiopia and appears to be a serious public health threat to tobacco naive communities in the region. Therefore, their rapid progression needs to be met with appropriate interventions urgently. It also warrants further investigations.