The article by Daniels and Roman is a descriptive study of the perceptions about the waterpipe use by university students in the Western Cape, South Africa. This quantitative study aimed at investigating students’ attitudes towards a social phenomenon of waterpipe smoking. The reason for the conduction of the research was a popular belief that waterpipe smoking does less damage to one’s health when compared to cigarette smoking. Additionally, this belief was contrasted with the opinion that waterpipe smoke contains significantly higher doses of harmful substances. This information led the authors towards the suggestion that the real danger from waterpipe smoking is concealed with prejudices about the positive impact of water filtration. Thus, the transfer from a cultural to a social phenomenon makes waterpipe smoking one of the factors that add to cancer and respiratory disease statistics.
Therefore, the authors performed a cross-sectional study at one of the Western Cape universities. Their aim was to reveal the attitude patterns of students towards the discussed phenomena. Moreover, the results of the study indicated that students believed that the danger of waterpipe smoking was exaggerated. Additionally, they rejected the possibility of long-term addiction or adverse health effects. Consequently, the authors indicated the necessity of broadening the lists of universities for the research. Furthermore, they suggested that there was a need to review South African tobacco policies. Finally, one of their concerns was the early exposure of children to waterpipe smoking due to the beliefs that it is harmless.
The research question of the study was “What are the beliefs of the students associated with waterpipe smoking?” It proposed such research objective as to assess attitudes and associated behaviors regarding the health risks of smoking of the waterpipe. Only two studies on the waterpipe use were conducted in South Africa; thus, the authors indicated the need for advanced analysis of this subject. The results of previous studies caused scholar’s concerns and reasons for setting the research question. These research studies claimed that 60% of the participants smoked the waterpipe, which included 20% daily smoking. In addition, waterpipe smoking was considered dangerous because of risk-taking initiatives of substituting tobacco with alternative related products. Thus, there was a need for revealing the basic attitudes and behavior patterns of African students towards waterpipe smoking. As stated by the scholars, they investigated “the risk perceptions and behaviors of university student waterpipe users in the Western Cape in South Africa.
The research consisted of a cross-sectional study conducted in the Faculty of Community and Health Sciences. The reason for selecting the faculty was raising the awareness of the students of the risks associated with smoking the waterpipe. The scholars randomly selected several classes to participate in the study, hence applying random probability sampling method. The final scope of the participants included 389 self-selected students. The final samples of the research included 250 (64%) females and 139 (36%) males with a mean age of 22.2 (SD = 5.04) years. As for the ethnicity, about 50% participants identified themselves as Colored, 40% as Black African, 6% as Whites, and 4% as Indians. The data collection phase included the use of a self-administered questionnaire. The items for selection were developed at the University of Missouri in Columbia, USA and were the constituents of the Missouri College Health Behavior Survey.
Furthermore, the next stage of the research was a pilot study conducted with second-year students. The aim of the pilot study was to assure the validity and reasonability of the questions proposed for the research. Further analysis of the results of the pilot study allowed the scholars correcting the study tool. Consequently, the number of questions characterizing attitudes and behaviors was increased alongside with the improvement of the Likert scale from a 3-point to a 5-point one. In addition, the participants of the study were informed about its purpose, the utilization of the obtained data, and ethical considerations. Moreover, the study included the use of the Chi-square (X2) tests to trace the differences between the perceptions of the waterpipe smokers and non-smokers. The scholars analyzed the obtained data with the Statistical Package for Social Science (SPSS v 20.0). Among its independent variables of the study are the student’s are and chosen specialty whereas the dependent ones are daily occupation, academic success and activities associated with smoking.
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Findings and Implications
The findings of the study correlated with previous research studies on the subject. Thus, 40% of the respondents characterized themselves as waterpipe users. Consequently, the percentage of waterpipe smokers was higher than 18.6% and lower than 60% prevalence indicated by previous studies. At the same time, the questionnaire revealed that waterpipe smokers did not associate smoking with the health risk. Therefore, 43% of waterpipe smokers and 17% non-smokers believed that waterpipe has less nicotine. Additionally, 48% and 13% of them treated the dangers of such smoking as exaggerated as well as believed that the water filter removes tobacco toxins (44% and 27%). Moreover, the predominant part of the respondents (58% and 20%) believed that such behavior is non-addictive; therefore, smokers could easily quit (53% and 17%). One more fact to mention is that non-smokers believed that smoking the waterpipe might cause long-term health problems, affecting the respiratory and cardiovascular systems. The age of onset of smoking the waterpipe was 15.7 years.
Consequently, the results of the studies raised concerns about the need for waterpipe smoking management through legal regulations. Some of the reasons for this were the social acceptability of waterpipe smoking and the accessibility of the tobacco used for the waterpipe. These factors led to the fact that some of the students smoke waterpipe on campus on a daily basis. The scholars also presumed that the acceptability of the use of waterpipe was highlighted by the absence of legal regulations of the tobacco use in South Africa. It appears that though smoking tobacco is prohibited in public places in Africa, waterpipe smoking is not affected by any restricting policy. Such tendency supports the misconceptions of the safety of waterpipe smoking, which should be disproved. Therefore, the authors proposed performing broader studies in the universities in South Africa.
The proposed research will focus on a further investigation of the students’ behavior associated with waterpipe smoking. It will be a qualitative research aimed at investigating the attitudes and developed behaviors among waterpipe smokers of South African universities. Moreover, its questionnaire will be enhanced with the questions, which reveal the impact of waterpipe smoking on the quality of students’ lives. Thus, it will have a special focus on students who smoke waterpipe occasionally or on the daily basis. One presumes that regular smokers would have addictive behavioral patterns regulated by the customs or habits of casual waterpipe smoking. Additionally, the proposal has a hypothesis that the misjudgments revealed in the analyzed study of Daniels and Roman are shared among a broader range of student populations. Therefore, other students are also expected to demonstrate their unawareness of waterpipe smoking harm and its long-term health effects. Additionally, the research is expected to reveal the predomination of waterpipe smokers among the students of South African universities. Such assumption is the result of the analysis of the statistics of other research studies indicated by Daniels and Roman. Thus, there is a need to prove or disprove the above hypotheses, which would possibly impact the changes of the tobacco policies in South Africa.
The proposed study will include several research questions. The primary one is “What is the influence of waterpipe smoking on the behavioral patterns of the students of South African universities?" Alongside, the secondary question will coincide with the one selected by Daniels and Roman, namely “What are the beliefs of students associated with waterpipe smoking?" Their study is expected to be applied towards a broader range of audiences, including the on-campus and home waterpipe smoking. Moreover, the study will address the cases of substitution of waterpipe tobacco with other substances, including marijuana or other drugs. Therefore, the results of the analysis of the obtained statistics will impact the regional tobacco policies.
The basic methodological toolkit for the study will include a questionnaire, which will address several critical aspects. The selection of aspects leads to the need of subdividing the questionnaire into several sections. The first one would consider the attitudes of the participants towards the habits and the impact of waterpipe smoking. The next section would consider the influence of a habit of waterpipe smoking on the participant’s life. Therefore, the second part of the study will divide the participants on the experimental and control groups as proposed by White and McBurney. Both groups are supposed to answer the question of the factors that affect their ordinary life activity, habits, and health condition. The experimental group will consist of waterpipe smokers whereas the control group will comprise non-smoking individuals. Since there is a presumption that waterpipe smoking has long-term consequences, one suggests repeating the study during each of the semesters during the two years. It would allow identifying the changes of basic habits and the development of possible waterpipe addition. One suggests a two-year study because casual waterpipe smoking in Africa is regarded as smoking on the daily basis. This fact possibly impacts the development of addiction. Furthermore, there is a need to conduct the pilot study to approve the validity and the reasonability of questions and the answering scale. Moreover, the participants of the study will include an equal number of males and females of each ethnicity among the first- and second-year students. This measure is obligatory to assure the validity of the obtained results. One presumes that the processing of the obtained statistics should be performed with the help of SPSS v 20.0 as in the case of the study of Daniels and Roman.
Potential Findings and Implications
One assumes that the potential findings of the proposed research would approve the statistics revealed by the study of Daniels and Roman in broader audiences. Thus, one supposes that the number of waterpipe smokers would be about 50% of all populations. Moreover, the predominant part of them would support the misconception about the safety of waterpipe smoking. Additionally, about 10-15% of students are expected to substitute the waterpipe tobacco with other substances, including marijuana. As a result, the study predicts that waterpipe smoking would affect the habits of about 30% of students with almost half of them having a substance addiction. Therefore, the proposed study is expected to obtain the statistics necessary for initiating the waterpipe smoking regulation policies in South Africa. Moreover, it would add to the social awareness of the populations of South Africa about the danger of waterpipe smoking.