Junior doctors and waterpipe tobacco smoking

Rawaf et al ¹ present data from three small studies that add to the growing body of evidence that waterpipe tobacco smoking is an increasing public health concern in the UK.² Ismail’s study corroborates previous work showing that 76% of waterpipe-only users would answer ‘no’ to the question ‘Do you smoke?’.³ This is an important consideration for tobacco monitoring in primary care.

Much UK waterpipe tobacco smoking research has focused on large cities, and none on healthcare professionals themselves. We surveyed 65 junior doctors in Stoke-on-Trent, a small city in the West Midlands, (100% response rate) and a further 100 junior doctors across the West Midlands (21.5% response rate) using a 10-item, anonymous, cross-sectional questionnaire about prevalence and knowledge of waterpipe tobacco smoking.

All doctors were either foundation year one or two trainees, and were mainly female (58%) and non-cigarette smokers (86%). Additionally, 65% identified themselves as being of white ethnicity, 24% of South Asian ethnicity and the remainder from other ethnicities. Over half (57%) had tried waterpipe tobacco smoking at least once, although past-30 day use was low (4%). Only one-quarter claimed to have a ‘good’ understanding of waterpipe tobacco smoking, although 20% claimed to not know much about it. The remainder (55%) had heard of waterpipe tobacco smoking and knew about certain aspects.

One third of doctors (32%) incorrectly believed waterpipe tobacco smoking was less harmful than cigarettes, and 32% incorrectly believed waterpipe tobacco smoking did not have the same legislative requirements as cigarettes. Only 5% had asked patients about waterpipe tobacco smoking as part of a tobacco history, but two-thirds (63%) would give cessation advice to waterpipe users should the opportunity arise.

These data show an alarmingly high number of junior doctors have tried shisha at least once, and that their knowledge about its health effects and legislation were poor. These are similar findings to those of Rawaf et al, who showed a higher prevalence of ever waterpipe tobacco smoking among medical students in London (79%). In Imperial College London, 55% of medical students had tried waterpipe tobacco smoking and 40% thought it was safer than cigarettes.⁴ Waterpipe tobacco smoking health awareness should start in medical school as part of the wider public health and primary care curriculum. More research is needed into the epidemiology of waterpipe tobacco smoking in the UK and its relationship to tobacco cessation programmes.