BACKGROUND: The use of waterpipe and electronic cigarettes (e-cigarettes) is an emerging health crisis. These products have become increasingly popular among young people despite their addictive nature and health risks. This study explored South African university students’ accounts of how and why they initiated waterpipe and e-cigarette use
METHODS: Qualitative exploratory research design with semi-structured interviews conducted among 30 key informants who currently use waterpipe and/or e-cigarettes. Ten students aged 18-25yrs were purposively selected each from 3 universities located in the metro cities of Cape Town, Durban and Johannesburg in South Africa. Thematic analysis was used to analyze the data with the aid of NVivo v14.
RESULTS: Results were categorized under three major themes: How use was initiated, reasons for initiation and, use status of significant others. Participants described initial exposure to waterpipe and e-cigarettes through peer and familial interactions. The most common setting for initial exposure included social gatherings such as clubs, family gatherings, parties and the university environment. Reasons for initiation included peer and familial influence, as a coping mechanism used to ‘escape from reality’ or university stress, as a socialization tool, curiosity and experimentation and perception as an alternative to using other substances. Lastly participants reported observing the use of waterpipe, e-cigarettes, traditional cigarettes and other substances by their family members and friends hence the normalization of the use of these products.
CONCLUSIONS: The findings of the study reveal multiple ways and reasons in which students get exposed to initiating waterpipe and/or e-cigarette use. Influences such as peers and family remain influential routes to initiation. Efforts to de-normalize the use of these products in society would protect young people from initiating use.