An evidence based public campaign against waterpipe / hookah smoking in Turkey

Background and challenges to implementation Hookah use has been spreading rapidly in epidemic proportions in Turkey Intervention or response Both qualitative and quantitative pre-campaign research has been conducted in order to define the perception, attitudes and behaviors of the target population regarding hookah. In this stage we conducted focus group studies and a baseline survey encompassing interviews with 1288 people. As a result of the pre-campaign analyses, we observed that the level of awareness on the dangers of hookah was very low compared to that of cigarettes, that hookah was not perceived as a tobacco product, that it was preferred due its scents and flavors and that many false beliefs were propagated such as its smoke being less dangerous due to passing from water. Measurable objectives of our campaign, campaign strategies and concepts were defined according to the data collected through the pre-campaign analyses. We applied our campaign in four phases. In each phase of our campaign we delivered different messages and the public was gradually informed of hookah facts through the use of TV and radio ads, outdoor materials, newspaper inserts, brochures and banners, PR studies as well as the use of internet and social media. Results and lessons learnt Following the campaign we surveyed 1266 people.The results of the post-campaign evaluation show that the campaign was successful in establishing perceived risk of hookah, changing perception and attitudes and developing the intention of quitting smoking hookah among the target population. Conclusions and key recommendations Restrictions of flavored hookah tobacco would positively impact our struggle against prevalent hookah use, since the analyses of target population showed that 88% of users preferred flavored hookah. Legal restrictions on the fast spreading hookah cafes would also reduce the prevalence since hookah is perceived as a means of socialization in hookah bars. Legal and environmental regulations and restrictions are necessary in order to prevent the hookah epidemic