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Circumventing tobacco control and safety policies to promote waterpipe use in smoking venues: the perspective of staff in waterpipe smoking venues
  1. Jung Jae Lee1,
  2. Karly Cheuk Yin Yeung2,
  3. Man Ping Wang1,
  4. Sally Thorne3,
  5. Henry Sau Chai Tong4,
  6. Vienna Lai4
  1. 1 School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
  2. 2 Department of Psychology, University of Bath, Bath, Somerset, UK
  3. 3 School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Hong Kong Council on Smoking and Health, Wanchai, Hong Kong
  1. Correspondence to Dr Jung Jae Lee, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F William MW Mong Block Building, 21 Sassoon Rd, Pokfulam, Hong Kong; leejay{at}


Objective To understand Hong Kong waterpipe smoking (WPS) sales and promotion, including strategies to avoid policy enforcement, from the perspective of WPS venue staff.

Methods Qualitative interviews and observations were guided by interpretive description. 20 WPS venue staff who were responsible for preparing and serving waterpipes to patrons and had worked at the bar for at least 3 months were recruited. In-depth semistructured interviews with WPS venue staff were conducted, in addition to covert and participant observations in 10 WPS venues in Hong Kong. Interpretive description involving constant comparative analysis of qualitative data was adopted to facilitate an inductive analytic approach to generate findings.

Results Two primary themes emerged from analyses of interview and observation data: strategies to avoid law enforcement, and perceived health and safety concerns linked to working and smoking in waterpipe venues. The findings suggest that many Hong Kong venues may be failing to comply with tobacco control policies and developing strategies to circumvent law enforcement. Moreover, waterpipe preparation, allowance of WPS and burning of charcoal in indoor areas were perceived as negatively affecting the health and safety of staff and customers.

Conclusions The study provides preliminary evidence indicating the ineffectiveness of current tobacco control policy on WPS. Due to its risks to health and safety, and the need to sustain tobacco control efforts for their intended purpose, waterpipe-specific regulations and stricter surveillance on waterpipe sales and promotion are urgently required.

  • end game
  • non-cigarette tobacco products
  • public policy
  • surveillance and monitoring
  • taxation

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  • Contributors JJL and KC-YY contributed to the study design, data acquisition and analysis and to the drafting of the manuscript. MPW, ST, HSCT and VL contributed to the analysis, draft and critical revision of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors received a research grant from the Hong Kong Council on Smoking and Health for the conduct of the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.