Abstract
To date, the sharing behaviors associated with the homemade tobacco waterpipe used in rural areas of the Western Pacific Region have not been studied. Evidence from studies of manufactured waterpipes raises the possibility of infectious disease transmission due to waterpipe sharing. The objective of our pilot study in rural Lao People’s Democratic Republic (PDR) was to identify and measure the prevalence of waterpipe sharing behaviors. We first conducted ethnographic studies to investigate waterpipe-smoking behaviors. These findings were then used to develop an interviewer-administered household survey that was used in a sampling of waterpipe smokers from three villages of the Luang Namtha province of Lao PDR (n = 43). Sampled waterpipe smokers were predominantly male (90.7%), older (mean age 49, SD 13.79), married (95.4%), farmers (78.6%), and had completed no primary education. Pipes were primarily made from bamboo (92.9%). Almost all (97.6%) smokers were willing to share their pipe with others. At the last time they smoked, smokers shared a pipe with at least one other person (1.2 ± 0.5 persons). During the past week, they had shared a pipe with five other persons (5.2 ± 3.8 persons). The high prevalence of sharing behaviors among waterpipe smokers in rural Southeast Asia raises the possibility that this behavior provides important and unmeasured social network pathways for the transmission of infectious agents.
Highlights
The World Health Organization has reported that the Western Pacific Region has the highest global rate of cigarette smoking, with nearly two-thirds of men being current smokers [1]
We focus on the homemade tobacco waterpipes of Lao People’s Democratic Republic (PDR) that tend to be made of bamboo, and less commonly of adapted pieces of plumbing pipe (PVC) or metal (Figure 1)
A wider variety of waterpipe types were observed during windshield surveys of the region, the quantitative survey findings shown in Table 2 reveal that the waterpipe smokers we studied primarily use homemade bamboo waterpipes (92.86%) as compared to metal (4.76%) and PVC pipe
Summary
The World Health Organization has reported that the Western Pacific Region has the highest global rate of cigarette smoking, with nearly two-thirds of men being current smokers [1]. Throughout Southeast Asia, several ethnic groups (i.e., Akha, Hmong, Khamu) living in communities as large as 90,000 have long smoked tobacco using homemade bamboo waterpipes [2]. In 2010, findings from the Global Adult Tobacco Survey of Vietnam indicated that there were an estimated 4.1 million tobacco waterpipe smokers in the nation [3]. Recent findings link pipe tobacco use to poverty in Vietnam [4]. In a 2006 national survey of Cambodia, the prevalence of tobacco pipe use among ethnic minorities living on the Lao-Cambodia border exceeded
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