Nakkash et al. BMC Public Health 2011, 11:315 http://www.biomedcentral.com/1471-2458/11/315 people would then want to try it out, once they intro- duce the peach flavour, again people would want to try it out... I mean I think if they had only stopped with the apple flavour, maybe a lot of people would have had gave up waterpipe smoking....” (Male non- smoker - urban area) Contrasting the experience to that of smoking cigar- ettes, alluding to the different tastes of flavours, one waterpipe smoker said: “There is a difference in the taste [between a water- pipe and another] I have never through my entire life found a taste difference between one cigarette and another ... I mean the apple flavour is different than the melon, than the grape, than others... the water- pipe has a taste, and it is a good taste.” (Female smoker - urban area) Sensory qualities of waterpipe tobacco smoking The sensory qualities of waterpipe smoking were impor- tant in encouraging use. The younger age groups and the smokers (regardless of age group) noted the sensory qualities evoked from waterpipe tobacco smoking as rea- sons that motivated smoking. Men and women equally attributed motivation to the sensory qualities such as taste, smell, sight of smoke, and bubbly sounds of the water in the bowl. Both smokers and non smokers equally cited taste and smell, however smokers more than non-smokers mentioned the sight and bubbly sounds. In the Shouf [Mountains in Lebanon], when we’re sit- ting together in the evening, drinking something and it’s quiet and tranquil... [pauses for a moment] it’s sound is very nice... When you inhale it, and the water does this sound [referring to the sound of bub- bling water]...” (Male, non-smoker - urban area) “.. I like the smoke when it comes out as it does... When I wasn’t smoking the waterpipe, I used to look at someone who smoked it and see how the smoke comes out of it and that made me love it.” (Male smoker - rural area) The taste and smell of Ma’asal tobacco were listed as main reasons for some to try the waterpipe, and even- tually become addicted “my parents used to sit and smoke the waterpipe ... Then from its nice smell we got hooked“ (Female smoker - rural area). The smell of the waterpipe even in public places was a motivator to initi- ate WTS: Page 5 of 9 “When you arrive to a café, you smell the waterpipe from the outside, you say that’s it, you want to smoke it” (Male smoker - urban area) Media Influence Men and women, smokers and non smokers, and the younger age groups noted the influence of the media - particularly advertisements, movies and TV series broad- cast during the month of Ramadan - through its positive depictions of waterpipe tobacco smoking scenes. Much like the cigarette is portrayed as glamorous, sexy, and cool; the media also associated the waterpipe with gla- mour and lavishness “What do the media do? [They make you] want to try, everything new they advertise... they tempt you with the design etc...“ The use of women in the media was common and a strategy used by media to motivate women to take up WTS “... In an advertise- ment for any café, the first thing they show you is a girl smoking a waterpipe... The Media has a big influence...” (Male smoker - rural area). Other brands were specifi- cally developed and marketed for youth, for example like the new Ma’asal brand produced named “Shabablik “which means in Arabic “that which is youthful.” “When it [Shabablik] was newly released into the market... the media has a big influence. And they seduce you, for example they give you a certain design for the package, they seduce you to try it, or maybe they do it in a cool attractive way ...” (Male smoker - rural area) The media also made the waterpipe more common and familiar to the people. In the early 1990’s, during the month of Ramadan, scenes from cafés and restau- rants serving the waterpipe were broadcast live across satellite TV in the middle east region which served to “advertise the waterpipe” and popularize it. “What really made the waterpipe in vogue over the last 10 years was the cafés, restaurants, Ramadan tents [coffee shops built temporarily during the holy month of Ramadan], these places were aired by TV stations, so... people were encouraged to go to such places. It [the waterpipe] has its own ambiance, they are promoting it.”(Male smoker - urban area) Policy FGD participants noted that tobacco control policies should be set by the government and should regulate all forms of tobacco use, in particular that of waterpipe.