Nakkash et al. BMC Public Health 2011, 11:315 http://www.biomedcentral.com/1471-2458/11/315 desirability is also a possible limitation as participants and interviewees may provide the response they believe the interviewer wants to hear. However, the interviewer had extensive experience in conducting qualitative focus groups and interviews and has been trained to listen without responding or giving cues, such as facial expres- sions or judgmental statements approving or disapprov- ing participant views during data collection - thus limiting the expression of social desirability. Conclusions This research documents waterpipe smokers and non- smokers explanations for the rise in WTS in Lebanon. They suggest motivations reminiscent of the lure of cigarette smoking, and driven by marketing of tobacco products. The increasing prevalence of WTS - particu- larly among youth, has been documented in countries of Europe and the US. Some of the same reasons stated in Lebanon for the rise of WTS could be playing out in other countries as well. Our results confirm the neces- sity of implementing the FCTC policies and strategies proposed by MPOWER across countries, and argue for strict inclusion of all tobacco products, including the waterpipe. National and international advocacy efforts are clearly needed to stem the waterpipe tobacco epi- demic in Lebanon, the Arab region, and the world. Acknowledgements The authors would like to thank our research partners in the Palestine, Syria, and Egypt: Ms. Yara Jarallah, Dr. Fadi Hammal, Dr. Fouad Fouad, Dr. Mustafa Mohammad, and Ms. Maha Ayad. The authors would also like to thank all those who participated openly in the interviews and focus group discussions. The authors would like to thank reviewers for valuable comments that strengthened the manuscript. This research was funded by a grant from International Development Research Center, Research for International Tobacco Control (IDRC-RITC). Authors’ contributions RAA was the principal investigator on this research project. She was involved in conception, analysis, interpretation of data, and drafting and reviewing multiple drafts of this manuscript. RTN was involved in conception, analysis, and interpretation of data and was responsible for drafting the manuscript. JK did all the data collection, analysis and interpretation of data. She assisted in drafting and reviewing multiple parts of this manuscript. All authors read and approved the final version of the paper. Competing interests The authors declare that they have no competing interests. Received: 18 August 2010 Accepted: 14 May 2011 Published: 14 May 2011 References 1. Maziak W: The waterpipe: time for action. Addiction 2008, 103:1763-1767. 2. 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