Jesús Torres-Medina¹, Jorge Min Hui Zhou-Zhou¹.

  1. Faculty of Medicine, University of Granada (UGR).
    Gudrun Palomino-Tirado², Laura Copado-Jiménez², Elena Company-Campos², Amelia Perdigón-Hernández²,
    Claudia Conde-Sánchez².
  2. Faculty of Translation and Interpreting, University of Granada (UGR).

The use of shisha is widespread worldwide. We found systematic reviews on its use (1), on its health effects (2-4), and on the toxic content of inhaled smoke (5). However, no systematic reviews were found that collected and analyzed false beliefs about its use. Therefore, it is an under-researched topic and these false beliefs need to be described in order to provide more evidence in this field and increase knowledge about shisha use.
The primary objective of this study is to conduct a systematic review on the existence of false beliefs and perceptions of shisha use among young people.
In March 2020, a systematic literature search was conducted in three databases (MEDLINE, SCOPUS, and Web of Science Core Collection). The elements of the PICOS acronym in our research question were: the studied population (P) were young people aged 12 to 35, the intervention (I) was to ask about false beliefs about shisha use, comparison (C) was not described, the outcome (O) was to describe these false beliefs, and the design of the studies included (S) was descriptive. With these elements, a search string was developed and the selection criteria were established: 1) population aged 12 to 35 years, 2) questions about false beliefs about shisha use, 3) descriptive studies, and 4) studies written in English, French, Spanish or Chinese. Using the search string, a total of 105 studies were obtained from the three databases. After an initial analysis of titles and abstracts, 15 articles were selected and read thoroughly, after which 6 of them were excluded for not meeting the selection criteria.

After evaluating 105 articles, 9 studies were included in this review. More than twenty false beliefs were identified and grouped into five categories: health harm, levels of nicotine and addictiveness, smoke content, fruit flavor or aroma and other beliefs. Most of these beliefs relate to the perception of risk to health. It is common to think that shisha is harmless or less harmful than tobacco, or that its negative health effects are over-estimated. There is also considerable confusion regarding sharing the mouthpiece, as it is thought that diseases cannot be transmitted this way. Many young people also believe that shisha is not addictive or that it is less so than tobacco, and that it does not contain nicotine or contains a lesser amount of it. In addition, some think that water filters out tobacco toxins and, therefore, the smoke does not contain any hazardous chemicals. Moreover, some believe that smoking fruit-flavored tobacco makes it healthier and less addictive, or even that smoking shisha helps to relax and stay slim. It is also emphasized that women smoking shisha in public is no longer taboo. Finally, we identified the most frequently asked beliefs in the questionnaires and those statistically significant related to shisha use.
This systematic review identified a large number of false beliefs about shisha use among young people, making evident the existing misinformation in this age group i regarding its health effects. Furthermore, despite the social and cultural differences, as well as those concerning the use of shisha in the populations studied in this review, all of them showed similar misconceptions. In Spain, shisha use is permitted in cafés and pubs, and it is even included for free with the purchase of a certain number of drinks. This shows that the applied health policy is very permissive and must change for the good of the youth. Therefore, it is necessary to implement the existing legal measures and educate adolescents at an early stage so that they can understand the harmful effects of shisha, and avoid the risk of smoking initiation through new fashionable forms of use. Further research should assess these false beliefs in a larger number of countries to homogenize the population studied. This would increase the evidence provided in similar reviews. To conclude, the limitations of this systematic review include that the search string is restrictive, no backward reference searching was conducted, and the study population of the articles included is heterogeneous.

Keywords: youth, false beliefs, shisha, survey.

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