https://doi.org/10.1177/1474515117719592 European Journal of Cardiovascular Nursing 2018, Vol. 17(1) 85–92 © The European Society of Cardiology 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1474515117719592 journals.sagepub.com/home/cnu EUROPEAN SOCIETY OF CARDIOLOGY ® Introduction Waterpipe smoking (WPS) is the second most prevalent global tobacco epidemic after cigarette smoking. 1 The popularity of this form of smoking keeps increasing world- wide. 2 Statistics from Western and Eastern countries both revealed widespread and increasing interest inWPS. 1,2 The literature shows that WPS prevalence ranges from 6–34% in Middle Eastern adolescents, 5–17% in American ado- lescents, 1 and 39.6 % among a British adolescent sample who have ever used a waterpipe (WP). 3 The Jordanian Ministry of Health conducted a national survey to assess the prevalence of risk factors of non- communicable diseases in Jordan. 4 Through a random cluster sampling technique, 3654 participants were included, of whom, 29% and 9.3% of participants were cigarette and WP smokers respectively. 4 However, other Knowledge, attitudes, beliefs and patterns of waterpipe use among Jordanian adults who exclusively smoke waterpipes Nidal F Eshah 1 and Erika S Froelicher 2 Abstract Background: Widespread waterpipe smoking (WPS) is reported worldwide. Although remarkable numbers of waterpipe smokers do not smoke cigarettes, very few studies have explored the phenomenon of WPS in people who smoke water pipes exclusively. The aim of this study was to assess levels of knowledge, attitudes, beliefs and patterns of WPS among Jordanian waterpipe-only smokers. Methods: A cross-sectional descriptive design was used; with 247 participants who were recruited through convenience sampling from 23 cafés offering waterpipes. An interview and self-reported questionnaire was used to collect data. Results: The average age for starting WPS was 19.4 ± 5.6 years, of whom 71% started as teenagers. Participants like WPS because they like its flavor and social environment (46.3% and 29.5% respectively). The majority of participants reported that they smoked a waterpipe for the first time with their friends (66.8%), they usually smoke in the company of others (63.2%), and believe that quitting cigarettes smoking is harder than quitting WPS (61.6%). More than half (56.7%) of participants have extremely poor knowledge about the health effects of WPS. Participants who had smoked cigarettes in the past, were more knowledgeable than those who had never smoked cigarettes. The majority of participants, and specifically women, have high positive feelings and emotions (attitude) toward WPS, and 88.3% of them reported that it is a socially acceptable behavior. Conclusions: Waterpipe smoking participants started WPS at an early age, and are attracted to the social environment that accompanies WPS. Participants have high positive attitude about WPS however they lack knowledge about harmful health effects of WPS. Keywords Waterpipe, knowledge, attitudes, beliefs, patterns, smokers Date received 4 April 2017; revised 15 June 2017; accepted 16 June 2017 1 Zarqa University, Faculty of Nursing, Jordan 2 Department of Physiological Nursing, Department of Epidemiology & Biostatistics, Schools of Nursing & Medicine, University of California San Francisco, CA, USA Corresponding author: Nidal F Eshah, Zarqa University, Faculty of Nursing, Jordan, Zarqa, 13132 - P.O. Box 132222, Jordan. Email: nidal2000jo@yahoo.com, nfareed@zu.edu.jo 719592CNU 0 0 10.1177/1474515117719592European Journal of Cardiovascular NursingEshah and Froelicher research-article 2017 Original Article