The students were between 15–17 years of age, and were studying either at the 10th or the 11th grades of high school.
During thematic analysis, the predominant theme aroused was termed as “highly negative attitude towards HS and hookah smokers”. The students explained the SUoHS in the indecency of the behavior as well as the impudence, impertinence and rudeness of the hookah smokers. The participants perceived HS as a rude and disrespectful behavior. They also considered the smokers as individuals that disrespect the people around them while smoking. The results were universal across the students, regardless of their age and gender.
Themes were grouped as follow: social disvaluing of hookah smoking and smokers, negative attitude towards hookah smokers and their families, and consequences of hookah smoking.
Social disvaluing of hookah smoking and smokers
Based on the students’ opinion, the SUoHS was seen in the disvaluing of the society to the behavior and those who perform it. They believed that the people in the society have a highly negative opinion of the hookah smokers. For this theme, three main categories were identified as follow:
Behaving against social values and norms:
As participants believed, hookah users behave against the social norms and values, and disregard the culture of society. “These people have come to value a thing [hookah smoking] that is, in fact, a disvalue. This behavior is against religious and social values”(p. 7). They believed that hookah smokers were a plague and burden on society. “I say they’re a burden on society because these are the people who do not serve it. They just cause trouble”(p. 6). “I say, you're a plague on society”(p. 5).
Violating the others’ rights
The students believed that hookah smokers violate the rights of people in the community. The smokers bother people around them because of the bad smoke and the bad smell of hookah. “Hookah use may disturb others as well. Maybe those around you cannot tolerate it”(p. 6). They also reported that hookah smokers do not respect others and are troublemakers for their society. “This behavior is not respectful; they do not respect others” (p. 7). According to another participant, hookah users may, “harass some people... may insult girls...”(p. 29).
Being untrustworthy
The participants believed that hookah users are untrustworthy and cannot be acknowledged or approved by others. “Maybe these are people we cannot trust anymore”(p. 6).
Negative attitude towards hookah smokers and their families
The students considered the SUoHS in the negative attitude towards the smokers and their families. This theme was grouped into three categories:
Negative attitude towards hookah smokers
The students perceived HS as a rude behavior, because the smokers were seen as individuals with playfulness, weak willpower, irresponsibility, poor knowledge/experience, and promiscuity. They believed that the smokers were bad role models within community and may be also attracted toward addiction. According to them, hookah users pave the way for ruder behaviors by smoking hookah, as this behavior may mark the beginning of using narcotics, and addiction. “Hookah itself is very addictive and one becomes dependent on it by experimenting it even once with friends”(p. 11). Participants believed that hookah users have lost their identity, do not pursue any clear goal in life, and waste their life. “First, they have lost their identity. Second, they have lost themselves by doing this”(p. 5). They also believed that hookah users have a weak willpower and they lack the skill of saying no. “Hookah users may have no willpower. That is, they lack the will not to pursue it [hookah smoking]”(p. 29). “These people are playful. They do not care about anything else”(p. 13).
According to them, hookah users are ignorant and are, unmindfully, proud of their HS. “One can say that these people are ignorant of what they are doing”(p. 7). Participants also believed that hookah users are promiscuous, improvident, hooligans, rowdy, and dishonorable, and may do anything. “Maybe one can refer to them as a hooligan person with improvident and undisciplined behavior”(p. 28). “I believe those who use hookah are promiscuous”(p. 14). Participants considered hookah users as smoky, shameless, liars, criminals, and abusive individuals. In total, they perceived hookah users as a negative role model in the society. They also believed that hookah users have a bad personality, and can mislead others. “These people are considered as smokers in the society”(p. 11). “What you expect of a graceful and dignified person in terms of the language they use and the way they dress?”(p. 6).
Highly negative attitude towards female hookah smokers
Many students believed that female hookah users have forgotten their true nature (as a beauty symbol), messed up their physical and spiritual beauty, and may even have illegitimate relations with others. “I think she [a female hookah smoker] has forgotten her nature and the goal of her creation”(p. 7). They presented a more negative attitude toward HS for females, compared to males. They considered these women shameless, unchaste, nasty, notorious, and rowdy. “When we see some of them are smoking hookah, they seem to be nasty and notorious”(p. 6).
They also believed that these women are Khiabani girls [street girls: a local folk expression used to explain the women (particularly girls) who have run away from their family] who desert their families and home, turn to whorehouses, and go astray. “These are often girls running from home and having problems with their parents. They've turned to streets and men”(p. 22).
Negative attitude towards the family of hookah users
The students would often report that in the families of hookah users there were not a good parent-child relationship. Due to their familial problems, the parents mistrust their children. “[It is] a family who never trust their children”(p. 25). “their parents may have problems and do not have good relationships”(p. 29). They also believed that such families do not raise their children well and cannot control them. “They do not have the culture of parenting, have not raised their children well”(p. 14). Based on their ideas, these families were either too strict or too lenient. “They may be families who have imposed too many limitations on their children from the beginning”(p. 31). “I think they are careless and do not care about their children at all”(p. 25).
According to them, such families are unaware and ignorant families who consider HS as a healthy hobby and do not know its harms. “They think it is a healthy hobby”(p. 19). They also believed that HS is a normal behavior in the users’ families. They viewed these families as promiscuous, shameless, degenerate, ignorant, uncultured, and lowborn families. “They have not been born in a high-class family”(p. 14). “The family of hookah users is too uncultured family”(p. 28).
Consequences of hookah smoking
Based on the students’ ideas, HS was considered to be a socially undesirable behavior because it damages the physical, mental and familial health of the smokers. They also believed that the behavior may damage their social health. The sub-categories are explored in more detail below:
Self-harm
A majority of participants believed that HS was harmful and may cause cardiac and pulmonary diseases and cancer, and may damage one's physical beauty. “Those who use hookah may be suffered with different diseases, like pulmonary diseases”(p17). “It makes you lose your physical beauty”(p14). They commented that hookah users are dependent to the behavior, and explained the users as unhealthy individuals with poor mental health who may even attempt suicide. “Hookah users are depressed guys who may attempt to kill themselves”(p. 14).
Harm to the society
According to students, HS may damage the community health and development. They perceived HS as a behavior that facilitates the spread of different diseases and substance use within community, and thus endangers community health. “Hookah endangers our health and destroys the health of our family, community, and society”(p. 3). Not commonly commented on, some students believed that the individuals from different age groups congregate in hookah lounges where fighting, violence, and ethnic groupings are common. The promotion of behavior within society results in development of hookah lounges, which consequently promote violent behaviors in the community. “In these places, there are many delinquents, and fights and violence are common, ethnic grouping is common”(p. 18).
Harm to the family ties
Many students believed that the smokers do not pay attention to their family, have misbehavior with their family members, and have weak parent-child ties. “A characteristic of hookah smokers is that they do not pay any attention to their family”(p. 28). As they noted, it may also cause detachment between the smoker and his/her family and what he/she was going on. “It makes you move away from things you like”(p31). “[hookah smokers] actually destroy God's blessing with their own hands”(p7). “they [hookah smokers] do not respect their parents or do not ask their permission”(p23).