Former studies conducted among primary care physicians in Bahrain [16, 17] found a higher prevalence of male smokers (26.6% in 1999, 24% in 2005 and 20% in the current study), but they applied different methodologies compared with the current study. For example, the study conducted in 2005 did not define ‘smoker’ and used a selective sample as their population while in the study in 1999, ‘smoker’ was defined differently than in this study. However, our results revealed a higher percentage of waterpipe smokers (<1% in the 1998 study, 3% in the 2005 study, and 6% in the current study). The increasing use of waterpipes among physicians as well as the general population could be attributed to various reasons, including the common misconception that waterpipe smoking is less harmful than cigarette smoking [4], the introduction of flavoured tobacco to attract waterpipe users [24] and flattering images in the media of waterpipe tobacco smoking [25]. Therefore, our results have direct implications for necessary public health interventions targeting primary care physicians. Additionally, an attempt to reverse the current smoking patterns should be made by increasing awareness of the harmful effects associated with any method of tobacco smoking including waterpipe smoking and promoting legislation to remove all waterpipe tobacco flavours.
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