Comparison of patterns of use, beliefs, and

attitudes related to waterpipe between

beginning and established smokers.
Asfar T, Ward KD, Eissenberg T, Maziak W.

Syrian Center for Tobacco Studies, Aleppo, Syria. taghrid@scts-sy.org

Abstract

BACKGROUND: To compare patterns of use, beliefs, and attitudes related to waterpipe

smoking between university students (beginning smokers) and cafe customers (established
smokers) in Aleppo Syria, in order to explore the evolution of this smoking method.

METHODS: Two cross-sectional surveys were conducted among representative samples of

university students (total 587, 48.4% men, mean age 22 years), and waterpipe users among cafe'
customers (total 268, 60% men, mean age 30 years) in Aleppo, Syria. We used interviewer-
administered questionnaire inquiring about pattern of waterpipe smoking (initiation, frequency),
situational characteristics of use (partner, place, sharing), beliefs related to waterpipe smoking
(harmful/addictive properties of waterpipe), attitudes related to waterpipe smoking (confidence
in quitting, will to quit, motivation for quitting, past year quit attempt), and cigarette smoking.

RESULTS: Daily and regular patterns of smoking become more prevalent with increased
duration of smoking, but intermittent smoking remains the predominant pattern of waterpipe use.
Women seem to be drawn later to the habit, which seem to escape the usual taboo against
women's cigarette smoking. Patterns and context of waterpipe use tend to change with progress
of the practice affecting frequency, setting, and sharing of waterpipe. Unlike beginners,
established waterpipe smokers seem more smoking-method oriented, more hooked on the habit,
less willing to quit, and less likely to foresee challenges to quitting.

CONCLUSION: Use patterns and attitudes related to waterpipe smoking evolve to accommodate
the change in dependence and life circumstances of the smoker. Most of use features, beliefs,
attitudes, as well as time-course seem unique to this smoking method requiring novel approach
to intervention.

Understanding Your beliefs

Adapting and Adaption

Before we start talking about balancing your
beliefs, let's begin by looking at how these
things called beliefs come into your life. There
is a familiar process that we're going through all
day every day of our lives called "adapting" or
"adaption". You might call it "changing myself
so that I can fit in better”. It's one of the first
things you learn to do even as a baby and even
if today you regard yourself as a total rebel you
will still be adapting several times a day. Some
people adapt much too often, or change
themselves so much that they no longer have
any idea of who they really are or who they
really were before they made the changes, but
that's another story. You would never do that
would you?
Whenever you come to believe anything, and accept it as true, correct, fair, right, or permanent
you are creating something deep inside you that was not there before. Something inside you
changes and as a result the way you will live your life also changes. Usually one of the
advantages of changing like this, by taking on a new belief is that it helps you to adapt, to "fit in"
better with our family and the world around you.

But, and this is a very big 'but' ..... just because you believe it is true and just because it works for
you doesn't mean that it is actually true, correct, fair, or right. That's the problem with beliefs!

That's why there is actually a range of different levels of belief, and these vary according to how
much hard evidence is available to confirm that what we believe.

Let's go back to what I was explaining in the introduction page and have a look at it in a bit more
detail .... (I hope you will forgive me repeating myself here)

1. The more proof, data or evidence we can find to support an everyday belief the easier it is to
accept that belief.
Most people don't have too much difficulty following a set of rules for living their daily life, or
where they work. There is plenty of evidence around to prove the rules are necessary. We can
observe that they usually work for you and me and other people around us. Usually there is lots
of evidence around to convince you of what would happen if you don't follow those rules. So the
rules and our beliefs about those rules stay fairly stable (as they need to do). You would probably
say you believed in them.

2. The more proof, data or evidence you can find to support simple straightforward everyday
beliefs the easier it is to question, change or even to reject that kind of belief provided you
have new evidence to support the change.
From time to time you will find yourself questioning some everyday rules, the kind you follow in
your daily activities, your everyday opinions, your views on daily life. It's not too hard to change
what you believe about them as long as you can find some clear proof or evidence to support the
change.
Think about a bad rule or one that doesn't work. The more proof or evidence available to show
that it's not working the easier it is to stop believing in that rule or, if you have the opportunity, to
change that rule. That makes sense when you are dealing with ordinary beliefs. Nothing unusual
so far but keep this in mind as we go deeper.

3. The deeper a belief becomes established in your mind, the harder it is to question or change
that belief. Once a belief gets locked in and the longer it stays locked in, the deeper and deeper it
goes until it becomes a core belief.
Your core beliefs, like mine, are so deep they cannot be changed by loading up on lots of logical
evidence. Now it is the other way round, trying to change a core belief this way usually locks it
in ever more securely!

4. Even when there is clear proof or evidence or data available that should convince you that a
core belief is out of date or no longer applicable it is still unbelievably difficult to see this and
even harder to make any change.

* The less evidence there is to support a deeply held core belief the more the more rigid it
becomes and the more strongly people seem to hold on to it!
* The older the belief the harder it is to question it

Even when there is clear proof or evidence or data available that should convince you that a core
belief is out of date or no longer applicable it is still unbelievably difficult to change it. In fact
the less the proof the harder it may be to question or change that belief. This is not logical, it's a
contradiction, a paradox (if you like academic words). It doesn't make sense, but unfortunately
that's how it happens to work. There are a couple of examples of this in two case studies in The
Self fulfilling prophecy trap

Let's start by looking at some of the different levels of belief. These can vary from things that
you believe in may straightforward everyday basis down to the deepest core beliefs. All of them
will influence the way you live your life, but the deeper the belief stronger its influence.

Let me try to explain this in more detail

Where Rules come from
We may not like a rule but if there is always
plenty of solid evidence around to support the
rule it's this evidence which will help convince
us that we had better believe in it and follow it.
A bad rule is, by definition one that lacks
supporting evidence.
Our family environment, our community our
entire government, education, business and legal
system is based on rules like this. Rules are
maintained by a very familiar process, "reward
or punishment". The most powerful rules are the
laws which support our legal system. Our courts
are constantly testing laws and all the associated
rules and regulations to make sure that they are
still supported by valid evidence. Come to think
of it even illegal or criminal systems have rules
too.
The first level of adaption which begins even before we can talk is "learning the family's rules".
That's something that most small children become quite good at doing and by age two they will
have learned hundreds of family rules. Family rules are the most basic form of belief because to
learn a rule we must believe that we need to learn it. That's where evidence comes in. For a small
child there is some very clear and easy to notice evidence about what happens when they don't
obey the rules. There may also be evidence in the form of rewards when they do obey the rules
Altering or changing our own set of rules may not be easy, but provided we can get some solid
evidence in support of changing an old rule then the shift is relatively straightforward. The
stronger the new or contrary evidence the easier it is to change a simple belief or rule.
Opinions and Attitudes
Opinions are like a complex set of rules rolled
together into one but they aren't necessarily
supported by the same amount of evidence that
was available to back up rules and laws. If there
is little supporting evidence to back up an
opinion it may be difficult to confirm its
reliability. Often what counts as "evidence" is
more likely to be the belief that if other people
that we regard as powerful or reliable hold these
opinions we should hold the same beliefs.
Having an opinion gives you the ability to express your own position or take a stand on issues
that matter to you or your family. Once an opinion is formed it is likely to stay in place for a long
time. However you may find yourself over time questioning a particular opinion or attitude on
some specific issues such as your voting preferences each time elections come round. This is
more likely if your logical analytical rational thinking mind is presented with clear evidence
which throws doubt on your previous opinion. So once again if the evidence is there then
opinions and attitudes can change but it has to be very clearly presented evidence.

Now let's go a little deeper, and as you do notice that suddenly the less evidence to support a
deeply held belief the more rigid it can be.

Values and Moral codes

Values and moral codes are like very broad and
very strict rules and they are often applied with
a great deal of rigidity. However, if you were to
look for some solid reliable data to support
moral and ethical values you might find it quite
hard to discover any.
You might describe your value system and is a
set of ideals or "super rules". You can expect
that you and other people will hold very
strongly to values like honesty, ethical
behaviour and morals. The Golden Rule "Do
unto others …..” is really more of a moral value
than a rule. Your deepest core values will be so
important to you that you may be prepared to
risk your income, your relationships, your
home, even your life to defend them.
Two situations can bring about a change in
values or moral codes. The most common one is
pressure from another person whose opinion we
hold in very high regard (or who we love or who
we want to love us!) and who wants us to
change our values or our moral code to match
theirs.
Many people will bend temporarily to get
approval or avoid conflict, but deep down inside
they will not actually change their basic values
or their moral codes. People sometimes come to
question a value in times of major crisis, such as
a war, the death of a loved family member,
divorce or a life-threatening health issue. For the
rest of the time our value system will be neither
questioned nor changed a great deal.
The older the belief the less it is questioned and the less likely it is to change

Because there is so little evidence to support any particular set of values or moral codes people
tend to discourage any questioning of deeper values so the values stay locked in place. They rely
more on old ways and traditions (That's the way we've always done it) or ancient records which
have been passed down through many generation. It's as if the age of the belief makes it more
reliable than up-to-date observations. That's why your value system is much more permanent and
once established may remain fixed for life.

Conflict over the “right” way

Notice two things I mentioned above:
1. The less evidence there is to support a deeply held belief pattern the more strongly people
seem to hold on to it!
2. The older the belief the harder it is to question it

Even if other people disagree with our beliefs it is unlikely that we will change what we believe
to fit in with theirs. Throughout history, people who held different values have been forever
clashing, with each person assuming that their opinion is "right" (Because that's the way we've
always done it) and that this is all the proof required to show that other person must be "wrong".
Any real proof in support of either position may be incredibly scarce yet wars are often fought
around this level of disagreement. (Because your beliefs are so wrong I may have to kill you to
protect my beliefs!). Much family conflict is also related to the same level, again with very little
supporting proof or none at all from either side about reality.

Core Beliefs
Core beliefs are the deepest of all because what
we believe "deep down inside" underpins our
value system and our attitudes and opinions.
This is one of the reasons why core beliefs are
seldom questioned even when they are causing
enormous problems within the person who holds
that core belief. This lack of supporting
evidence rather than making it easier to change
a core belief actually guarantees that it will
remain locked in place far more firmly. Even
where there is solid evidence such as our own
personal observations that should indicate the
belief is not correct this is rejected.
Most of us are used to solving problems based on available proof, data or evidence which we can
think about and analyse. Core beliefs operate almost entirely as a result of non-analytical thought
processes that take place somewhere in parts of your mind not closely connected with your
rational analytical thinking processes.

Rational analysis helps by providing us with some vague clues, but it is almost useless when it
comes to working out solutions to core belief related problems. Rational thinking or cognitive
therapy has little chance of changing a belief and even less chance of getting rid of one. It often
just fixes the belief even more firmly in place.

Balancing negative and positive core beliefs is a better way - use your grown-up
self-awareness and self empowerment
The process which is very different but incredibly powerful and which does work comes through
growing your own self-awareness. The more your own personal self-awareness expands the
more self-empowered you become. It is self-awareness and self empowerment (not rational
thinking) which equip you to you to overcome your individual core belief issues by :

1. Identifying them, acknowledging and accepting that they became a part of you a long time ago
because in some way they were at that time needed to help you "fit in".

2. Accepting that they cannot be changed or got rid of They became part of your belief system to
help you a long time ago. At that time they were a friend, a tough friend but that's what you
needed then. You don't kick an old friend out just because they are no longer any use to you.

3. Balancing them with positive core beliefs instead of trying to change them or make them go
away. Balancing the negative with a positive belief is the only way that works permanently.

How you do this is explained but only as a summary on number of separate pages linked on this
site. (Balancing your Core beliefs)
Balancing the negative with a positive belief is the only way that works permanently but there is
more o do than just reading a few web pages. Getting ready to balance will require a bit of time
and effort on your part, including answering some questions on a series of worksheets to make
sure you identify your own negative core belief or beliefs. But if you do you will achieve real
success just as hundreds of ordinary people around the world do it every day.

The whole process of identifying your own negative core beliefs and then balancing them is a
very individual matter. There are no general rules, no standard step by step approach. If there
was I would print it here.
To achieve success also requires some time and thought on your part. I have found it works best
for people who are serious about this to do the work step-by-step in their own time. That's why I
am now providing a series of workbooks (total over 60 pages) at a special introductory price

Would you like to :

1. Discover your own hidden troublemakers and identify your own hidden negative core beliefs?

2. Identify the problems that your individual core beliefs are causing you and that you want to fix

3. Discover why identifying your own negative core beliefs, accepting them and not trying to
change them is a positive and self-empowering step forward.

4. Find out how to balance your negative beliefs with positive ones. This begins to work as soon
as you know why you need to balance them (and why you must not try to get rid of them
altogether)

5. Avoid getting triggered again as you have in the past

http://www.ncbi.nlm.nih.gov/pubmed/15733316