Legislation Enforcement of the Waterpipe Tobacco Industry: A Qualitative Analysis of the London Experience

Introduction: Waterpipe tobacco smoking (WTS) is prevalent worldwide and is legislatively enforceable under many countries' existing tobacco laws. Globally, however, the waterpipe tobacco industry anecdotally appears poorly controlled. This study aimed to gather intelligence from local government (known as local authority [LA]) staff in London, United Kingdom, about their WTS enforcement experiences. Methods: In-depth telephone interviews were conducted among 26 LA staff from 14 London boroughs, exploring industry characteristics and tobacco legislation compliance. Recurrent themes were analyzed and derived deductively. Results: Approximately 400 waterpipe premises operate across London, benefiting from high profit margins. LA staff are resource strained, limiting their surveillance of waterpipe premises, some of which are associated with an underground culture. Noise and nuisance are key features of waterpipe premises. Most waterpipe premises were generally noncompliant with most aspects of existing tobacco legislation, mainly due to disproportionately low fines and unclear legislation enforcement guidance. Successful methods for enforcing legislation included a synchronized, multiagency approach; however, this was inconsistently implemented across boroughs. Many LA staff believe licensing waterpipe premises will improve surveillance and control the industry's proliferation. Conclusions: The waterpipe tobacco industry is unregulated and places a significant burden on many LAs in London, mainly due to lack of resources. These problems may also occur in other large cities worldwide. Existing tobacco legislation should be amended to accommodate WTS, including consideration of licensing the industry. More research is needed to gain a full understanding of the waterpipe tobacco industry and its impact on other global cities.