RESUMEN
To investigate the use of unconventional substances and materials in water pipe among café water pipe smokers. This was a questionnaire-based survey among subjects attending coffee shops in the region of Al Madinah, Saudi Arabia between February and March 2013. We invited 110 subjects, only 90 consented to participate in the study. A percentage of 1.1% used fluids other than water in the water pipe tank, 18.9% added other soft drinks to the tank, and 7.8% added flowers, spices or drugs to the tobacco mix placed in the head of the water pipe. A proportion of participants used fruits to replace the water pipe head [12.2%], or to replace water pipe tank [4.4%]. Higher number of children the smokers had and cafe smoking were all significantly associated with unconventional practices. A substantial percentage of sample of water pipe smokers in Al Madinah, Saudi Arabia use unusual materials and/or substances in the water pipe and this is probably encouraged by cafe smoking