Introduction:
To analyze prevalence of water pipe use and attitudes related to it among Serbian adults.

Methods:
Data were obtained through cross sectional survey conducted in December 2017. Three stage random nationally representative stratified sample was used. Data from 1045 Serbian adults were collected through computer assisted personal interviewing.

Results:
Lifetime prevalence of waterpipe use is 6% (7% male, 5% female). In addition, 7% of population visited bars specialized for waterpipe use (waterpipe bars) but haven’t smoke waterpipe. The highest percentage of waterpipe lifetime users was in the 18-24 age group (15%), followed by age group 25-34 (12%). In the same age groups, additional 22% and 12% respectively have visited waterpipe bar, but haven’t smoke waterpipe. Almost every third citizen of Serbia (29%) thinks that waterpipe use is less harmful than cigarette use, 39% agree with the statement that waterpipe users can develop nicotine addiction and 36% think that waterpipe use is risk factor for malignant diseases. Young adults 18-24 years old are less aware of harmful consequences of waterpipe use. There are more citizens that agree that waterpipe use in hospitality sector should be banned than those who disagree with such measure (40% vs.24%). Younger population is less favorable to the waterpipe smoking ban in hospitality sector.

Conclusions:
Waterpipe use and spending time in specialized waterpipe bars is popular in Serbia, especially among young adults. Insufficient number of citizens is aware of risks associated with waterpipe use. Findings indicate need of awareness raising on health effects associated with waterpipe smoking and exposure to waterpipe smoke.