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Social Media Use for Public Health Campaigning in a Low Resource Setting: The Case of Waterpipe Tobacco Smoking. BIOMED RESEARCH INTERNATIONAL 2015; 2015:562586. [PMID: 26273631 PMCID: PMC4529915 DOI: 10.1155/2015/562586] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 11/17/2022]
Abstract
Introduction. Waterpipe tobacco smoking prevalence is increasing worldwide despite its documented health effects. A general belief that it is less harmful than cigarettes may be fuelled by the lack of media campaigns highlighting its health effects. We aimed to create and assess the impact of a social media campaign about dangers of waterpipe smoking. Methods. The “ShishAware” campaign included three social media (Facebook, Twitter, and YouTube) and a website. Nine months after launch we collected data to assess use of, and reaction to, our media accounts. Results. Requiring limited maintenance resources, Facebook attracted campaign supporters but YouTube attracted opposers. Twitter enabled the most organisation-based contact but Facebook was the most interactive medium. Facebook users were more likely to “like” weekday than weekend statuses and more likely to comment on “shisha fact” than “current affairs” statuses. Follower subscription increased as our posting rate increased. Our YouTube video gained 19,428 views (from all world continents) and 218 comments (86% from pro-waterpipe smokers). Conclusions. Social media campaigns can be created and maintained relatively easily. They are innovative and have the potential for wide and rapid diffusion, especially towards target audiences. There is a need for more rigorous evaluation of their effects, particularly among the youth.
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102
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Jawad M, Nakkash RT, Hawkins B, Akl EA. Gaining Insights Into the Waterpipe Tobacco Industry: Participant Observation and a Cross-Sectional Survey of Products at a Trade Exhibition. Nicotine Tob Res 2015; 18:874-8. [PMID: 26175460 DOI: 10.1093/ntr/ntv155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/07/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The rise in waterpipe tobacco smoking has been accompanied by the emergence of a diverse range of products, such as "herbal" waterpipe tobacco substitutes and electronic waterpipes. The aims of this study were to assess the extent to which emerging waterpipe products are being developed by waterpipe tobacco companies themselves, to understand the key characteristics of the main market players, and to examine the connections between producers of different product categories. METHODS In 2014, one researcher attended an international waterpipe trade exhibition in Germany, conducting a survey of products at exhibition stands, and gathering qualitative data on exhibitors and products using participant observation. Cross-tabulations and chi-square tests identified the association between waterpipe tobacco, waterpipe tobacco substitutes, and electronic waterpipe products. We thematically analyzed field notes into information about exhibitors and products. RESULTS Of 97 exhibitors, 55 displayed waterpipe-related products. Of these, nearly half (45%) displayed electronic waterpipe products, 38% displayed waterpipe tobacco and 23% displayed waterpipe tobacco substitutes. There was an inverse association between the display of waterpipe tobacco and electronic waterpipe products, and a positive association between the display of waterpipe tobacco and waterpipe tobacco substitutes. We found that Japan Tobacco Inc, Philip Morris, and British American Tobacco were partnered or affiliated with exhibitors displaying waterpipe-related products. CONCLUSIONS Electronic waterpipe products were the main feature of this exhibition. Waterpipe tobacco substitutes are likely to be produced by the waterpipe tobacco industry whereas electronic waterpipes are not. There is a developing interest in waterpipe-related products by transnational tobacco corporations. Further industry surveillance is warranted.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom; Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom;
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ben Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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103
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Gathuru IM, Tarter RE, Klein-Fedyshin M. Review of hookah tobacco smoking among college students: policy implications and research recommendations. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:272-80. [PMID: 26057153 DOI: 10.3109/00952990.2015.1043738] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. OBJECTIVE Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. METHODS PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy". RESULTS Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking. CONCLUSION Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.
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López-Giraldo A, Rodríguez-Roisin R, Agustí A. Enfermedad pulmonar obstructiva crónica: la década prodigiosa. Implicaciones para su diagnóstico, prevención y tratamiento. Med Clin (Barc) 2015; 144:507-13. [DOI: 10.1016/j.medcli.2014.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/22/2013] [Accepted: 03/04/2014] [Indexed: 11/30/2022]
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105
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Tee GH, Hairi NN, Nordin F, Choo WY, Chan YY, Kaur G, Veerasingam PD, Bulgiba A. Systematic Review on International Practices in Controlling Waterpipe Tobacco Smoking. Asian Pac J Cancer Prev 2015; 16:3659-65. [DOI: 10.7314/apjcp.2015.16.9.3659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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106
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Jawad M, Lee JT, Millett C. Waterpipe Tobacco Smoking Prevalence and Correlates in 25 Eastern Mediterranean and Eastern European Countries: Cross-Sectional Analysis of the Global Youth Tobacco Survey. Nicotine Tob Res 2015; 18:395-402. [PMID: 25957438 DOI: 10.1093/ntr/ntv101] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/01/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking is highly prevalent among young people in some settings. There is an absence of nationally representative prevalence studies of waterpipe tobacco use and dual use with other tobacco products in young people. METHODS We conducted a secondary analysis of the Global Youth Tobacco Survey, a nationally representative cross-sectional study of students aged 13-15 years. Of 180 participating countries, 25 included optional waterpipe tobacco smoking questions: 15 Eastern Mediterranean and 10 Eastern European countries. We calculated the prevalence of current (past 30-day) waterpipe tobacco use, including dual waterpipe and other tobacco use, and used logistic regression models to identify sociodemographic correlates of waterpipe tobacco smoking. Individual country results were combined in a random effects meta-analysis. RESULTS Waterpipe tobacco smoking prevalence was highest in Lebanon (36.9%), the West Bank (32.7%) and parts of Eastern Europe (Latvia 22.7%, the Czech Republic 22.1%, Estonia 21.9%). These countries also recorded greater than 10% prevalence of dual waterpipe and cigarette use. In a meta-analysis, higher odds of waterpipe tobacco smoking were found among males (Adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] = 1.18% to 1.59%), cigarette users (AOR = 6.95, 95% CI = 5.74% to 8.42%), those whose parents (AOR = 1.54, 95% CI = 1.31% to 1.82%) or peers smoked (AOR = 3.53, 95% CI = 2.97% to 4.20%) and those whose parents had higher educational attainment (Father, AOR = 1.47, 95% CI = 1.14% to 1.89%; Mother, AOR = 1.62, 95% CI = 1.07% to 2.46%). We report on regional- and country income-level differences. CONCLUSIONS Waterpipe tobacco smoking, including dual waterpipe and cigarette use, is alarmingly high in several Eastern Mediterranean and Eastern European countries. Ongoing waterpipe tobacco smoking surveillance is warranted.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
| | - John Tayu Lee
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
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Jawad M, Afifi RA, Mahfoud Z, Bteddini D, Haddad P, Nakkash R. Validation of a simple tool to assess risk of waterpipe tobacco smoking among sixth and seventh graders in Lebanon. J Public Health (Oxf) 2015; 38:403-10. [PMID: 25911620 DOI: 10.1093/pubmed/fdv048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Waterpipe tobacco smoking (WTS) is highly prevalent in the Eastern Mediterranean region. While studies have identified socio-demographic factors differentiating smokers from non-smokers, validated tools predicting WTS are lacking. METHODS Over 1000 (n = 1164) sixth and seventh grade students in Lebanon were randomly assigned to a prediction model group and validation model group. In the prediction model group, backward stepwise logistic regression enabled the identification of socio-demographic and psychosocial factors associated with ever and current WTS. This formed risk scores which were tested on the validation model group. RESULTS The risk score for current WTS was out of four and included reduced religiosity, cigarette use and the perception that WTS was associated with a good time. The risk score for ever WTS was out of seven and included an additional two variables: increased age and the belief that WTS did not cause oral cancer. In the validation model group, the model displayed moderate discrimination [area under the curve: 0.77 (current), 0.68 (ever)], excellent goodness-of-fit (P > 0.05 for both) and optimal sensitivity and specificity of 80.1 and 58.4% (current), and 39.5 and 94.4%, (ever), respectively. CONCLUSIONS WTS use can be predicted using simple validated tools. These can direct health promotion and legislative interventions.
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Affiliation(s)
- Mohammed Jawad
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-2036, Riad El Solh, Beirut 1107 2020, Lebanon Department of Primary Care and Public Health, Imperial College London, London W6 8RH, UK
| | - Rema A Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-2036, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Ziyad Mahfoud
- Department of Global and Public Health, Weill Cornell Medical College, PO Box 24144, Doha, Qatar
| | - Dima Bteddini
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-2036, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Pascale Haddad
- Biostatistics, Epidemiology and Biomathematics Research Core, Weill Cornell Medical College, PO Box 24144, Doha, Qatar
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-2036, Riad El Solh, Beirut 1107 2020, Lebanon
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108
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Jawad M, Nakkash RT, Mahfoud Z, Bteddini D, Haddad P, Afifi RA. Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon. Public Health 2015; 129:370-6. [PMID: 25749674 DOI: 10.1016/j.puhe.2015.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon. STUDY DESIGN The study design was a cross sectional survey. METHODS 126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS. RESULTS Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS. CONCLUSIONS Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.
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Affiliation(s)
- M Jawad
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon; Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - R T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Z Mahfoud
- Department of Global and Public Health, Weill Cornell Medical College, Doha, Qatar
| | - D Bteddini
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - P Haddad
- Biostatistics, Epidemiology and Biomathematics Research Core, Weill Cornell Medical College, Doha, Qatar
| | - R A Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.
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Nemmar A, Al Hemeiri A, Al Hammadi N, Yuvaraju P, Beegam S, Yasin J, Elwasila M, Ali BH, Adeghate E. Early pulmonary events of nose-only water pipe (shisha) smoking exposure in mice. Physiol Rep 2015; 3:e12258. [PMID: 25780090 PMCID: PMC4393146 DOI: 10.14814/phy2.12258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/01/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022] Open
Abstract
Water pipe smoking (WPS) is increasing in popularity and prevalence worldwide. Convincing data suggest that the toxicants in WPS are similar to that of cigarette smoke. However, the underlying pathophysiologic mechanisms related to the early pulmonary events of WPS exposure are not understood. Here, we evaluated the early pulmonary events of nose-only exposure to mainstream WPS generated by commercially available honey flavored "moasel" tobacco. BALB/c mice were exposed to WPS 30 min/day for 5 days. Control mice were exposed using the same protocol to atmospheric air only. We measured airway resistance using forced oscillation technique, and pulmonary inflammation was evaluated histopathologically and by biochemical analysis of bronchoalveolar lavage (BAL) fluid and lung tissue. Lung oxidative stress was evaluated biochemically by measuring the level of reactive oxygen species (ROS), lipid peroxidation (LPO), reduced glutathione (GSH), catalase, and superoxide dismutase (SOD). Mice exposed to WPS showed a significant increase in the number of neutrophils (P < 0.05) and lymphocytes (P < 0.001). Moreover, total protein (P < 0.05), lactate dehydrogenase (P < 0.005), and endothelin (P < 0.05) levels were augmented in bronchoalveolar lavage fluid. Tumor necrosis factor α (P < 0.005) and interleukin 6 (P < 0.05) concentrations were significantly increased in lung following the exposure to WPS. Both ROS (P < 0.05) and LPO (P < 0.005) in lung tissue were significantly increased, whereas the level and activity of antioxidants including GSH (P < 0.0001), catalase (P < 0.005), and SOD (P < 0.0001) were significantly decreased after WPS exposure, indicating the occurrence of oxidative stress. In contrast, airway resistance was not increased in WPS exposure. We conclude that subacute, nose-only exposure to WPS causes lung inflammation and oxidative stress without affecting pulmonary function suggesting that inflammation and oxidative stress are early markers of WPS exposure that precede airway dysfunction. Our data provide information on the initial steps involved in the respiratory effects of WPS, which constitute the underlying causal chain of reactions leading to the long-term effects of WPS.
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Affiliation(s)
- Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed Al Hemeiri
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Naser Al Hammadi
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Priya Yuvaraju
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sumaya Beegam
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed Elwasila
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Badreldin H Ali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khod, Sultanate of Oman
| | - Ernest Adeghate
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control 2015; 24 Suppl 1:i31-i43. [PMID: 25661414 PMCID: PMC4345795 DOI: 10.1136/tobaccocontrol-2014-051908] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/23/2014] [Accepted: 01/15/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE It is widely held that waterpipe smoking (WPS) is not associated with health hazards. However, several studies have documented the uptake of several toxicants and carcinogens during WPS that is strongly associated with harmful health effects. This paper reviews the literature on the health effects of WPS. DATA SOURCES Three databases-PubMed, MEDLINE and EMBASE-were searched until August 2014 for the acute and long-term health effects of WPS using the terms 'waterpipe' and its synonyms (hookah, shisha, goza, narghileh, arghileh and hubble-bubble) in various spellings. STUDY SELECTION We included original clinical studies, case reports and systematic reviews and focused on clinical human studies. ∼10% of the identified studies met the selection criteria. DATA EXTRACTION Data were abstracted by all three authors and summarised into tables. Abstracted data included study type, results and methodological limitations and were analysed jointly by all three authors. DATA SYNTHESIS WPS acutely leads to increased heart rate, blood pressure, impaired pulmonary function and carbon monoxide intoxication. Chronic bronchitis, emphysema and coronary artery disease are serious complications of long-term use. Lung, gastric and oesophageal cancer are associated with WPS as well as periodontal disease, obstetrical complications, osteoporosis and mental health problems. CONCLUSIONS Contrary to the widely held misconception, WPS is associated with a variety of adverse short-term and long-term health effects that should reinforce the need for stronger regulation. In addition, this review highlights the limitations of the published work, which is mostly cross-sectional or retrospective. Prospective studies should be undertaken to assess the full spectrum of health effects of WPS, particularly in view of its growing popularity and attractiveness to youth.
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Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Hassan A Chami
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ghazi S Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
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Baheiraei A, Shahbazi Sighaldeh S, Ebadi A, Kelishadi R, Majdzadeh R. The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study. Glob J Health Sci 2015; 7:1-10. [PMID: 26156895 PMCID: PMC4803904 DOI: 10.5539/gjhs.v7n5p1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/02/2014] [Indexed: 11/12/2022] Open
Abstract
Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members' smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls' participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well.
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112
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Cavazos-Rehg PA, Krauss MJ, Kim Y, Emery SL. Risk Factors Associated With Hookah Use. Nicotine Tob Res 2015; 17:1482-90. [PMID: 25646349 DOI: 10.1093/ntr/ntv029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/24/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement. METHOD An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent). RESULT Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05). CONCLUSIONS Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.
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Affiliation(s)
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Yoonsang Kim
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Sherry L Emery
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
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113
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El-Shahawy O, Haddad L. Correlation between nicotine dependence and barriers to cessation between exclusive cigarette smokers and dual (water pipe) smokers among Arab Americans. Subst Abuse Rehabil 2015; 6:25-32. [PMID: 25674035 PMCID: PMC4321602 DOI: 10.2147/sar.s72360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Evidence suggests that dual cigarette and water pipe use is growing among minority groups, particularly among Arab Americans. Differences in nicotine dependence and barriers to smoking cessation among such dual smokers have not been previously examined in this population. We examined potential differences that might exist between exclusive cigarette smokers and dual smokers (cigarette and water pipe) pertaining to nicotine dependence and barriers to cessation among Arab Americans. Methods We conducted a cross-sectional study using a convenience sample of self-identified Arab immigrant smokers (n=131) living in the Richmond, VA metropolitan area. Data were collected using four questionnaires: Demographic and Cultural Information questionnaire, Tobacco Use questionnaire, Fagerström Test for Nicotine Dependence (FTND) questionnaire, and Barriers to Cessation questionnaire. We examined differences in nicotine dependence and barriers to cessation between exclusive cigarette smokers and dual smokers of cigarettes and water pipe. Furthermore, we explored the correlations of these measures with select variables. Results There was a significant difference in the FTND scores between the exclusive cigarette smokers (mean M=2.55, standard deviation [SD] =2.10) and dual smokers (M=3.71, SD =2.42); t(129) = (2.51), P=0.0066. There was also a significant difference in the Barriers to Cessation scores between exclusive cigarette smokers (M=38.47, SD =13.07) and dual smokers (M=45.21, SD =9.27); t(129) = (2.56), P=0.0058. Furthermore, there was a highly significant correlation among FTND scores, Barriers to Cessation scores, and past quit attempts among dual smokers. Conclusion Water pipe tobacco smoking seems to be both adding to the dependence potential of cigarette smoking and enhancing barriers to cessation in our study sample. However, the high correlation between quit attempts, FTND, and barriers to cessation needs further investigation to ascertain the possible reasons behind it. This preliminary study utilized a cross-sectional survey among participants of a rather small convenience sample, especially in the dual smokers group. Thus, there is a need to examine these differences via a longitudinal design in a larger sample.
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Affiliation(s)
- Omar El-Shahawy
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Linda Haddad
- College of Nursing, University of Florida, Gainesville, FL, USA
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Jawad M, Bakir AM, Ali M, Jawad S, Akl EA. Key health themes and reporting of numerical cigarette-waterpipe equivalence in online news articles reporting on waterpipe tobacco smoking: a content analysis. Tob Control 2015; 24:43-7. [PMID: 23868396 DOI: 10.1136/tobaccocontrol-2013-050981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There is anecdotal evidence that health messages interpreted from waterpipe tobacco smoking (WTS) research are inconsistent, such as comparing the health effects of one WTS session with that of 100 cigarettes. This study aimed to identify key health themes about WTS discussed by online news media, and how numerical cigarette-waterpipe equivalence (CWE) was being interpreted. METHODS We identified 1065 online news articles published between March 2011 and September 2012 using the 'Google Alerts' service. We screened for health themes, assessed statements mentioning CWE and reported differences between countries. We used logistic regression to identify factors associated with articles incorrectly reporting a CWE equal to or greater than 100 cigarettes, in the absence of any comparative parameter ('CWE ≥100 cigarettes'). RESULTS Commonly mentioned health themes were the presence of tobacco (67%) and being as bad as cigarettes (49%), and we report on differences between countries. While 10.8% of all news articles contained at least one positive health theme, 22.9% contained a statement about a CWE. Most of these (18.6% total) were incorrectly a CWE ≥100 cigarettes, a quarter of which were made by healthcare professionals/organisations. Compared with the Middle East, articles from the USA and the UK were the most significant predictors to contain a CWE ≥100 cigarettes statement. CONCLUSIONS Those wishing to write or publish information related to WTS may wish to avoid comparing WTS to cigarettes using numerical values as this is a major source of confusion. Future research is needed to address the impact of the media on the attitudes, initiation and cessation rates of waterpipe smokers.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ali M Bakir
- Faculty of Medicine, Imperial College London, London, UK
| | - Mohammed Ali
- Faculty of Medicine, Imperial College London, London, UK
| | - Sena Jawad
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, State University of New York at Buffalo, Buffalo, New York, USA
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115
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Sidani JE, Shensa A, Primack BA. Water pipe steam stones: familiarity and use among US young adults. Nicotine Tob Res 2015; 17:114-8. [PMID: 25145376 PMCID: PMC4318932 DOI: 10.1093/ntr/ntu137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/06/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Water pipe tobacco smoking (WTS) is associated with substantial toxicant exposure. Water pipe steam stones (WSS) are marketed as a healthier alternative. The purpose of this study was to determine, in a nationally representative sample, young adults' familiarity with, perceptions regarding, and use of WSS. METHODS A survey about WTS was completed by 3,253 members of an online nonvolunteer access panel. Four items specifically addressed WSS. RESULTS Of the 228 individuals who had heard of WSS, 17% (n = 41) reported using them. Use was associated with ever (adjusted odds ratio [AOR] = 7.7, 95% confidence interval [CI] = 2.7-21.8) and current (AOR = 16.1, 95% CI = 5.1-51.5) WTS. Compared with those who thought that WSS had about the same harm as WTS, those who thought that WSS was "a lot less harmful" to a person's health had substantially higher odds of having tried WSS (AOR = 6.8, 95% CI = 2.0-23.1). CONCLUSIONS Approximately 1 in 6 young adults who have heard of WSS used them. WSS use is associated with the perception of reduced harm.
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Affiliation(s)
- Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA; Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA;
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA; Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
| | - Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA; Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA; Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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116
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She J, Yang P, Wang Y, Qin X, Fan J, Wang Y, Gao G, Luo G, Ma K, Li B, Li C, Wang X, Song Y, Bai C. Chinese water-pipe smoking and the risk of COPD. Chest 2014; 146:924-931. [PMID: 24557573 DOI: 10.1378/chest.13-1499] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies show that the incidence of COPD has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. Chinese water-pipe tobacco smoking (commonly referred to as water-pipe smoking), which is thought to be less harmful under the assumption that no charcoal is used and water filters tobacco smoke, is popular in China. We investigated whether Chinese water-pipe use and exposure are associated with the risk of COPD. METHODS This multicenter, cross-sectional study enrolled 1,238 individuals from 10 towns in the Fuyuan area, Yunnan Province, China. A matched design was used to estimate the impact of active and passive exposure to Chinese water-pipe smoking on COPD risk; multivariate analyses adjusted for other risk factors. We also collected the water from Chinese water pipes to assess the mutagenicity of its major components and simulated Chinese water-pipe smoke exposure fine particulate 2.5 (PM2.5) by using the High Volume Air Sampler and individuals' sera to search for the potential protein biomarkers of COPD. RESULTS The increased risk of COPD was profound for Chinese water-pipe smokers (adjusted OR, 10.61; 95% CI, 6.89-16.34), Chinese water-pipe passive smokers (adjusted OR, 5.50; 95% CI, 3.61-8.38), cigarette smokers (adjusted OR, 3.18; 95% CI, 2.06-4.91), and cigarette passive smokers (adjusted OR, 2.52; 95% CI, 1.62-3.91) compared with never-smoking control subjects. Chinese water-pipe use aggravates lungs with more PM2.5 compared with cigarettes. ChemR23 and tissue inhibitor of metalloproteinase-1 may be potential protein biomarkers of COPD. CONCLUSIONS Chinese water-pipe smoking significantly increases the risk of COPD, including the risk to women who are exposed to the water-pipe smoke. TRIAL REGISTRY Chinese Clinical Trial Registry; No.: ChiCTR-CCH-12002235; URL: www.chictr.org/cn/
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Affiliation(s)
- Jun She
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Yuqi Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinyu Qin
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia Fan
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Preventive Medicine, Wenzhou Medical University, Zhejiang, China
| | | | | | | | - Baoyan Li
- Fuyuan County Hospital, Yunnan, China
| | - Caihua Li
- Fuyuan County Hospital, Yunnan, China
| | - Xiangdong Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
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Lipkus IM, Eissenberg T, Schwartz-Bloom RD, Prokhorov AV, Levy J. Relationships among factual and perceived knowledge of harms of waterpipe tobacco, perceived risk, and desire to quit among college users. J Health Psychol 2014; 19:1525-35. [PMID: 23928987 PMCID: PMC4358735 DOI: 10.1177/1359105313494926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Waterpipe tobacco smoking is increasing in the United States among college students. Through a web-based survey, we explored associations among factual and perceived knowledge, perceived risks and worry about harm and addiction, and desire to quit among 316 college waterpipe tobacco smoking users. Overall, factual knowledge of the harm of waterpipe tobacco smoking was poor, factual and perceived knowledge was weakly correlated, both forms of knowledge were related inconsistently to perceived risks and worry, and neither form of knowledge was associated with the desire to quit. Findings provide preliminary insights as to why knowledge gaps may not predict cessation among waterpipe users.
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Abstract
Cigarette smoking is known to cause a wide range of damaging health outcomes; however, the effects of non-cigarette tobacco products are either unknown or perceived as less harmful than cigarettes. Smokeless tobacco, cigar smoking, and waterpipe smoking have increased in usage over the past few decades. Some experts believe that their use is reaching epidemic proportions. Factors such as a perception of harm reduction, targeted advertising, and unrecognized addiction may drive the increased consumption of non-cigarette tobacco products. In particular, the need for social acceptance, enjoyment of communal smoking activities, and exotic nature of waterpipe smoking fuels, in part, its popularity. The public is looking for "safer" alternatives to smoking cigarettes, and some groups advertise products such as smokeless tobacco and electronic cigarettes as the alternatives they seek. Though it is clear that cigar and waterpipe tobacco smoking are probably as dangerous to health as cigarette smoking, there is an opinion among users that the health risks are less compared to cigarette smoking. This is particularly true in younger age groups. In the cases of smokeless tobacco and electronic cigarettes, the risks to health are less clear and there may be evidence of a harm reduction compared to cigarettes. In this article, we discuss commonly used forms of non-cigarette tobacco products, their impacts on lung health, and relevant controversies surrounding their use.
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119
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Meo SA, AlShehri KA, AlHarbi BB, Barayyan OR, Bawazir AS, Alanazi OA, Al-Zuhair AR. Effect of shisha (waterpipe) smoking on lung functions and fractional exhaled nitric oxide (FeNO) among Saudi young adult shisha smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9638-48. [PMID: 25233010 PMCID: PMC4199040 DOI: 10.3390/ijerph110909638] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 12/15/2022]
Abstract
Shisha (waterpipe) smoking is becoming a more prevalent form of tobacco consumption, and is growing worldwide, particularly among the young generation in the Middle East. This cross-sectional study aimed to determine the effects of shisha smoking on lung functions and Fractional Exhaled Nitric Oxide (FeNO) among Saudi young adults. We recruited 146 apparently healthy male subjects (73 control and 73 shisha smokers). The exposed group consisted of male shisha smokers, with mean age 21.54 ± 0.41 (mean ± SEM) range 17-33 years. The control group consisted of similar number (73) of non-smokers with mean age 21.36 ± 0.19 (mean ± SEM) range 18-28 years. Between the groups we considered the factors like age, height, weight, gender, ethnicity and socioeconomic status to estimate the impact of shisha smoking on lung function and fractional exhaled nitric oxide. Lung function test was performed by using an Spirovit-SP-1 Electronic Spirometer. Fractional Exhaled Nitric Oxide (FeNO) was measured by using Niox Mino. A significant decrease in lung function parameters FEV1, FEV1/FVC Ratio, FEF-25%, FEF-50%, FEF-75% and FEF-75-85% was found among shisha smokers relative to their control group. There was also a significant reduction in the Fractional Exhaled Nitric Oxide among Shisha smokers compared to control group.
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Affiliation(s)
- Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Khaled Ahmed AlShehri
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Bader Bandar AlHarbi
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Omar Rayyan Barayyan
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Abdulrahman Salem Bawazir
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Omar Abdulmohsin Alanazi
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Ahmed Raad Al-Zuhair
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia
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Haddad L, El-Shahawy O, Ghadban R. Comparison of barriers to cessation among Arab American smokers of cigarettes and waterpipe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9522-31. [PMID: 25226410 PMCID: PMC4199033 DOI: 10.3390/ijerph110909522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
This cross-sectional study examined the differences in barriers to cessation and reasons for quitting smoking among dual smokers of cigarettes and waterpipe tobacco, exclusive cigarette smokers and exclusive waterpipe smokers. Participants were Arab American adults residing in Richmond, Virginia, who were recruited from Middle Eastern grocery stores, restaurants/lounges and faith and charity organizations. The study yielded several key findings: (1) Exclusive cigarette and waterpipe smokers had similar mean barriers to quitting and were more concerned about their health than dual smokers. (F(2, 150) = 5.594, p = 0.0045). This implies that barriers to smoking and health concerns could be a function of the individual who smokes rather than the modality of smoking itself. (2) Exclusive cigarette or waterpipe smokers and dual smokers may have different reasons for quitting, since they have different reasons for smoking. The proportion of smokers who endorsed smoking as a messy habit as the reason among exclusive cigarette smokers was 0.37, whereas the proportion among exclusive waterpipe smokers was 0.04 and among dual smokers 0.39. The difference in proportions is significant, χ2 (df = 2, N = 154) = 13.17, p = 0.0014. In summary, this study supports the need to further investigate dual cigarette and waterpipe smokers, as the study results indicate greater barriers to smoking cessation in this group. Recognition and understanding of these barriers among dual tobacco users would be important for any future tobacco intervention among waterpipe smokers.
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Affiliation(s)
- Linda Haddad
- College of Nursing, University of Florida, Gainesville, FL 32604, USA.
| | - Omar El-Shahawy
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23219, USA.
| | - Roula Ghadban
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23219, USA.
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Layoun N, Saleh N, Barbour B, Awada S, Rachidi S, Al-Hajje A, Bawab W, Waked M, Salameh P. Waterpipe effects on pulmonary function and cardiovascular indices: a comparison to cigarette smoking in real life situation. Inhal Toxicol 2014; 26:620-7. [DOI: 10.3109/08958378.2014.945106] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The growing epidemic of water pipe smoking: health effects and future needs. Respir Med 2014; 108:1241-53. [PMID: 25130679 DOI: 10.1016/j.rmed.2014.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/01/2014] [Accepted: 07/29/2014] [Indexed: 11/22/2022]
Abstract
Water pipe smoking (WPS), an old method of tobacco smoking, is re-gaining widespread popularity all over the world and among various populations. Smoking machine studies have shown that the water pipe (WP) mainstream smoke (MSS) contains a wide array of chemical substances, many of which are highly toxic and carcinogenic for humans. The concentrations of some substances exceed those present in MSS of cigarettes. Despite being of low grade, current evidence indicates that WPS is associated with different adverse health effects, not only on the respiratory system but also on the cardiovascular, hematological, and reproductive systems, including pregnancy outcomes. In addition, association between WPS and malignancies, such as lung, oral and nasopharyngeal cancer, has been suggested in different studies and systematic reviews. Despite its long standing history, WPS research still harbors a lot of deficiencies. The magnitude of toxicants and carcinogen exposures, effects on human health, as well as the addiction and dependence potentials associated with WPS need to be studied in well-designed prospective trials. Unfortunately, many of the tobacco control and clean indoor policies have exempted water pipes. World wide awareness among the public, smokers, and policymakers about the potential health effects of WPS is urgently required. Furthermore, stringent policies and laws that control and ban WPS in public places, similar to those applied on cigarettes smoking need to be implemented.
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123
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Pepper JK, Eissenberg T. Waterpipes and electronic cigarettes: increasing prevalence and expanding science. Chem Res Toxicol 2014; 27:1336-43. [PMID: 25338174 PMCID: PMC4137989 DOI: 10.1021/tx500200j] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
![]()
The
prevalence of noncigarette tobacco product use is on the rise
across the globe, especially for waterpipes (also known as hookah,
narghile, and shisha) and electronic cigarettes (e-cigarettes). The
scientific literature reveals that waterpipe tobacco smoking is associated
with exposure to a variety of toxicants that can cause short- and
long-term adverse health events. In contrast, there is far less evidence
of health harms related to e-cigarette use, although the variety of
products in this category makes it difficult to generalize. We searched
the PubMed database for all publications on waterpipes and e-cigarettes
from January 2000 to March 2014. The number of publications on waterpipes
rose in a slow, linear pattern during this time, while the number
of publications on e-cigarettes showed exponential growth. The different
trends suggest there may be more interest in studying a novel nicotine
product (the e-cigarette) over a traditional tobacco product (the
waterpipe). We posit that, although the specific research needs for
these products are different, public health would be served best by
a more equitable research approach. Scientists should continue to
devote attention to understanding the unknown long-term health effects
of e-cigarettes and their potential to serve as harm reduction or
smoking cessation tools while simultaneously investigating how to
reduce waterpipe smoking given that it exposes users to toxicants
known to cause harm to health. Recent regulatory action in the United
States, which proposes to include waterpipes and e-cigarettes under
some of the same regulations as tobacco cigarettes, makes such research
particularly timely.
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Affiliation(s)
- Jessica K Pepper
- Center for Regulatory Research on Tobacco Communication, Lineberger Comprehensive Cancer Center, University of North Carolina , 319D Rosenau Hall, CB #7400, Chapel Hill, North Carolina 27599, United States
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Kassem NOF, Daffa RM, Liles S, Jackson SR, Kassem NO, Younis MA, Mehta S, Chen M, Jacob P, Carmella SG, Chatfield DA, Benowitz NL, Matt GE, Hecht SS, Hovell MF. Children's exposure to secondhand and thirdhand smoke carcinogens and toxicants in homes of hookah smokers. Nicotine Tob Res 2014; 16:961-75. [PMID: 24590387 PMCID: PMC4072898 DOI: 10.1093/ntr/ntu016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/19/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We examined homes of hookah-only smokers and nonsmokers for levels of indoor air nicotine (a marker of secondhand smoke) and indoor surface nicotine (a marker of thirdhand smoke), child uptake of nicotine, the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and the toxicant acrolein by analyzing their corresponding metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and NNAL-glucuronides (total NNAL) and 3-hydroxypropylmercapturic acid. METHODS Data were collected at 3 home visits during a 7-day study period from a convenience sample of 24 households with a child 5 years or younger. Three child urine samples and 2 air and surface samples from the living room and the child bedroom were taken in homes of nonsmokers (n = 5) and hookah-only smokers (n = 19) comprised of daily hookah smokers (n = 8) and weekly/monthly hookah smokers (n = 11). RESULTS Nicotine levels in indoor air and on surfaces in the child bedrooms in homes of daily hookah smokers were significantly higher than in homes of nonsmokers. Uptake of nicotine, NNK, and acrolein in children living in daily hookah smoker homes was significantly higher than in children living in nonsmoker homes. Uptake of nicotine and NNK in children living in weekly/monthly hookah smoker homes was significantly higher than in children living in nonsmoker homes. CONCLUSIONS Our data provide the first evidence for uptake of nicotine, the tobacco-specific lung carcinogen NNK, and the ciliatoxic and cardiotoxic agent acrolein in children living in homes of hookah smokers. Our findings suggest that daily and occasional hookah use in homes present a serious, emerging threat to children's long-term health.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA;
| | - Reem M Daffa
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Maram A Younis
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Setoo Mehta
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
| | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Peyton Jacob
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA
| | | | - Dale A Chatfield
- Department of Chemistry, San Diego State University, San Diego, CA
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA
| | - Georg E Matt
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA; Department of Psychology, San Diego State University, San Diego, CA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA
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125
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St Helen G, Benowitz NL, Dains KM, Havel C, Peng M, Jacob P. Nicotine and carcinogen exposure after water pipe smoking in hookah bars. Cancer Epidemiol Biomarkers Prev 2014; 23:1055-66. [PMID: 24836469 PMCID: PMC4047652 DOI: 10.1158/1055-9965.epi-13-0939] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Water pipe tobacco smoking is spreading globally and is increasingly becoming popular in the United States, particularly among young people. Although many perceive water pipe smoking to be relatively safe, clinical experimental studies indicate significant exposures to tobacco smoke carcinogens following water pipe use. We investigated biomarkers of nicotine intake and carcinogen exposure from water pipe smoking in the naturalistic setting of hookah bars. METHODS Fifty-five experienced water pipe users were studied before and after smoking water pipe in their customary way in a hookah bar. Urine samples were analyzed for nicotine, cotinine, the tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and mercapturic acid metabolites of volatile organic compounds (VOC). RESULTS We found an average 73-fold increase in nicotine, 4-fold increase in cotinine, 2-fold increase in NNAL, and 14% to 91% increase in VOC mercapturic acid metabolites immediately following water pipe smoking. We saw moderate to high correlations between changes in tobacco-specific biomarkers (nicotine, cotinine, and NNAL) and several mercapturic acid metabolites of VOCs. CONCLUSION Water pipe smoking in a hookah bar is associated with significant nicotine intake and carcinogen exposure. IMPACT Given the significant intake of nicotine and carcinogens, chronic water pipe use could place users at increased risk of cancer and other chronic diseases. Cancer Epidemiol Biomarkers Prev; 23(6); 1055-66. ©2014 AACR.
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Affiliation(s)
- Gideon St Helen
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
| | - Neal L Benowitz
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
| | - Katherine M Dains
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
| | - Christopher Havel
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
| | - Margaret Peng
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
| | - Peyton Jacob
- Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
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Bentur L, Hellou E, Goldbart A, Pillar G, Monovich E, Salameh M, Scherb I, Bentur Y. Laboratory and Clinical Acute Effects of Active and Passive Indoor Group Water-Pipe (Narghile) Smoking. Chest 2014; 145:803-809. [DOI: 10.1378/chest.13-0960] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Khan JH, Lababidi HMS, Al-Moamary MS, Zeitouni MO, AL-Jahdali HH, Al-Amoudi OS, Wali SO, Idrees MM, Al-Shimemri AA, Al Ghobain MO, Alorainy HS, Al-Hajjaj MS. The Saudi Guidelines for the Diagnosis and Management of COPD. Ann Thorac Med 2014; 9:55-76. [PMID: 24791168 PMCID: PMC4005164 DOI: 10.4103/1817-1737.128843] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 12/26/2022] Open
Abstract
The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.
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Affiliation(s)
- Javed H. Khan
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Hani M. S. Lababidi
- Department of Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed S. Al-Moamary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Hamdan H. AL-Jahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Omar S. Al-Amoudi
- College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Siraj O. Wali
- College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A. Al-Shimemri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed O. Al Ghobain
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hassan S. Alorainy
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Jawad M. Legislation enforcement of the waterpipe tobacco industry: a qualitative analysis of the London experience. Nicotine Tob Res 2014; 16:1000-8. [PMID: 24642591 DOI: 10.1093/ntr/ntu022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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129
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Tobacco Smoking and Environmental Risk Factors for Chronic Obstructive Pulmonary Disease. Clin Chest Med 2014; 35:17-27. [DOI: 10.1016/j.ccm.2013.09.011] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Hawari FI, Obeidat NA, Ayub H, Ghonimat I, Eissenberg T, Dawahrah S, Beano H. The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants. Inhal Toxicol 2014; 25:492-7. [PMID: 23905967 DOI: 10.3109/08958378.2013.806613] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS's chronic effects or have evaluated limited respiratory/cardiac parameters. OBJECTIVE We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity. METHOD We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48 h) post-test (within 0.5 h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10 min). RESULTS Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7 ppm to 24.4; oxygen consumption decreased (from 1.86 L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51 L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9 mmHg to 129.2; from 45.3 mmHg to 55.6; and from 9.9 mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89 ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91). CONCLUSION Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.
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Affiliation(s)
- Feras I Hawari
- King Hussein Cancer Center, Cancer Control Office, Amman, Jordan.
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131
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Grant A, Morrison R, Dockrell MJ. Prevalence of waterpipe (Shisha, Narghille, Hookah) use among adults in Great Britain and factors associated with waterpipe use: data from cross-sectional Online Surveys in 2012 and 2013. Nicotine Tob Res 2014; 16:931-8. [PMID: 24550183 DOI: 10.1093/ntr/ntu015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We assessed the prevalence and frequency of waterpipe smoking among adults (aged 18+ years) in Great Britain (GB) and determined demographic factors associated with use. METHODS We used cross-sectional representative population surveys conducted online in 2012 and 2013. A total of 12,436 adults in 2012 and 12,171 in 2013 were recruited from a commercial online survey panel. RESULTS The prevalence of ever use of waterpipe across both survey years combined was 11.6% (95% confidence interval [CI] = 11.0-12.1). Frequent use (at least once or twice a month) was 1.0% (95% CI = 0.8-1.2) and was similar in both 2012 and 2013. There was some suggestion of increased ever but not frequent use among 18-24-year-olds between survey years. After adjustment for covariates, females had lower odds of ever waterpipe use than males (odds ratio [OR] = 0.71, 95% CI = 0.63-0.79), those in the lowest social grade had lower odds of use compared to those in the highest social grade (OR = 0.43, 95% CI = 0.35-0.54), older people were at much lower odds of ever use than younger people, ever having smoked cigarettes increased odds of ever waterpipe use, and being Asian (OR = 1.84, 95% CI = 1.39-2.45) or of mixed ethnicity (OR = 2.36, 95% CI = 1.64-3.40) increased likelihood of ever use compared to White ethnicity. CONCLUSIONS Frequent waterpipe smoking was relatively rare in these representative samples of the GB adult population, and prevalence was similar between 2012 and 2013. Continued monitoring and targeted interventions are appropriate.
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Affiliation(s)
- Aimee Grant
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK;
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Blachman-Braun R, Del Mazo-Rodríguez RL, López-Sámano G, Buendía-Roldán I. Hookah, is it really harmless? Respir Med 2014; 108:661-7. [PMID: 24582881 DOI: 10.1016/j.rmed.2014.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/29/2014] [Indexed: 11/18/2022]
Abstract
The hookah is a snuff smoking device whose origin dates back to the fifteenth century, has been used extensively in the Middle East in recent decades has become popular in Western culture countries, particularly in Americas and Europe. It has been reported that like other forms smoking tobacco, their use can lead to addiction also is used for inhaling and other addictive substances. Has also been considered a risk factor for various isolated diseases, including chronic obstructive pulmonary disease (COPD), different types of cancer, hemodynamic alterations, vascular disease, infectious diseases, among others. In pregnant women has been reported that there use condition a diminution on fetal growth and different diseases in the newborn. It was also mentioned that hookah smoke contains several toxic substances that can affect both, the primary and the passive smoker, so we did this review to determine the complications associated with its use.
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Affiliation(s)
- Ruben Blachman-Braun
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Av. Universidad Anahuac No. 46, Col. Lomas Anáhuac, Huixquilucan, Edo. de México C.P. 52786, Mexico
| | - Raquel Lira Del Mazo-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Av. Universidad Anahuac No. 46, Col. Lomas Anáhuac, Huixquilucan, Edo. de México C.P. 52786, Mexico
| | - Gustavo López-Sámano
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Av. Universidad Anahuac No. 46, Col. Lomas Anáhuac, Huixquilucan, Edo. de México C.P. 52786, Mexico
| | - Ivette Buendía-Roldán
- Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, sección XVI, Del. Tlalpan, CP14080 México, D.F., Mexico.
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Jawad M, McIver C, Iqbal Z. Prevalence and correlates of lifetime waterpipe, cigarette, alcohol and drug use among secondary school students in Stoke-on-Trent, UK: a post hoc cross-sectional analysis. J Public Health (Oxf) 2014; 36:615-21. [PMID: 24496555 DOI: 10.1093/pubmed/fdu002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Waterpipe smoking is a growing public health concern in the UK. We sought to examine the prevalence and correlates of waterpipe use among young people in Stoke-on-Trent, comparing results with other substances of use. METHODS We analysed data from the Young People's Lifestyle Survey, conducted among 1252 secondary school students aged 11-16 years in Stoke-on-Trent, UK. Logistic regression models were created to compare correlates of lifetime waterpipe smoking to cigarette, alcohol and drug use. RESULTS The prevalence of lifetime waterpipe smoking was 12.0%, higher than lifetime drug use (6.5%) but lower than cigarette (22.2%) and alcohol (49.2%) use. All substances of use were significant correlates of each other. Other significant correlates for lifetime waterpipe use included increasing age, male gender and South Asian ethnicity. For lifetime cigarette use, these were increasing age and presence of free school meals. For lifetime alcohol use, these were increasing age, female gender and White ethnicity. Lifetime drug use had no additional significant correlates. CONCLUSIONS Waterpipe smoking was correlated with different factors compared with other common forms of substance use. Detailed waterpipe questions should be added to routine national health surveys to understand its future epidemiological course in the UK.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Claire McIver
- Department of Public Health, Stoke-on-Trent City Council, Stoke-on-Trent ST4 1HH, UK
| | - Zafar Iqbal
- Department of Public Health, Stoke-on-Trent City Council, Stoke-on-Trent ST4 1HH, UK
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134
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Blank MD, Brown KW, Goodman RJ, Eissenberg T. An observational study of group waterpipe use in a natural environment. Nicotine Tob Res 2014; 16:93-9. [PMID: 23943842 PMCID: PMC3864492 DOI: 10.1093/ntr/ntt120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/03/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION To date research on tobacco smoking with a waterpipe (hookah, narghile, and shisha) has focused primarily on the individual user in a laboratory setting. Yet, waterpipe tobacco smoking is often a social practice that occurs in cafés, homes, and other natural settings. This observational study examined the behavior of waterpipe tobacco smokers and the social and contextual features of waterpipe use among groups in their natural environment. METHODS Trained observers visited urban waterpipe cafés on multiple occasions during an 8-month period. Observations of 241 individual users in naturally formed groups were made on smoking topography (puff frequency, duration, and interpuff interval [IPI]) and engagement in other activities (e.g., food and drink consumption, other tobacco use, and media viewing). RESULTS Most users were male in group sizes of 3-4 persons, on average, and each table had 1 waterpipe, on average. The predominant social features during observational periods were conversation and nonalcoholic drinking. Greater puff number was associated with smaller group sizes and more waterpipes per group, while longer IPIs were associated with larger group sizes and fewer waterpipes per group. Additionally, greater puff frequency was observed during media viewing and in the absence of other tobacco use. CONCLUSIONS Overall, the results suggest that waterpipe smoking behavior is affected by group size and by certain social activities. Discussion focuses on how these findings enhance our understanding of factors that may influence exposure to waterpipe tobacco smoke toxicants in naturalistic environments.
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Affiliation(s)
- Melissa D. Blank
- Department of Psychology, Center for Neuroscience, West Virginia University, Morgantown, WV
| | - Kirk Warren Brown
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Robert J. Goodman
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA
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Primack BA, Mah J, Shensa A, Rosen D, Yonas MA, Fine MJ. Associations between race, ethnicity, religion, and waterpipe tobacco smoking. J Ethn Subst Abuse 2014; 13:58-71. [PMID: 24564560 PMCID: PMC3998664 DOI: 10.1080/15332640.2013.850462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We surveyed a random sample of 852 students at a large university in 2010-2011 to clarify associations between waterpipe tobacco smoking (WTS), ethnicity, and religion. Current (past 30 day) WTS was reported by 116 (14%) students, and 331 (39%) reported ever WTS. Middle Eastern ethnicity was associated with current WTS (odds ratio [OR] = 2.37; 95% confidence interval [CI] = 1.06, 5.34) and ever WTS (OR = 2.59; 95% CI = 1.22, 5.47). South Asian ethnicity was associated with lower odds for ever WTS (OR = 0.42; 95% CI = 0.21, 0.86), but there was no significant association between South Asian ethnicity and current WTS. Being an atheist and having lower religiosity were associated with both WTS outcomes.
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Affiliation(s)
- Brian A Primack
- a Division of General Internal Medicine and the Division of Adolescent Medicine, Department of Pediatrics , University of Pittsburgh School of Medicine, and the Program for Research on Media and Health, University of Pittsburgh , Pittsburgh , Pennsylvania
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Ben Saad H, Khemiss M, Nhari S, Ben Essghaier M, Rouatbi S. Pulmonary functions of narghile smokers compared to cigarette smokers: a case-control study. Libyan J Med 2013; 8:22650. [PMID: 24382307 PMCID: PMC3877776 DOI: 10.3402/ljm.v8i0.22650] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies of the lung function profiles of exclusive narghile smokers (ENS) are few, have some methodological limits, and present contradictory conclusions. The present study aimed to compare the plethysmographic profiles of ENS with age- and height-matched exclusive cigarette smokers (ECS). METHODS Males aged 35-60 living in Sousse, Tunisia, who have been smoking narghile exclusively for more than 10 narghile-years (n = 36) or cigarettes exclusively for more than 10 pack-years (n = 106) were recruited to participate in this case-control study. The anthropometric and plethysmographic data were measured according to international recommendations using a body plethysmograph (ZAN 500 Body II, Meβgreräte GmbH, Germany). Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as: first second forced expiratory volume/forced vital capacity (FEV1/FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total lung capacity < LLN. Lung hyperinflation was defined as residual volume > upper-limit-of-normal. Student t-test and χ(2) test were used to compare plethysmographic data and profiles of the two groups. RESULTS The subjects in the ENS and ECS groups are well matched in age (45±7 vs. 47±5 years) and height (1.73±0.06 vs. 1.72±0.06 m) and used similar quantities of tobacco (36±22 narghile-years vs. 35±19 pack-years). Compared to the ENS group, the ECS group had significantly lower FEV1 (84±12 vs. 60±21%), FVC (90±12 vs. 76±18%), and FEV1/FVC (99±7 vs. 83±17%). The two groups had similar percentages of RVD (31 vs. 36%), while the ECS group had a significantly higher percentage of LAOVD (8 vs. 58%) and lung hyperinflation (36 vs.57%). CONCLUSION Chronic exclusive narghile smoking has less adverse effects on pulmonary function tests than chronic exclusive cigarette smoking.
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Affiliation(s)
- Helmi Ben Saad
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine, University of Sousse, Sousse, Tunisia; Research Unit: Secondary Prevention After Myocardial Infarction, N: 04/UR/08-18, Faculty of Medicine of Sousse, Sousse, Tunisia;
| | - Mehdi Khemiss
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Saida Nhari
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Mejda Ben Essghaier
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine, University of Sousse, Sousse, Tunisia
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Dogar O, Jawad M, Shah SK, Newell JN, Kanaan M, Khan MA, Siddiqi K. Effect of cessation interventions on hookah smoking: post-hoc analysis of a cluster-randomized controlled trial. Nicotine Tob Res 2013; 16:682-8. [PMID: 24376277 DOI: 10.1093/ntr/ntt211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We explored the differential effect of cessation interventions (behavioral support sessions with [BSS+] and without [BSS] bupropion) between hookah and cigarette smokers. METHODS We reanalyzed the data from a major cluster-randomized controlled trial, ASSIST (Action to Stop Smoking In Suspected Tuberculosis), which consisted of 3 conditions: (a) behavioral support sessions (BSS), (b) behavioral support sessions plus 7 weeks of bupropion therapy (BSS+), and (c) controls receiving usual care. The trial originally recruited 1,955 adult smokers with suspected tuberculosis from 33 health centers in the Jhang and Sargodha districts of Pakistan between 2010 and 2011. The primary endpoint was continuous 6-month smoking abstinence, which was determined by carbon monoxide levels. Subgroup-specific relative risks (RRs) of smoking abstinence were computed and tested for differential intervention effect using log binomial regression (generalized linear model) between 3 subgroups (cigarette-only: 1,255; mixed: 485; and hookah-only: 215). RESULTS The test result for homogeneity of intervention effects between the smoking forms was statistically significant (p-value for BSS+: .04 and for BSS: .02). Compared to the control, both interventions appeared to be effective among hookah smokers (RR = 2.5; 95% CI = 1.3-4.7 and RR = 2.2; 95% CI = 1.3-3.8, respectively) but less effective among cigarette smokers (RR = 6.6; 95% CI = 4.6-9.6 and RR = 5.8; 95% CI = 4.0-8.5), respectively. CONCLUSIONS The differential intervention effects on hookah and cigarette smokers were seen (a) because the behavioral support intervention was designed primarily for cigarette smokers; (b) because of differences in demographic characteristics, behavioral, and sociocultural determinants; or (c) because of differences in nicotine dependency levels between the 2 groups.
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Affiliation(s)
- Omara Dogar
- Department of Health Sciences, University of York, York, UK
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Reveles CC, Segri NJ, Botelho C. Factors associated with hookah use initiation among adolescents. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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139
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Fielder RL, Carey KB, Carey MP. Hookah, cigarette, and marijuana use: a prospective study of smoking behaviors among first-year college women. Addict Behav 2013; 38:2729-35. [PMID: 23934004 DOI: 10.1016/j.addbeh.2013.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 06/13/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
Better understanding of the temporal sequence of hookah, cigarette, and marijuana use will help to inform smoking prevention efforts. To address this gap in the literature, we assessed all three of these smoking behaviors in a sample of 424 first-year college women. Using a longitudinal design, we investigated whether hookah use predicts initiating/resuming cigarette and/or initiating marijuana use, and whether cigarette and/or marijuana use predicts initiating hookah use. Participants (67% White, M age = 18.1 years) completed nine monthly surveys. The initial (i.e., baseline) survey assessed demographics, sensation-seeking, impulsivity, and pre-college substance use. Follow-up surveys assessed past-month substance use; outcomes were initiating/resuming cigarette use, initiating marijuana use, and initiating hookah use during the first year of college. We controlled for sensation-seeking, impulsivity, binge drinking, and other smoking behaviors in our multivariate logistic regression models. The results showed that (a) pre-college hookah use predicted initiating/resuming cigarette use; (b) pre-college marijuana use predicted initiation of hookah tobacco smoking; and (c) pre-college cigarette use predicted neither hookah nor marijuana initiation. The findings highlight the co-occurrence of smoking behaviors as well as the need for bundling preventive interventions so that they address hookah, cigarette, and marijuana use.
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Reveles CC, Segri NJ, Botelho C. Factors associated with hookah use initiation among adolescents. J Pediatr (Rio J) 2013; 89:583-7. [PMID: 24035875 DOI: 10.1016/j.jped.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE to determine the prevalence and to analyze factors associated with hookah use initiation among adolescents. METHODS This was a cross-sectional study, in which questionnaires were collected from 495 students attending public and private schools of the urban area of the city of Várzea Grande, in the state of Mato Grosso, Brazil. Data were analyzed through descriptive, bivariate, and multiple Poisson regression analyses. RESULTS A total of 19.7% students had tried a hookah. The use of hookah was associated with the final period of adolescence [PR=6.54 (2.79, 15.32)]; enrollment in private schools [PR=2.23 (1.73, 2.88)]; and presence of work activities [PR=1.80 (1.17, 2.78)]. CONCLUSION The proportion of adolescents that had tried a hookah was high. The influence of age, work activities, and class period on smoking initiation using the hookah was observed. Preventive measures encompassing all forms of tobacco smoking should be targeted at adolescents in the school environment, aiming at tobacco use control.
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141
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Jawad M, McEwen A, McNeill A, Shahab L. To what extent should waterpipe tobacco smoking become a public health priority? Addiction 2013; 108:1873-84. [PMID: 23863044 DOI: 10.1111/add.12265] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 04/08/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Waterpipe tobacco smoking (WTS) popularity is increasing world-wide, and health effects are emerging in the light of evidence that WTS is perceived by users as less harmful than cigarette smoking. However, there remains a paucity of available evidence from which to draw firm conclusions about its public health significance. AIMS This narrative review aims to summarize WTS literature to date to inform tobacco control specialists and health-care professionals about this phenomenon and help them to assess whether or not WTS should become a public health priority. METHODS Standard electronic databases as well as conference proceedings and personal libraries were searched in English, French and Arabic with inclusive terminology for the variety of names given to WTS. FINDINGS Waterpipe smoke contains significant levels of toxins, some of which are known to be carcinogenic to humans. Recent epidemiological trends have established an increasing prevalence of WTS in the Middle East and the United States, particularly among adolescents. It is used commonly across multiple ethnicities and both genders with less of a social gradient than cigarette smoking. Attitudes and beliefs have been researched widely and several reasons for believing it is less harmful than cigarette smoking include water filtration and social acceptability. A wide range of diseases have been associated with WTS, but research in this area is relatively underdeveloped and a better evidence base is needed. Worryingly, the waterpipe industry, including waterpipe cafes, operates in an almost completely unregulated market and employs deceptive marketing techniques to attract new users. CONCLUSIONS Waterpipe tobacco smoking (WTS) appears to be on the increase, especially among younger users, and therefore represents a potential public health concern. While legislators should consider enforcing and extending existing tobacco laws to a growing WTS industry, further research is required to fill gaps in the literature and provide evidence-based interventions for tobacco control specialists and health-care professionals.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK
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142
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Mohammad Y, Shaaban R, Al-Zahab BA, Khaltaev N, Bousquet J, Dubaybo B. Impact of active and passive smoking as risk factors for asthma and COPD in women presenting to primary care in Syria: first report by the WHO-GARD survey group. Int J Chron Obstruct Pulmon Dis 2013; 8:473-82. [PMID: 24124359 PMCID: PMC3794890 DOI: 10.2147/copd.s50551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The burden of chronic respiratory disease (CRD) is alarming. International studies suggest that women with CRD are undersurveyed and underdiagnosed by physicians worldwide. It is unclear what the prevalence of CRD is in the general population of Syria, particularly among women, since there has never been a survey on CRD in this nation. The purpose of this study was to investigate the impact of different patterns of smoking on CRD in women. Materials and methods We extracted data on smoking patterns and outcome in women from the Global Alliance Against Chronic Respiratory Diseases survey. Using spirometric measurements before and after the use of inhaled bronchodilators, we tracked the frequency of CRD in females active and passive narghile or cigarette smokers presenting to primary care. We administered the questionnaire to 788 randomly selected females seen during 1 week in the fiscal year 2009–2010 in 22 primary care centers in six different regions of Syria. Inclusion criteria were age >6 years, presenting for any medical complaint. In this cross-sectional study, three groups of female subjects were evaluated: active smokers of cigarettes, active smokers of narghiles, and passive smokers of either cigarettes or narghiles. These three groups were compared to a control group of female subjects not exposed to active or passive smoking. Results Exposure to active cigarette smoke but not narghile smoke was associated with doctor-diagnosed chronic obstructive pulmonary disease (COPD). However, neither cigarette nor narghile active smoking was associated with increased incidence of spirometrically diagnosed COPD. Paradoxically, exposure to passive smoking of either cigarettes or narghiles resulted in association with airway obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 70% according to the Global initiative for chronic Obstructive Lung Disease criteria; association with FEV1 < 80% predicted, evidencing moderate to severe GOLD spirometric grade, and doctor-diagnosed COPD. Physicians tend to underdiagnose COPD in women who present to primary care clinics. Whereas around 15% of enrolled women had evidence of COPD with FEV1/FVC < 70% after bronchodilators, only 4.8% were physician-diagnosed. Asthma did not appear to be a significant spirometric finding in these female subjects, although around 11% had physician-diagnosed asthma. One limitation is FEV1/FVC < 70% could have also resulted from uncontrolled asthma. The same limitation has been reported by the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study. Conclusion Contrary to popular belief in developing countries, women exposed to tobacco smoke, whether active or passive, and whether by cigarettes or narghiles, like men are at increased risk for the development of COPD, although cultural habits and taboos may decrease the risk of active smoking in some women. Recommendations These findings will be considered for country and region strategy for noncommunicable diseases, to overcome underdiagnosis of CRD in women, fight widespread female cigarette and narghile smoking, and promote behavioral research in this field.
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Affiliation(s)
- Yousser Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
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143
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Nemmar A, Raza H, Yuvaraju P, Beegam S, John A, Yasin J, Hameed RS, Adeghate E, Ali BH. Nose-only water-pipe smoking effects on airway resistance, inflammation, and oxidative stress in mice. J Appl Physiol (1985) 2013; 115:1316-23. [PMID: 23869065 DOI: 10.1152/japplphysiol.00194.2013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Water-pipe smoking (WPS) is a common practice in the Middle East and is now gaining popularity in Europe and the United States. However, there is a limited number of studies on the respiratory effects of WPS. More specifically, the underlying pulmonary pathophysiological mechanisms related to WPS exposure are not understood. Presently, we assessed the respiratory effects of nose-only exposure to mainstream WPS generated by commercially available honey flavored "moasel" tobacco. The duration of the session was 30 min/day and 5 days/wk for 1 mo. Control mice were exposed to air only. Here, we measured in BALB/c mice the airway resistance using forced-oscillation technique. Lung inflammation was assessed histopathologically and by biochemical analysis of bronchoalveolar lavage (BAL) fluid, and oxidative stress was evaluated biochemically by measuring lipid peroxidation, reduced glutathione and several antioxidant enzymes. Pulmonary inflammation assessment showed an increase in neutrophil and lymphocyte numbers. Likewise, airway resistance was significantly increased in the WPS group compared with controls. Tumor necrosis factor α and interleukin 6 concentrations were significantly increased in BAL fluid. Lipid peroxidation in lung tissue was significantly increased whereas the level and activity of antioxidants including reduced glutathione, glutathione S transferase, and superoxide dismutase were all significantly decreased following WPS exposure, indicating the occurrence of oxidative stress. Moreover, carboxyhemoglobin levels were significantly increased in the WPS group. We conclude that 1-mo nose-only exposure to WPS significantly increased airway resistance, inflammation, and oxidative stress. Our results provide a mechanistic explanation for the limited clinical studies that reported the detrimental respiratory effects of WPS.
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Affiliation(s)
- Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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144
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Alzoubi KH, Khabour OF, Azab M, Shqair DM, Shihadeh A, Primack B, Eissenberg T. CO exposure and puff topography are associated with Lebanese waterpipe dependence scale score. Nicotine Tob Res 2013; 15:1782-6. [PMID: 23616231 DOI: 10.1093/ntr/ntt049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking involves self-administration of the dependence-producing drug nicotine. Few studies have examined if dependence in waterpipe smokers influences toxicant exposure and smoking behavior. METHOD Current waterpipe tobacco smokers were categorized based on Lebanese Waterpipe Dependence Scale-11 (LWDS-11) score (LWDS-11: LOW < 7; N = 59; HIGH > 13; N = 59). Participants abstained from smoking for 12 hr and then completed a single 30-min waterpipe tobacco smoking episode. Expired-air carbon monoxide (CO) was measured before and 5 min after smoking and puff topography was measured during smoking. RESULTS Total mean smoking time was 30.9 min (SD = 3.5) and did not differ significantly by LWDS-11 score. CO boost was greater for participants in the HIGH versus LOW groups (62.3 vs. 43.6 ppm, p < .01). Similarly, those in the HIGH versus LOW group took more puffs (198.6 vs. 157.1 puffs, p < .01), longer duration puffs (2.7 vs. 2.3 s, p < .05), puffs with lower flow rate (10.3 vs. 12.6 L/min, p < .01), and less time between puffs (8.0 vs. 12.4 s, p < .001). CONCLUSION The puff topography of waterpipe tobacco smokers can be predicted by LWDS-11 score, with those scoring higher taking longer duration and lower velocity puffs at a higher frequency. These behavioral differences may underlie the 40% greater CO exposure observed for those with higher LWDS-11 scores. To the extent that waterpipe dependence is associated with more smoke inhalation, more dependent smokers will be exposed to greater amounts of toxic smoke constituents.
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Affiliation(s)
- Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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145
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Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2013; 187:347-65. [PMID: 22878278 DOI: 10.1164/rccm.201204-0596pp] [Citation(s) in RCA: 3597] [Impact Index Per Article: 327.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jørgen Vestbo
- Manchester Academic Sciences Health Centre, Respiratory Research Group, University of Manchester, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK.
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146
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Islami F, Pourshams A, Vedanthan R, Poustchi H, Kamangar F, Golozar A, Etemadi A, Khademi H, Freedman ND, Merat S, Garg V, Fuster V, Wakefield J, Dawsey SM, Pharoah P, Brennan P, Abnet CC, Malekzadeh R, Boffetta P. Smoking water-pipe, chewing nass and prevalence of heart disease: a cross-sectional analysis of baseline data from the Golestan Cohort Study, Iran. Heart 2013; 99:272-8. [PMID: 23257174 PMCID: PMC3671096 DOI: 10.1136/heartjnl-2012-302861] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Water-pipe and smokeless tobacco use have been associated with several adverse health outcomes. However, little information is available on the association between water-pipe use and heart disease (HD). Therefore, we investigated the association of smoking water-pipe and chewing nass (a mixture of tobacco, lime and ash) with prevalent HD. DESIGN Cross-sectional study. SETTING Baseline data (collected in 2004-2008) from a prospective population-based study in Golestan Province, Iran. PARTICIPANTS 50 045 residents of Golestan (40-75 years old; 42.4% men). MAIN OUTCOME MEASURES ORs and 95% CIs from multivariate logistic regression models for the association of water-pipe and nass use with HD prevalence. RESULTS A total of 3051 (6.1%) participants reported a history of HD, and 525 (1.1%) and 3726 (7.5%) reported ever water-pipe or nass use, respectively. Heavy water-pipe smoking was significantly associated with HD prevalence (highest level of cumulative use vs never use, OR=3.75; 95% CI 1.52 to 9.22; p for trend=0.04). This association persisted when using different cut-off points, when restricting HD to those taking nitrate compound medications, and among never cigarette smokers. There was no significant association between nass use and HD prevalence (highest category of use vs never use, OR=0.91; 95% CI 0.69 to 1.20). CONCLUSIONS Our study suggests a significant association between HD and heavy water-pipe smoking. Although the existing evidence suggesting similar biological consequences of water-pipe and cigarette smoking make this association plausible, results of our study were based on a modest number of water-pipe users and need to be replicated in further studies.
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Affiliation(s)
- Farhad Islami
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- The Tisch Cancer Institute and Institute for Transitional Epidemiology, Mount Sinai School of Medicine, New York, United States
| | - Akram Pourshams
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Vedanthan
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Hossein Poustchi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Asieh Golozar
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Arash Etemadi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Hooman Khademi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Shahin Merat
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vaani Garg
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jon Wakefield
- Departments of Biostatistics and Statistics, University of Washington, Seattle, United States
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Paul Pharoah
- Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Christian C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Reza Malekzadeh
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Transitional Epidemiology, Mount Sinai School of Medicine, New York, United States
- International Prevention Research Institute, Lyon, France
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147
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Khabour OF, Alzoubi KH, Bani-Ahmad M, Dodin A, Eissenberg T, Shihadeh A. Acute exposure to waterpipe tobacco smoke induces changes in the oxidative and inflammatory markers in mouse lung. Inhal Toxicol 2013; 24:667-75. [PMID: 22906173 DOI: 10.3109/08958378.2012.710918] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Tobacco smoking represents a global public health threat, claiming approximately 5 million lives a year. Waterpipe tobacco use has become popular particularly among youth in the past decade, buttressed by the perception that the waterpipe "filters" the smoke, rendering it less harmful than cigarette smoke. OBJECTIVE In this study, we examined the acute exposure of waterpipe smoking on lung inflammation and oxidative stress in mice, and compared that to cigarette smoking. MATERIALS AND METHODS Mice were divided into three groups; fresh air control, cigarette and waterpipe. Animals were exposed to fresh air, cigarette, or waterpipe smoke using whole body exposure system one hour daily for 7 days. RESULTS Both cigarette and waterpipe smoke exposure resulted in elevation of total white blood cell count, as well as absolute count of neutrophils, macrophages, and lymphocytes (P < 0.01). Both exposures also elevated proinflammatory markers such as TNF-α and IL-6 in BALF (P < 0.05), and oxidative stress markers including GPx activity in lungs (P < 0.05). Moreover, waterpipe smoke increased catalase activity in the lung (P < 0.05). However, none of the treatments altered IL-10 levels. DISCUSSION AND CONCLUSION Results of cigarette smoking confirmed previous finding. Waterpipe results indicate that, similar to cigarettes, exposure to waterpipe tobacco smoke is harmful to the lungs.
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Affiliation(s)
- Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan.
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148
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Primack BA, Shensa A, Kim KH, Carroll MV, Hoban MT, Leino EV, Eissenberg T, Dachille KH, Fine MJ. Waterpipe smoking among U.S. university students. Nicotine Tob Res 2013; 15:29-35. [PMID: 22641433 PMCID: PMC3524056 DOI: 10.1093/ntr/nts076] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 02/04/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics. METHODS We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever. RESULTS Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States. CONCLUSIONS After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.
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Affiliation(s)
- Brian A Primack
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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149
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Cobb CO, Sahmarani K, Eissenberg T, Shihadeh A. Acute toxicant exposure and cardiac autonomic dysfunction from smoking a single narghile waterpipe with tobacco and with a "healthy" tobacco-free alternative. Toxicol Lett 2012; 215:70-5. [PMID: 23059956 PMCID: PMC3641895 DOI: 10.1016/j.toxlet.2012.09.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/28/2012] [Accepted: 09/30/2012] [Indexed: 12/19/2022]
Abstract
Tobacco smoking using a waterpipe (narghile, hookah, shisha) has become a global epidemic. Unlike cigarette smoking, little is known about the health effects of waterpipe use. One acute effect of cigarette smoke inhalation is dysfunction in autonomic regulation of the cardiac cycle, as indicated by reduction in heart rate variability (HRV). Reduced HRV is implicated in adverse cardiovascular health outcomes, and is associated with inhalation exposure-induced oxidative stress. Using a 32 participant cross-over study design, we investigated toxicant exposure and effects of waterpipe smoking on heart rate variability when, under controlled conditions, participants smoked a tobacco-based and a tobacco-free waterpipe product promoted as an alternative for "health-conscious" users. Outcome measures included HRV, exhaled breath carbon monoxide (CO), plasma nicotine, and puff topography, which were measured at times prior to, during, and after smoking. We found that waterpipe use acutely decreased HRV (p<0.01 for all measures), independent of product smoked. Plasma nicotine, blood pressure, and heart rate increased only with the tobacco-based product (p<0.01), while CO increased with both products (p<0.01). More smoke was inhaled during tobacco-free product use, potentially reflecting attempted regulation of nicotine intake. The data thus indicate that waterpipe smoking acutely compromises cardiac autonomic function, and does so through exposure to smoke constituents other than nicotine.
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Affiliation(s)
- Caroline O. Cobb
- Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Kamar Sahmarani
- Aerosol Research Lab, Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Alan Shihadeh
- Aerosol Research Lab, Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
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150
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Shafique K, Mirza SS, Mughal MK, Arain ZI, Khan NA, Tareen MF, Ahmad I. Water-pipe smoking and metabolic syndrome: a population-based study. PLoS One 2012; 7:e39734. [PMID: 22848361 PMCID: PMC3407230 DOI: 10.1371/journal.pone.0039734] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/25/2012] [Indexed: 11/28/2022] Open
Abstract
Water-pipe (WP) smoking has significantly increased in the last decade worldwide. Compelling evidence suggests that the toxicants in WP smoke are similar to that of cigarette smoke. The WP smoking in a single session could have acute harmful health effects even worse than cigarette smoking. However, there is no evidence as such on long term WP smoking and its impact on chronic health conditions particularly cardiovascular and metabolic conditions. Therefore, we conducted this study to investigate the relationship between WP smoking and metabolic syndrome (MetS). This was a cross-sectional study carried out in Punjab province of Pakistan using the baseline data of a population-based study – Urban Rural Chronic Diseases Study (URCDS). Information was collected by trained nurses regarding the socio-demographic profile, lifestyle factors including WP smoking, current and past illnesses. A blood sample was obtained for measurement of complete blood count, lipid profile and fasting glucose level. MetS was ascertained by using the International Diabetic Federation’s criteria. We carried out multiple logistic regressions to investigate the association between WP smoking and MetS. Final sample included 2,032 individuals – of those 325 (16.0%) were current WP smokers. Age adjusted-prevalence of MetS was significantly higher among current WP smokers (33.1%) compared with non-smokers (14.8%). Water-pipe smokers were three times more likely to have MetS (OR 3.21, 95% CI 2.38–4.33) compared with non-smokers after adjustment for age, sex and social class. WP smokers were significantly more likely to have hypertriglyceridemia (OR 1.63, 95% CI 1.25–2.10), hyperglycaemia (OR 1.82, 95% CI 1.37–2.41), Hypertension (OR 1.95, 95% CI 1.51–2.51) and abdominal obesity (OR 1.93, 95% CI 1.52–2.45). However, there were no significant differences in HDL level between WP smokers and non-smokers. This study suggests that WP smoking has a significant positive (harmful) relationship with MetS and its components.
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Affiliation(s)
- Kashif Shafique
- Institute of Basic Medical Sciences, Dow University of Health Sciences, Karachi, Pakistan.
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