151
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Lipkus IM, Eissenberg T, Schwartz-Bloom RD, Prokhorov AV, Levy J. Affecting perceptions of harm and addiction among college waterpipe tobacco smokers. Nicotine Tob Res 2011; 13:599-610. [PMID: 21471304 DOI: 10.1093/ntr/ntr049] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The spread of waterpipe tobacco use among youth may be due in part to perceptions that waterpipe tobacco use is safer than other tobacco products, such as cigarettes. In two pilot studies, we sought to modify college waterpipe smokers' perceived risks and worry about waterpipe tobacco smoking. METHODS We conducted two web-based studies that varied whether college waterpipe users received information on (a) spread of and use of flavored tobacco in waterpipe and (b) harms of waterpipe smoking. Study 1 (N = 91) tested the "incremental" effects on perceptions of risk and worry of adding information about harms of waterpipe smoking to information on the spread of waterpipe and use of flavorings in the tobacco. Study 2 (N = 112) tested the effects on perceptions of risk and worry of reviewing information about harms of waterpipe smoking compared to a no information control group. In Study 1 only, we assessed as part of a 6-month follow-up (n = 70) the percentage of participants who reported no longer using waterpipe. RESULTS Pooling data from both studies, participants who received information about the harms of waterpipe smoking reported greater perceived risk and worry about harm and addiction and expressed a stronger desire to quit. In Study 1, 62% of participants in the experimental group versus 33% in the control group reported having stopped waterpipe use. CONCLUSIONS These are the first studies to show that perceptions of addiction and harm from waterpipe use can be modified using minimally intensive interventions; such interventions show promise at decreasing waterpipe use.
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Affiliation(s)
- Isaac M Lipkus
- Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, USA.
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152
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Ahmed B, Jacob P, Allen F, Benowitz N. Attitudes and Practices of Hookah Smokers in the San Francisco Bay Area. J Psychoactive Drugs 2011; 43:146-52. [DOI: 10.1080/02791072.2011.587707] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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153
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Raad D, Gaddam S, Schunemann HJ, Irani J, Abou Jaoude P, Honeine R, Akl EA. Effects of water-pipe smoking on lung function: a systematic review and meta-analysis. Chest 2011; 139:764-774. [PMID: 20671057 DOI: 10.1378/chest.10-0991] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Although common in many Middle Eastern countries, water-pipe tobacco smoking, commonly known as water-pipe smoking (WPS), is increasingly popular in Western cultures. The primary objective of this study was to systematically review the effects of WPS on lung function. The secondary objective was to compare the effects of WPS and cigarette smoking on lung function. METHODS We conducted a systematic review using the approach of the Cochrane Collaboration to search for, select, and abstract studies. We conducted two separate meta-analyses comparing water-pipe smokers with nonsmokers, and water-pipe smokers with cigarette smokers for each of three spirometric measurements (FEV₁, FVC, and FEV₁/ FVC). We used the standardized mean difference (SMD) to pool the results. RESULTS Six cross-sectional studies were eligible for this review. Compared with no smoking, WPS was associated with a statistically significant reduction in FEV₁ (SMD = -0.43; 95% CI, -0.58 to -0.29; equivalent to a 4.04% lower FEV₁%), a trend toward lower FVC (SMD = -0.15; 95% CI, -0.34 to 0.04; equivalent to a 1.38% reduction in FVC%), and lower FEV₁/ FVC (SMD = -0.46; 95% CI, -0.93 to 0.01; equivalent to a 3.08% lower FEV₁/ FVC). Comparing WPS with cigarette smoking, there was no statistically significant difference in FEV₁, FVC, and FEV₁/ FVC. The six studies suffered from methodologic limitations. CONCLUSIONS WPS negatively affects lung function and may be as harmful as cigarette smoking. WPS, therefore, is likely to be a cause of COPD.
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Affiliation(s)
- Dany Raad
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Swarna Gaddam
- Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Holger J Schunemann
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY; Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Jihad Irani
- Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | | | - Roland Honeine
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Elie A Akl
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY; Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY; Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada.
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154
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Hakim F, Hellou E, Goldbart A, Katz R, Bentur Y, Bentur L. The acute effects of water-pipe smoking on the cardiorespiratory system. Chest 2011; 139:775-781. [PMID: 21030492 DOI: 10.1378/chest.10-1833] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE There are limited data on the acute effects of water-pipe tobacco smoking, commonly known as water-pipe smoking (WPS), on cardiopulmonary parameters. This study evaluated the acute effects of a single 30-min session of WPS on carboxyhemoglobin (COHb) levels, pulmonary function test results, vital signs, fractional exhaled nitric oxide (Feno) levels, and exhaled breath condensate (EBC) cytokine levels in volunteers in a domestic, open-air, group smoking setting. METHODS This prospective study evaluated the above-noted outcome parameters before and after 30 min of WPS. The primary outcome parameter was the change in COHb levels. RESULTS Forty-five volunteers (30 men, 15 women), aged 32.35 ± 15.33 years, were recruited. After one session of WPS, the COHb levels rose significantly, from 1.47% ± 0.57% (median 1.4) to 9.47% ± 5.52% (median 7.4), P < .001. Systolic and diastolic BP levels significantly increased after smoking (systolic, 119.52 ± 12.07 mm Hg vs 131.98 ± 17.8 mm Hg; diastolic, 74.84 ± 7.89 mm Hg vs 82.98 ± 12.52 mm Hg, respectively; P < .001). Heart rates increased from 80.39 ± 9.92 beats/min to 95.59 ± 17.41 beats/min, P < .001; and respiratory rates increased from 14.36 ± 1.63 breaths/min to 16.68 ± 2.24 breaths/min, P < .001. There were decreases in forced expiratory flow between 25% and 75% of FVC, peak expiratory flow rate, Feno levels, percentage of eosinophils in peripheral blood, and 8-isoprostane levels in EBC. CONCLUSIONS This study shows that one session of WPS causes acute biologic changes that might result in marked health problems. It adds to the limited evidence that WPS is harmful and supports interventions to control the continuing global spread of WPS, especially among youth. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01157832; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Fahed Hakim
- Pediatric Pulmonology Unit, Meyer Children's Hospital, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elias Hellou
- Rambam Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Aviv Goldbart
- The Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Rina Katz
- Department of Immunology, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yedidia Bentur
- The Israel Poison Information Center, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonology Unit, Meyer Children's Hospital, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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155
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Smith JR, Novotny TE, Edland SD, Hofstetter CR, Lindsay SP, Al-Delaimy WK. Determinants of Hookah Use among High School Students. Nicotine Tob Res 2011; 13:565-72. [DOI: 10.1093/ntr/ntr041] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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156
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Cobb CO, Shihadeh A, Weaver MF, Eissenberg T. Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects. Nicotine Tob Res 2011; 13:78-87. [PMID: 21127030 PMCID: PMC3107609 DOI: 10.1093/ntr/ntq212] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/26/2010] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking is increasing worldwide and is believed by many users to be less harmful and addictive than cigarette smoking. In fact, waterpipe tobacco and cigarette smoke contain many of the same chemicals, and users are exposed to the dependence-producing drug nicotine as well as other smoke toxicants. The subjective effect profile of these 2 tobacco use methods has not been compared directly, though this information is relevant to understanding the risk of dependence development. METHODS Fifty-four participants who reported waterpipe and cigarette smoking completed 2, 45-min, counter-balanced sessions in which they completed a waterpipe use episode (mean smoking time = 43.3 min) or a cigarette (mean = 6.1 min). Outcome measures included plasma nicotine, carboxyhemoglobin (COHb), and subjective effects, including those relevant to predicting dependence potential. RESULTS Mean (±SEM) peak plasma nicotine concentration did not differ by session (waterpipe = 9.8 ± 1.0 ng/ml; cigarette = 9.4 ± 1.0 ng/ml). Mean peak COHb concentration differed significantly (waterpipe = 4.5% ± 0.3%; cigarette = 1.2% ± 0.1%). Subjective effect changes for waterpipe and cigarette were comparable in magnitude but often longer lived for waterpipe. CONCLUSIONS Relative to a cigarette, waterpipe tobacco smoking was associated with similar peak nicotine exposure, 3.75-fold greater COHb, and 56-fold greater inhaled smoke volume. Waterpipe and cigarette influenced many of the same subjective effect measures. These findings are consistent with the conclusion that waterpipe tobacco smoking presents substantial risk of dependence, disease, and death, and they can be incorporated into prevention interventions that might help deter more adolescents and young adults from experimenting with an almost certainly lethal method of tobacco use.
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Affiliation(s)
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
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157
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Martinasek MP, McDermott RJ, Martini L. Waterpipe (hookah) tobacco smoking among youth. Curr Probl Pediatr Adolesc Health Care 2011; 41:34-57. [PMID: 21232693 DOI: 10.1016/j.cppeds.2010.10.001] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Waterpipe tobacco smoking is a centuries old practice, influenced by cultural tradition in Eastern Mediterranean countries, the Middle East, and parts of Asia. It historically has been an activity enjoyed primarily by men. In the past 2 decades, however, this method of tobacco smoking has increased in popularity in other parts of the world, including the USA. Growing interest in this form of smoking can be traced, in part, to the advent of a flavored tobacco, called maassel. The combination of flavoring agents and the paraphernalia itself used in the smoking process, along with its mystic appeal, novelty, affordability, and the social atmosphere in which smoking often occurs, has made waterpipe smoking attractive to women as well as men, cigarette smokers and nonsmokers alike, and particular groups, including persons of college age and younger adolescents. Although waterpipe smoking is perceived by its new generation of users to be less addictive and hazardous to health than cigarette smoking, researchers draw diametrically opposed conclusions. Research demonstrates that numerous toxic agents, including carcinogens, heavy metals, other particulate matter, and high levels of nicotine, are efficiently delivered through waterpipes. Moreover, sidestream smoke exposes others in the vicinity of waterpipe smokers to the risk of respiratory diseases and other conditions. In addition, persons sharing waterpipe mouthpieces may share infectious agents as well. Waterpipe tobacco smoking has been declared a public health problem by the World Health Organization and other authorities. Recognition of the deleterious effects of waterpipe smoking has led to initial attempts to expand regulatory control. Because waterpipe tobacco is not directly burned in the smoking process, many existing control measures do not apply. Public health authorities should monitor waterpipe tobacco use carefully. Finally, pediatricians and other healthcare providers should discourage experimentation and continued use among their adolescent patients.
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Affiliation(s)
- Mary P Martinasek
- Department of Community and Family Health, University of South Florida, College of Public Health (MDC 056), Tampa, FL, USA
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158
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Maziak W. The global epidemic of waterpipe smoking. Addict Behav 2011; 36:1-5. [PMID: 20888700 PMCID: PMC4135081 DOI: 10.1016/j.addbeh.2010.08.030] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/26/2010] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
Abstract
In the past decade waterpipe (WP) smoking (a.k.a. hookah, shisha, and narghile) has been steadily spreading among the youth around the world. The allure of this tobacco use method for the youth can stem from its pleasant smooth smoke, social ambience and the perception of reduced harm. The material in this review is based on detailed Medline search for articles appearing especially in the past two years that are of relevance to WP epidemiology, health and addictive effects, and WP-related tobacco control policies. It shows that WP smoking is continuing to spread among the youth worldwide, and perhaps represents the second global tobacco epidemic since the cigarette. Available evidence suggests that the prevalence of current (past month) WP smoking range from 6 to 34% among Middle Eastern adolescents, 5%-17% among American adolescents, and that WP use is increasing globally. Studies on the health effects of WP smoking are limited by methodological quality, as well as by the novelty of WP epidemic relative to the long latency of important smoking-related health outcomes. Still, research indicates substantial WP harmful effects similar to those of cigarettes, as well as to the potential of providing a bridge to cigarette smoking or relapse. Developing effective interventions to curb WP use among the youth requires a detailed understanding of how dependence develops in WP users, and how it is shaped by WP's unique features such as the following; the predominantly intermittent use with prolonged sessions, preparation time, accessibility, potent sensory cues, and convivial experience of group use. It also requires assessing effective policy options such as factual and visible health warnings on all its parts, as well as youth access and indoor smoking restrictions. WP smoking is currently showing all signs of a burgeoning global epidemic with serious implications for public health and tobacco control worldwide. Investment in research and policy initiatives to understand and curb WP use needs to become a public health priority.
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Affiliation(s)
- Wasim Maziak
- School of Public Health, University of Memphis, Syrian Center for Tobacco Studies, Browning Hall 112, 3820 DeSoto Avenue, Memphis, TN 38152-3340, United States.
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159
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Ghasemi A, Syedmoradi L, Momenan AA, Zahediasl S, Azizi F. The influence of cigarette and qalyan (hookah) smoking on serum nitric oxide metabolite concentration. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:116-21. [PMID: 20156035 DOI: 10.3109/00365511003611282] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the effect of exposure to cigarette and qalyan (hookah) smoking on serum nitric oxide (NO) metabolites (NO(x)) concentration. MATERIAL AND METHODS Fasting serum NO(x) was measured by the Griess method in 333 men free of diabetes, hypertension and cardiovascular disease selected from participants of the Tehran Lipid and Glucose Study. Subjects were classified into active and passive cigarette smokers and they were age-matched with the non-smoker groups (n = 93/group). Twenty-seven qalyan smokers were also included in the study with their age-matched controls. RESULTS Multivariable-adjustment serum NO(x) values were compared between groups by analysis of covariance. Serum NO(x) was significantly higher (p < 0.05) in the active smokers [28.9 micromol/L (95% CI 26.2-32.0)] compared to nonsmokers [24.1 micromol/L (95% CI 21.8-26.7)]. A positive correlation was found between serum NO(x) and the number of cigarettes smoked per day (r = 0.222, p < 0.05). Qalyan smokers had higher serum NO(x) levels compared to the non-smoker controls [34.3 micromol/L (95% CI 27.8-42.3) vs. 22.5 micromol/L (95% CI 18.4-27.6), p < 0.01]. CONCLUSION Active cigarette and qalyan smoking are associated with high serum NO(x) levels.
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Affiliation(s)
- Asghar Ghasemi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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160
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Dugas E, Tremblay M, Low NCP, Cournoyer D, O'Loughlin J. Water-pipe smoking among North American youths. Pediatrics 2010; 125:1184-9. [PMID: 20457679 DOI: 10.1542/peds.2009-2335] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this analysis were to identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use. METHODS Data on sociodemographic characteristics, water-pipe smoking, and use of other psychoactive substances were collected in 2007 through mailed self-report questionnaires completed by 871 young adults, 18 to 24 years of age, who were participating in the Nicotine Dependence in Teens Study, a longitudinal investigation of the natural history of nicotine dependence among adolescents in Montreal, Canada. Independent sociodemographic correlates of water-pipe use were identified in multivariate logistic regression analyses. RESULTS Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year. CONCLUSIONS Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes. Evidence-based public health and policy interventions are required to equip the public to make informed decisions about water-pipe use.
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Affiliation(s)
- Erika Dugas
- University of Montreal, Department of Social and Preventive Medicine, 3875 St Urbain, Montreal, Quebec H2W 1V1, Canada
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161
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Cobb C, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe tobacco smoking: an emerging health crisis in the United States. Am J Health Behav 2010; 34:275-85. [PMID: 20001185 PMCID: PMC3215592 DOI: 10.5993/ajhb.34.3.3] [Citation(s) in RCA: 275] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the prevalence and potential health risks of waterpipe tobacco smoking. METHODS A literature review was performed to compile information relating to waterpipe tobacco smoking. RESULTS Waterpipe tobacco smoking is increasing in prevalence worldwide; in the United States, 10-20% of some young adult populations are current waterpipe users. Depending on the toxicant measured, a single waterpipe session produces the equivalent of at least 1 and as many as 50 cigarettes. Misconceptions about waterpipe smoke content may lead users to underestimate health risks. CONCLUSION Inclusion of waterpipe tobacco smoking in tobacco control activities may help reduce its spread.
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Affiliation(s)
- Caroline Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298, USA
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162
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Azab M, Khabour OF, Alkaraki AK, Eissenberg T, Alzoubi KH, Primack BA. Water pipe tobacco smoking among university students in Jordan. Nicotine Tob Res 2010; 12:606-12. [PMID: 20418383 DOI: 10.1093/ntr/ntq055] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although water pipe tobacco smoking is common in Lebanon and Syria, prevalence in neighboring Jordan is uncertain. The purposes of this study were (a) to assess the prevalence of water pipe tobacco smoking among university students in Jordan and (b) to determine associations between sociodemographic variables and water pipe tobacco smoking in this population. METHODS A trained interviewer administered a questionnaire among randomly selected students at four prominent universities in Jordan. The questionnaire assessed sociodemographic data, personal history of water pipe tobacco use, and attitudes regarding water pipe tobacco smoking. We used logistic regression to determine independent associations between sociodemographic and attitudinal factors and each of two dependent variables: ever use of water pipe and use at least monthly. RESULTS Of the 548 participants, 51.8% were male and mean age was 21.7 years. More than half (61.1%) had ever smoked tobacco from a water pipe, and use at least monthly was reported by 42.7%. Multivariable analyses controlling for all relevant factors demonstrated significant associations between ever use and only two sociodemographic factors: (a) gender (for women compared with men, odds ratio [OR] = 0.11, 95% CI = 0.07-0.17) and (b) income (for those earning 500-999 Jordanian dinar (JD) monthly vs. <250 JD monthly, OR = 2.37, 95% CI = 1.31-4.31). There were also significant associations between perception of harm and addictiveness and each outcome. DISCUSSION Water pipe tobacco smoking is highly prevalent in Jordan. Although use is associated with male gender and upper middle income levels, use is widespread across other sociodemographic variables. Continued surveillance and educational interventions emphasizing the harm and addictiveness of water pipe tobacco smoking may be valuable in Jordan.
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Affiliation(s)
- Mohammed Azab
- Department of Toxicology, Jordan University of Science and Technology, Irbid, Jordan
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163
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Primack BA, Fertman CI, Rice KR, Adachi-Mejia AM, Fine MJ. Waterpipe and cigarette smoking among college athletes in the United States. J Adolesc Health 2010; 46:45-51. [PMID: 20123257 PMCID: PMC3001225 DOI: 10.1016/j.jadohealth.2009.05.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 05/18/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Tobacco use using a waterpipe is an emerging trend among college students. Although cigarette smoking is low among college athletes, waterpipe tobacco smoking may appeal to this population. The purpose of this study was to compare cigarette and waterpipe tobacco smoking in terms of their associations with organized sport participation. METHODS In the spring of 2008, we conducted an online survey of 8,745 college students at eight institutions as part of the revised National College Health Assessment. We used multivariable regression models to assess the associations between tobacco use (cigarette and waterpipe) and organized sports participation. RESULTS Participants reported participation in varsity (5.2%), club (11.9%), and intramural (24.9%) athletics. Varsity athletes and individuals who were not varsity athletes had similar rates of waterpipe tobacco smoking (27.6% vs. 29.5%, p=.41). However, other types of athletes were more likely than their counterparts to have smoked waterpipe tobacco (35.1% vs. 28.7%, p < .001 for club sports and 34.8% vs. 27.7%, p < .001 for intramural sports). In fully-adjusted multivariable models, sports participants of any type had lower odds of having smoked cigarettes, whereas participants who played intramural sports (odds ratio=1.15, 95% confidence interval=1.03, 1.29) or club sports (odds ratio=1.15, 95% confidence interval=1.001, 1.33) had significantly higher odds of having smoked waterpipe tobacco. CONCLUSIONS College athletes are susceptible to waterpipe tobacco use. In fact, compared with their nonathletic counterparts, club sports participants and intramural sports participants generally had higher odds of waterpipe tobacco smoking. Allure for waterpipe tobacco smoking may exist even for individuals who are traditionally considered at low risk for tobacco use.
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Affiliation(s)
- Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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164
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Radwan GN, Loffredo CA, El Setouhy MA, Abdel Hamid M, Israel EJ, Mohamed MK. Waterpipe Smoking And The DRD2/ANKK1 Genotype. J Egypt Public Health Assoc 2010; 85:131-148. [PMID: 21244814 PMCID: PMC3622212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Waterpipe smoking is increasingly a worldwide phenomenon. Few studies have been conducted on the epidemiology of waterpipe smoking behavior and its genetic determinants. A polymorphism (TaqI) in the 3' untranslated region of the dopamine receptor gene (DRD2), later localized to the neighboring ANKK1 gene, has been previously linked to cigarette smoking. Since all tobacco products share the ability of stimulating the dopaminergic reward system, variation in the DRD2 genotype might be associated with waterpipe smoking addiction. AIM This study aims to explore genetic variations in DRD2 gene and waterpipe smoking, motives and addiction in Egyptian rural males. MATERIAL AND METHODS The subjects (N=154) were selected from participants in a household smoking prevalence survey if they were adults, males, currently smoking waterpipe and not smoking cigarettes. Participants were interviewed about their smoking behaviors. Blood samples were genotyped by polymerase chain reaction (PCR). Subjects were subsequently classified as either the A1 (presence of at least one A1 allele) or A2 group (A2 homozygotes). RESULTS The prevalence of A1 genotype was 34.4 % in current waterpipe users, and was associated with the maximum duration before smokers experienced craving to smoke: after adjusting for age of smoking initiation, smoking for addictive motives, and average daily tobacco consumption, the A1 carriers were more likely to experience craving within a shorter duration after abstinence (the first 24 hours) compared to subjects with A2/A2 genotype (Odds ratio [OR] 2.70, 95% confidence interval [CI]: 1.18 - 6.23). In addition, the frequent visitors of shisha cafes were more likely to be younger, heavy smokers and carriers of A1 allele (OR, 2.52, 95% CI: 1.06-6.02). CONCLUSION AND RECOMMENDATIONS This study revealed that the maximum duration before experiencing craving to smoke waterpipe and frequency of visiting cafés to smoke may be influenced by an inherited variations in the DRD2 genotype.
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165
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Chaouachi K, Sajid KM. A critique of recent hypotheses on oral (and lung) cancer induced by water pipe (hookah, shisha, narghile) tobacco smoking. Med Hypotheses 2009; 74:843-6. [PMID: 20036075 DOI: 10.1016/j.mehy.2009.11.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/19/2022]
Abstract
The medical hypothesis that the mainstream smoke (the one inhaled by the user) from "water pipes" (mainly: shisha, hookah, narghile) causes oral cancer is certainly acceptable. However, most of the recent reviews on this issue, including an attempt to develop an hypothesis for hookah carcinogenesis, have not cited key references of the world available literature which, so far, generally do not support such an hypothesis. Besides, the proposal is biased since it is apparently an adaptation of the cigarette model whereas cigarette and hookah smokes are, chemically to start with, completely different. Furthermore, all water pipes, despite their striking varieties and the consequences on the chemical processes, are, according to the same cancer-hypothesis, considered as one. The reason is the use, in the cited mainstream literature, of a nominalism ("waterpipe", often in one word) which does not allow any distinction between devices. This critical article suggests to take into account all the peculiar characteristics into consideration in order to come up with another (or several other) carcinogenesis model(s). "Firmly believ[ing] that water pipe smoking can provoke lung cancer as well as oral cancer", based on what may be seen as a rather reductionist view of the issue, is not enough.
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Affiliation(s)
- Kamal Chaouachi
- DIU Tabacologie, Universite Paris XI, 18 allée des petits bois, Versailles, France.
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166
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Ben Saad H. [The narghile and its effects on health. Part I: the narghile, general description and properties]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:369-375. [PMID: 19995660 DOI: 10.1016/j.pneumo.2009.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 08/26/2009] [Indexed: 05/28/2023]
Abstract
A narghile is a water-pipe used to smoke a tobacco preparation. As the smoker inhales, the tobacco smoke is sucked down from the bowl and then bubbles up through the water into the air of the smoke chamber and then through the hose to the smoker. Its origins are mysterious and controversial. Nevertheless it remains, under different names, an object used regularly by more than one hundred million people in the world. Since the eighties and especially nineties, its consumption has grown significantly and is now considered to be a worldwide epidemic. However, the knowledge about the effects of narghile smoke on health is partial and sometimes contradictory. Indeed, we are witnessing increasing confusion in biomedical studies and scientific debate about its health impact is unresolved. Given this situation, revealing a serious and profound lack of information about the real nature and toxicity of hookah smoke, the authors conducted this two-part study. The first part presents epidemiological data, describes the narghile and the different types of narghile tobacco and exposes the composition of narghile smoke. The second part highlights the lack of reliable data about the detrimental effects of the narghile pipe on health and especially on the cardiopulmonary function.
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Affiliation(s)
- H Ben Saad
- Service de physiologie et explorations fonctionnelles, EPS Farhat Hached, 4000 Sousse, Tunisie.
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167
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Maziak W, Rastam S, Ibrahim I, Ward KD, Shihadeh A, Eissenberg T. CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers. Nicotine Tob Res 2009; 11:806-11. [PMID: 19420278 PMCID: PMC2699927 DOI: 10.1093/ntr/ntp066] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 02/16/2009] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking is increasing in popularity though the toxicant exposure and effects associated with this tobacco use method are not well understood. METHODS Sixty-one waterpipe tobacco smokers (56 males; mean age +/- SD, 30.9 +/- 9.5 years; mean number of weekly waterpipe smoking episodes, 7.8 +/- 5.7; mean duration of waterpipe smoking 8.5 +/- 6.1 years) abstained from smoking for at least 24 hr and then smoked tobacco from a waterpipe ad libitum in a laboratory. Before and after smoking, expired-air carbon monoxide (CO) and subjective effects were assessed; puff topography was measured during smoking. RESULTS The mean waterpipe use episode duration was 33.1 +/- 13.1 min. Expired-air CO increased significantly from a mean of 4.0 +/- 1.7 before to 35.5 +/- 32.7 after smoking. On average, participants took 169 +/- 100 puffs, with a mean puff volume of 511 +/- 333 ml. Urge to smoke, restlessness, craving, and other tobacco abstinence symptoms were reduced significantly after smoking, while ratings of dizzy, lightheaded, and other direct effects of nicotine increased. DISCUSSION Expired-air CO and puff topography data indicate that, relative to a single cigarette, a single waterpipe tobacco smoking episode is associated with greater smoke exposure. Abstinent waterpipe tobacco smokers report symptoms similar to those reported by abstinent cigarette smokers, and these symptoms are reduced by subsequent waterpipe tobacco smoking. Taken together, these data are consistent with the notion that waterpipe tobacco smoking is likely associated with the risk of tobacco/nicotine dependence.
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Affiliation(s)
- Wasim Maziak
- Department of Health & Sport Sciences, and Center for Community Health, University of Memphis, Memphis, TN, USA
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168
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Rodrigues AA. Convencer e informar: questões éticas nas campanhas de saúde pública. J Bras Pneumol 2009; 35:396-7; author reply 397-8. [DOI: 10.1590/s1806-37132009000400016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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169
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Primack BA, Walsh M, Bryce C, Eissenberg T. Water-pipe tobacco smoking among middle and high school students in Arizona. Pediatrics 2009; 123:e282-8. [PMID: 19171581 PMCID: PMC3013632 DOI: 10.1542/peds.2008-1663] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Using a water pipe to smoke tobacco is increasing in prevalence among US college students, and it may also be common among younger adolescents. The purpose of this study of Arizona middle and high school students was to examine the prevalence of water-pipe tobacco smoking, compare water-pipe tobacco smoking with other forms of tobacco use, and determine associations between sociodemographic variables and water-pipe tobacco smoking in this population. METHODS We added items assessing water-pipe tobacco smoking to Arizona's 2005 Youth Tobacco Survey and used them to estimate statewide water-pipe tobacco smoking prevalence among various demographic groups by using survey weights. We also used multiple logistic regression to determine which demographic characteristics had independent relationships with each of 2 outcomes: ever use of water pipe to smoke tobacco and water-pipe tobacco smoking in the previous 30 days. RESULTS Median age of the sample was 14. Accounting for survey weights, among middle school students, 2.1% had ever smoked water-pipe tobacco and 1.4% had done so within the previous 30 days. Among those in high school, 10.3% had ever smoked from a water pipe and 5.4% had done so in the previous 30 days, making water-pipe tobacco smoking more common than use of smokeless tobacco, pipes, bidis, and kreteks (clove cigarettes). In multivariate analyses that controlled for covariates, ever smoking of water-pipe tobacco was associated with older age, Asian race, white race, charter school attendance, and lack of plans to attend college. CONCLUSIONS Among Arizona youth, water pipe is the third most common source of tobacco after cigarettes and cigars. Increased national surveillance and additional research will be important for addressing this threat to public health.
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Affiliation(s)
- Brian A. Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michele Walsh
- Evaluation, Research, and Development Unit, Department of Psychology, University of Arizona, Tucson, Arizona
| | - Cindy Bryce
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas Eissenberg
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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170
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Abstract
Nicotine is the principal alkaloid in both commercial and homemade products (e.g., cigarettes, smokeless tobacco, bidis, waterpipes) followed by nornicotine, anabasine, anatabine, and many other basic substances that contain a cyclic nitrogenous nucleus. Tobacco types, leaf position on the plant, agricultural practices, fertilizer treatment, and degree of ripening are among some prominent factors that determine the levels of alkaloids in tobacco leaf. From a random examination of 152 cultivated varieties of Nicotiana tabacum, a range of alkaloid variation between 0.17 and 4.93% was determined. In fact, every step in tobacco production that affects plant metabolism will influence the level of alkaloid content to a certain degree. Depending on blending recipe, type and amount of additives, and product design, all types of tobacco products contain a very wide range of nicotine concentration. However, the ultimate emission of nicotine to the user, exposure, and psychophar-macological effects depend not only on the content and emission, but also on the relationship between the product and the user.
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Affiliation(s)
- Mirjana V Djordjevic
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, EPN 4048, MSC 7337, Bethesda, MD 20892-7337, USA.
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171
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Genotoxic effects of waterpipe smoking on the buccal mucosa cells. Mutat Res 2008; 655:36-40. [PMID: 18662802 DOI: 10.1016/j.mrgentox.2008.06.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 06/08/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022]
Abstract
Waterpipe smoking is popular in many parts of the world. Micronuclei (MN) evaluation in the exfoliated oral cells of smokers is a non-invasive technique for evaluation of possible tobacco harm. We aimed to assess whether MN levels are higher in waterpipe smokers than in never smokers. We examined oral smears of 128 adult male waterpipe smokers and 78 males who never smoked tobacco in rural Egypt. The total number of MN per 1000 cells per subject, and the number of MN-containing cells per individual were compared. We observed a higher level of total MN in waterpipe smokers (10 +/- 4) than in never smokers (4 +/- 2, p < 0.001). A similar difference was found for the mean number of affected cells per individual (8 +/- 3 vs. 4 +/- 1.62, p < 0.001). MN levels were not significantly dose related. This study is among the first to assess the association between waterpipe smoking and a cytogenetic measure of tobacco harm. The twofold increase in MN level is consistent with previous reports of MN in cigarette smokers. More research is needed to determine if such MN levels are predictive of future health consequences.
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172
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Khater AEM, Abd El-Aziz NS, Al-Sewaidan HA, Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: activity concentrations and dose assessment. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2008; 99:1808-14. [PMID: 18768240 DOI: 10.1016/j.jenvrad.2008.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/13/2008] [Accepted: 07/20/2008] [Indexed: 05/26/2023]
Abstract
Narghile (hookah, shisha, goza, "water-pipe") smoking has become fashionable worldwide. Its tobacco pastes, known as moassel and jurak, are not standardized and generally contain about 30-50% (sometimes more) tobacco, molasses/juice of sugarcane, various spices and dried fruits (particularly in jurak) and, in the case of moassel, glycerol and flavoring essences. Tobacco contains minute amounts of radiotoxic elements such as (210)Pb, (210)Po and uranium, which are inhaled via smoking. Only very few data have been published on the concentrations of natural radionuclides in narghile tobacco mixtures. Consequently, the aim of this study was to draw first conclusions on the potential hazards of radioactivity in moassel tobacco in relation to narghile smoking. The results indicate the existence of a wide range in the radioactivity contents where the average (range) activity concentrations of (238)U, (234)Th (226)Ra, (210)Pb, (210)Po, (232)Th and (40)K, in Bq/kg dry weight were 55 (19-93), 11 (3-23), 3 (1.2-8), 14 (3-29), 13 (7-32), 7 (4-10) and 719 (437-1044)Bq/kg dry weight, respectively. The average concentrations of natural radionuclides in moassel tobacco pastes are comparable to their concentration in Greek cigarettes and tobacco leaves, and lower than that of Brazilian tobacco leaves. The distribution pattern of these radionuclides after smoking, between smoke, ash and filter, is unknown, except for (210)Po during cigarette smoking and from one existing study during moassel smoking. Radiological dose assessment due to intake of natural radionuclides was calculated and the possible radio-toxicity of the measured radionuclides is briefly discussed.
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Affiliation(s)
- Ashraf E M Khater
- National Center for Nuclear Safety and Radiation Control, Atomic Energy Authority, Cairo, Egypt.
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173
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Giuliani KKW, Mire OA, Jama S, Dubois DK, Pryce D, Fahia S, Ehrlich LC. Tobacco use and cessation among Somalis in Minnesota. Am J Prev Med 2008; 35:S457-62. [PMID: 19012839 DOI: 10.1016/j.amepre.2008.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/06/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Somalis compose the largest African refugee group living in the U.S., with more than 10,330 primary arrivals in fiscal year 2006 alone. Half of all Somalis in the U.S. live in Minnesota. Although tobacco use is a considerable problem among Somalis, especially among men, little research has examined factors affecting tobacco use and cessation. METHODS A sequential exploratory design informed the overall study methodology. Key informant interviews (n=20) and focus group discussions (13 groups; n=91) were conducted with Somali adults and youth in the fall of 2006 and the summer of 2007, respectively. Participants were asked about tobacco-use prevalence, prevention, and cessation, and the marketing of tobacco. RESULTS Perceived prevalence of tobacco use by Somalis is high at 50%. The main reason for initiating tobacco use was the influence of friends or peer pressure and included other social factors. Prevention and cessation messages suggested by participants include medical advice, education on the negative health effects of tobacco use, religion, and the support of family and friends. Barriers to cessation include lack of insurance coverage, lack of knowledge on where to find assistance, and lack of cessation support groups. Severe social stigma for Somali female smokers poses specific challenges to prevention and intervention efforts. Water-pipe smoking is perceived to be prevalent, particularly among female youth. CONCLUSIONS Somalis view tobacco use as an important issue in their community. Religious and social support and demographically targeted approaches should be key factors in creating effective prevention and cessation programs and must address water-pipe smoking.
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174
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Abstract
There are many preparations for tobacco use, which can be classified as smoking or smokeless tobacco. Among the noncigarette preparations that produce smoke, we cite cigars, pipes and narghiles. Smokeless tobacco can be found in preparations for chewing or for being absorbed by nasal and oral mucosae (snuff). However, all tobacco products deliver nicotine to the central nervous system and there is a confirmed risk of dependence. In addition, there is no safe form of tobacco use, and tobacco users have a significantly increased risk of morbidity and premature mortality due to tobacco-related diseases.
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175
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Abstract
The waterpipe, known in many cultures under different shapes and names (e.g. hookah, shisha, narghile), is a centuries-old tobacco use method that is witnessing a world-wide surge in popularity. This popularity is most noticeable among youths, and is surpassing cigarette smoking among this group in some societies. Many factors may have contributed to the recent waterpipe spread, including the introduction of sweetened/flavored waterpipe tobacco (known as Maassel), its reduced-harm perception, the thriving café culture, mass media and the internet. The passage of smoke through water on its way to the smoker underlies much of the common misperception that waterpipe use is less harmful than cigarettes. The health/addictive profile of waterpipe compared to cigarettes is largely unresearched and is likely to be influenced by the properties of smoke, duration and frequency of use, type of tobacco used, volume of smoke inhaled and the contribution of charcoal. However, the accumulation of evidence about the harmful and addictive potential of waterpipe use is outpacing the public health response to this health risk. A timely public health and policy action is needed in order to curb the emerging waterpipe smoking epidemic.
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Affiliation(s)
- Wasim Maziak
- University of Memphis, Syrian Center for Tobacco Studies, Memphis, TN 38152, USA.
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176
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Jackson D, Aveyard P. Waterpipe smoking in students: prevalence, risk factors, symptoms of addiction, and smoke intake. Evidence from one British university. BMC Public Health 2008; 8:174. [PMID: 18498653 PMCID: PMC2413225 DOI: 10.1186/1471-2458-8-174] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 05/22/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anecdotal reports suggest waterpipe smoking is becoming common in students in western countries. The aim was to examine prevalence, risk factors, symptoms of addiction, and smoke intake. METHODS This was a cross-sectional survey of students with subsidiary survey of regular waterpipe user and survey of exhaled carbon monoxide (CO) before and after waterpipe smoking in customers of a waterpipe café. 937 students of Birmingham University completed the initial survey with a follow up of 21 regular waterpipe smokers. 63 customers of a waterpipe café near the University completed the study of CO intake. RESULTS 355 (37.9%, 95% confidence intervals (CI) 34.8 to 41.1%) students had tried waterpipes, the prevalence of trying rising with duration at University. 75 (8.0%, 95%CI 6.4 to 10.0%) were regular smokers, similar to the prevalence of cigarette smoking (9.4%). Although cigarette smoking was the major risk factor for being a regular waterpipe smoker, odds ratio (95%CI) 2.77 (1.52 to 5.06), 65% of waterpipe smokers did not smoke cigarettes. Seven of 21 (33.3%) regular waterpipe smokers experienced cravings. Nearly all regular waterpipe users thought it less harmful than smoking cigarettes. The mean (standard deviation) rise in CO was 37.4 (25.8)ppm, nearly twice as high as a typical cigarette smoker seeking cessation treatment. CONCLUSION Waterpipe smoking is a common part of student culture in one British university, as in the Middle East and in the United States. It poses a potential threat to public health, with evidence of dependence and high smoke intake.
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Affiliation(s)
- Daniel Jackson
- Department of Primary Care & General Practice, University of Birmingham, Birmingham, B15 2TT, UK
| | - Paul Aveyard
- Department of Primary Care & General Practice, University of Birmingham, Birmingham, B15 2TT, UK
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Al-Lawati JA, Muula AS, Hilmi SA, Rudatsikira E. Prevalence and Determinants of Waterpipe Tobacco Use among Adolescents in Oman. Sultan Qaboos Univ Med J 2008; 8:37-43. [PMID: 21654955 PMCID: PMC3087736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 12/15/2007] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To assess the prevalence and determinants of waterpipe use among school-going adolescents in Oman. METHODS A cross-sectional, school-based study was conducted in 2003 involving 9 regions of Oman, as part of the Global Youth Tobacco Survey. Participants were requested to complete an anonymous questionnaire containing demographic characteristics, current and previous use of waterpipe tobacco, attitudes towards cigarette smoking, parents' and friends' cigarette smoking habits. Proportions were used to calculate prevalence rates and logistic regression analysis to obtain odds ratio (OR) and 95% confidence interval (CI). RESULTS 1,962 students participated of whom 1,005 (51.2%) were males. Eighty-eight percent were between 13 and 16 years of age. Five hundred and twenty-two (26.6%) reported ever smoking waterpipe tobacco while 189 (9.6%) were current users. Among males, 155 (15.5%) were current users while among females only 24 (2.6%) smoked currently. Study participants were more likely to use waterpipe if they had a parent or friend who smoked cigarettes. Adolescents were, however, less likely to use waterpipe tobacco if they believed that cigarette smoking was harmful to health. Students who were receiving 500 Baisas (US$ 1.3) or more per day pocket money were more likely to use waterpipe tobacco compared to those receiving less (OR 3.3, 95% CI 2.3 to 4.6). In multivariate analysis, the OR for males being a smoker of waterpipe tobacco compared to females was 4.46 (95% CI, 2.38 to 8.35); while the OR for most or all friends smoking cigarettes compared to non-smoking was OR 5.65 (95% CI 2.87 to 11.13). Study participants who perceived smoking as harmful to health were less likely to use waterpipe tobacco compared to those who did not believe smoking was harmful (OR 0.31, 95% CI 0.29 to 0.92) and those receiving 500 Baisas or more (OR 2.2, 95% CI 1.5 to 3.2). CONCLUSION Waterpipe smoking among Omani adolescents is an emerging public health concern. Efforts to prevent adolescent smoking should be designed with knowledge of associated factors of such behaviour and should include all forms of tobacco.
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Affiliation(s)
- Jawad A Al-Lawati
- Department of Non-Communicable Diseases, Ministry of Health, Muscat, Oman
| | - Adamson S Muula
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, USA
| | - Sahar A Hilmi
- Department of School Health, Ministry of Health, Muscat, Oman
| | - Emmanuel Rudatsikira
- Department of Global Health, School of Public Health, Loma Linda University, California, USA
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