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Rashed MHI, Chehab M, Selim N, Alkarbi K, Bougmiza MI. The prevalence and associated factors of shisha use among
smokers attending three primary healthcare centers in Qatar,
2020. Tob Prev Cessat 2022; 8:34. [PMID: 36132981 PMCID: PMC9461141 DOI: 10.18332/tpc/152887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking is one of the most serious health issues. One form of tobacco use, shisha, is prevalent in the Eastern Mediterranean Region. There is a misconception among smokers that waterpipe use poses no harm to human health. In Qatar, the Global Adult Tobacco Survey in 2013 has shown that 3.4% of adults in the country were current waterpipe users. Nevertheless, there remains a scarcity of data on the knowledge and practice of shisha smokers in Qatar. METHODS This was a cross-sectional study across three primary healthcare (PHC) centers in Qatar between September and December 2020. A convenient sampling technique was employed to enroll participants. Upon consent, an interview was conducted to collect data from adult smokers (aged ≥18 years). Descriptive and analytic statistics were used when appropriate. RESULTS A total of 281 individuals participated in this study. Nearly half (48.8%) were current shisha users and almost three-quarters (72.9%) had inadequate knowledge in this regard. In addition, only one-fifth (19.5%) of participants attended smoking cessation clinics at the primary healthcare centers and a quarter (25%) of the respondents managed to quit smoking before relapsing. A significant association was found between the shisha knowledge of participants and their nationality (Qatari), employment status (unemployed), smoking status (current smoker), and duration of smoking. CONCLUSIONS The study results convey a high prevalence of shisha use (47.8%), inadequate shisha knowledge (72.9%), and lack of awareness about available smoking cessation services (46.6%) among the participants. Further research is recommended to generate evidence on the determinants of shisha use and knowledge among the attendees of primary healthcare centers in Qatar.
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Affiliation(s)
| | - Mohamad Chehab
- Community Medicine Residency Program, Medical Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Nagah Selim
- Community Medicine Residency Program, Family and Community Medicine Department, Primary Health Care Corporation, Doha, Qatar
- Public Health and Preventive Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalid Alkarbi
- Operations Department, Primary Health Care Corporation, Doha, Qatar
| | - Mohamed I. Bougmiza
- Community Medicine Residency Program, Family and Community Medicine Department, Primary Health Care Corporation, Doha, Qatar
- Family and Community Medicine Department, Faculty of Medicine, Sousse University, Tunisia
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Bao X, Asgari A, Najafi ML, Mokammel A, Ahmadi M, Akbari S, Miri M. Exposure to waterpipe smoke and blood heavy metal concentrations. ENVIRONMENTAL RESEARCH 2021; 200:111460. [PMID: 34089744 DOI: 10.1016/j.envres.2021.111460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
Waterpipe (WP) smoking is a global phenomenon, with the most consumers in Middle East countries and China. Heavy metals exposure related to WP smoking has been associated with many adverse health effects. However, the association of lifestyle factors and smoking habits with blood heavy metals concentration in WP smokers is unclear yet. Therefore, we aimed to investigate the relationship of lifestyle factors (i.e., diet and physical activity) and smoking habits (i.e., duration of the use of WP and times of smoking WP per week) with blood concentrations of lead (Pb) and cadmium (Cd). This cross-sectional study was based on 86 WP smokers in Khalkhal, Iran (2018). Graphite furnace atomic absorption spectrometry (GFAAS) was used to measure heavy metals. The median (interquartile range (IQR)) of Pb and Cd concentrations were 39 (24) and 1.3 (1.2) μg/L. The blood Pb and Cd levels were significantly higher in participants with lower education level (P-value = 0.049 and 0.041, respectively). An IQR increase in physical activity per week was associated with -0.12 μg/L (95% confidence interval (CI): -0.23, -0.01, P-value = 0.04) decrease in Pb concentration. An increase in the times of consuming fruit per week was negatively associated with the concentration of Cd. Overall, our findings suggested that physical activity and healthy diet have been associated with lower blood heavy metal concentrations in WP smokers; however, further studies are needed to confirm these findings.
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Affiliation(s)
- Xianghua Bao
- Department of Occupational Disease, Yantai Shan Hospital, (Yantai Occupational Disease Hospital), NO. 167 Airport Road, Zhifu District, Yantai City, Shandong Province, 264025, China
| | - Amin Asgari
- Department of Environmental Health Engineering, Khalkhal University of Medical Sciences, Khalkhal, Iran; Sharifsafetyindex, Health, Safety, Environment Service, Co, Iran.
| | - Moslem Lari Najafi
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Adel Mokammel
- Department of Environmental Health Engineering, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Mohammad Ahmadi
- Student Research Committee, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Sajjad Akbari
- Student Research Committee, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Mohammad Miri
- Non-Communicable Diseases Research Center, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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Sighaldeh SS, Zarghami F, Charkazi A. Beliefs Regarding Waterpipe Smoking Among Iranian Men of Turkmen Ethnicity: A qualitative study conducted in Golestan Province. Sultan Qaboos Univ Med J 2020; 20:e216-e222. [PMID: 32655915 PMCID: PMC7328844 DOI: 10.18295/squmj.2020.20.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/21/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Waterpipe or hookah smoking has grown considerably in popularity over the past two decades; however, consumers often have misconceptions regarding this practice. This study aimed to determine common beliefs related to waterpipe smoking among Turkmen in Iran. Methods This qualitative study was conducted between February and June 2018 in Golestan Province, Iran, utilising data from a previously published study. A total of 26 male Turkmen waterpipe smokers of different ages, occupations and education levels underwent in-depth semi-structured interviews. A content analysis of beliefs regarding waterpipe smoking was performed. Results Five categories of beliefs were extracted during the content analysis, including beliefs related to addiction, health-related beliefs, preferential beliefs for waterpipe versus cigarette smoking, beliefs related to the social function of waterpipe smoking and beliefs attributed to waterpipe smoking. Several misconceptions were identified, including the idea that waterpipe smoking was not addictive, prevented the use of other more dangerous drugs (i.e. cannabis and opium) and was not as harmful as cigarette smoking. Conclusion The results of this study indicate that Turkmen in Iran hold several misconceptions regarding the use of waterpipe smoking. Educational programmes are essential to correct such misconceptions and to control the prevalence of this habit in Iran.
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Affiliation(s)
- Shirin S Sighaldeh
- Department of Reproductive Health, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zarghami
- Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdurrahman Charkazi
- Environmental Health Research Center, Faculty of Health, Golestan University of Medical Scienes, Golestan, Iran
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ALHarthi SS, BinShabaib MS, Ahmed HB, Mehmood A, Khan J, Javed F. Comparison of peri-implant clinical and radiographic inflammatory parameters among cigarette and waterpipe (narghile) smokers and never-smokers. J Periodontol 2019; 89:213-218. [PMID: 28777038 DOI: 10.1902/jop.2017.170358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/09/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The authors hypothesized that peri-implant clinical and radiographic inflammatory parameters are worse in waterpipe smokers (WS) and cigarette smokers (CS) compared with never-smokers (NS). The aim of the present retrospective study is to compare peri-implant clinical and radiographic inflammatory parameters among WS, CS, and NS. METHODS Forty-four CS (group 1), 41 WS (group 2), and 43 NS (group 3) were included. Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Sample size was estimated, and statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank-sum tests. For multiple comparisons, Bonferroni post hoc test was performed. P values < 0.05 were considered statistically significant. RESULTS Peri-implant PI and PD were higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. Peri-implant BOP was significantly higher in group 3 compared with individuals in groups 1 (P < 0.01) and 2 (P < 0.01). Peri-implant total marginal bone loss was significantly higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. There were differences in PI, BOP, PD, and CBL among participants in groups 1 and 2. CONCLUSIONS Peri-implant soft tissue inflammatory parameters and CBL are worse in CS and WS compared with NS. There is no difference in these parameters between CS and WS.
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Affiliation(s)
- Shatha Subhi ALHarthi
- Department of Periodontology, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Munerah Saleh BinShabaib
- Department of Periodontology, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | | | - Abid Mehmood
- Department of Dentistry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Junad Khan
- Department of Orofacial Pain and Temporomandibular Joint Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester,
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Mughal F, Rashid A, Jawad M. Tobacco and electronic cigarette products: awareness, cessation attitudes, and behaviours among general practitioners. Prim Health Care Res Dev 2018; 19:605-609. [PMID: 29880076 PMCID: PMC6692824 DOI: 10.1017/s1463423618000166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/30/2018] [Accepted: 05/28/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.AimTo examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation. METHOD A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.FindingsWe analysed 312 responses, of whom 63% were aware of WTS and between 5-32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03-0.99, P<0.049).Conclusions (implications for practice and research)GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.
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Affiliation(s)
- Faraz Mughal
- GP & Honorary Research Fellow, Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
- NIHR In-Practice Fellow, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Ahmed Rashid
- UCL Medical School, Royal Free Hospital, Hampstead, London, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, UK
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Kothari S, Berg CJ. Reasons for use, potential use, or discontinued use of hookah among US young adult college students. Tob Prev Cessat 2018; 4. [PMID: 30272038 PMCID: PMC6159938 DOI: 10.18332/tpc/81860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given the increase in hookah use among young adults, characteristics of hookah use/users, as well as reasons for its use or discontinuation among young adults, are critical to understand. METHODS Data from a study of 18–25 year olds from seven Georgia colleges/universities (n=2865) were analyzed to examined: 1) differences in socio-demographics and other substance use among current (past 4 months), never, and former hookah users; 2) use characteristics among current users (e.g. device types/flavors used, quit intentions); and 3) reasons for use, potential use, and discontinued use among current, never, and former users. RESULTS Of the students, 56.3% were never users, 12.4% were current, and 31.3% former users. Correlates of being a current (vs never) user included being ‘other race’ (vs White), attending a historically black college/university (HBCU vs technical college), and use of other substances. Correlates of being a former (vs never) hookah user included being older (vs younger), being ‘other race’ (vs White), attending an HBCU (vs technical college), and use of other tobacco products, marijuana, or alcohol. Among current users, 73.7% reported no intention to quit; 26.2% attempted to quit in the past year. Two factors were identified regarding reasons for current use (flavors, social reasons): one factor regarding potential use among never users (related to flavors and social factors), and three factors regarding discontinued use (inconvenience, anti-tobacco attitude, social reasons). CONCLUSIONS Findings indicate the risk factors for hookah use and the importance of particular factors (e.g. flavors, social influences) relevant to regulation/policy.
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Affiliation(s)
- Shreya Kothari
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States
| | - Carla J Berg
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, United States.,Winship Cancer Institute, Emory University, Atlanta, United States
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Khabour OF, Alzoubi KH, Al-Sheyab NA, Azab MA, Massadeh AM, Alomary AA, Eissenberg TE. Plasma and saliva levels of three metals in waterpipe smokers: a case control study. Inhal Toxicol 2018; 30:224-228. [PMID: 30257114 DOI: 10.1080/08958378.2018.1500663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this case-control study, the influence of waterpipe tobacco smoking on the plasma and saliva levels of cadmium, lead and zinc was examined in participants who were waterpipe tobacco smokers (WS) or never-smokers (NS). The concentration of metals was higher in WS relative to NS. The mean (SEM) cadmium concentration in plasma was 3.3 (0.18) µg/dL in WS versus 0.82 (0.09) µg/L in NS (p < .001) and in saliva was 5.1 (0.36) µg/L in WS versus 0.64 (0.2) µg/L in NS (p < .001). The mean (SEM) lead concentration in plasma was 5.2 (0.25) µg/dL in WS versus 3.4 (0.41) µg/dL in NS (p < .01) and in saliva was 4.8 (0.58) µg/L in WS versus 2.8 (0.27) µg/L in NS (p < .05). Similarly, a significant difference in zinc concentration was observed, with a mean of 2.0 (0.17) µg/mL in WS plasma versus 1.49 (0.16) µg/mL in NS (p < .05) and a mean 0.94 (0.07) µg/mL in WS saliva versus 0.45 (0.06) µg/mL in NS (p < .01). In conclusion, waterpipe tobacco smoking is associated with elevated levels of metals in body fluids. These results provide another demonstration of how waterpipe tobacco smoking exposes smokers to harmful toxicants.
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Affiliation(s)
- Omar F Khabour
- a Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences , Jordan University of Science and Technology , Irbid , Jordan
| | - Karem H Alzoubi
- b Department of Clinical Pharmacy, Faculty of Pharmacy , Jordan University of Science and Technology , Irbid , Jordan
| | - Nihaya A Al-Sheyab
- c Department of Maternal and Child Health Nursing, Faculty of Nursing , Jordan University of Science and Technology , Irbid , Jordan
| | - Mohammad A Azab
- d Department of Basic Medical Sciences, Faculty of Medicine , The Hashemite University , Zarqa , Jordan
| | - Adnan M Massadeh
- e Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy , Jordan University of Science and Technology , Irbid , Jordan
| | - Ahmed A Alomary
- f Department of Chemistry, Faculty of Sciences , Yarmouk University , Irbid , Jordan
| | - Thomas E Eissenberg
- g Department of Psychology , Center for the Study of Tobacco Products, Virginia Commonwealth University , Richmond , VA , USA
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Abduljabbar T, Al-Hamoudi N, AlQunayan M, AlAhmari A, AlMalki A, Gholamiazizi E, Vohra F. Peri-implant soft-tissue parameters and crestal bone levels among narghile smokers and nonsmokers. Inhal Toxicol 2018; 29:457-461. [PMID: 29124995 DOI: 10.1080/08958378.2017.1394401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This retrospective convenient sample case-control study investigated the peri-implant soft-tissue inflammatory parameters and crestal bone loss (CBL) among narghile smokers (NS) (Group I) and nonsmoking controls (Group II). Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding-on-probing (BOP) and pocket-depth (PD) were assessed; and peri-implant CBL was measured on standardized digital bite-wing radiographs. Sample-size was estimated and statistical analysis were done using Mann-Whitney U-test. Level of significance was set at p < .05. Seventy-two male individuals (35 in Group I and 37 in Group II) were included. The mean age of individuals in Groups I and II were 45.3 ± 5.2 and 42.6 ± 3.3 years, correspondingly. In Group 1, the duration and daily frequency of narghile smoking was 17.5 ± 1.6 years and 6.3 ± 0.5 times per day, respectively. The mean duration of each narghile smoking session was 28.5 ± 0.6 min. The mean peri-implant PI (p < .05), PD (p < .05) and mesial (p < .05) and distal (p < .05) CBL were statistically significantly higher among individuals in Group I compared with Group II. BOP was significantly higher in Group II than Group I (p < .05). Narghile smoking increases peri-implant soft-tissue inflammation and CBL.
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Affiliation(s)
- Tariq Abduljabbar
- a Department of Prosthetic Dental Sciences , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
| | - Nawaf Al-Hamoudi
- b Department of Periodontics and Community Dentistry , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
| | - Muath AlQunayan
- c Department of General Dentistry , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
| | - Abdullah AlAhmari
- c Department of General Dentistry , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
| | - Alwaleed AlMalki
- c Department of General Dentistry , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
| | - Elham Gholamiazizi
- d Department of Mechanical Engineering , Capital College, Pennsylvania State University , Pennsylvania , PA , USA
| | - Fahim Vohra
- a Department of Prosthetic Dental Sciences , College of Dentistry, King Saud University , Riyadh , Saudi Arabia
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Ali M, Jawad M. Health Effects of Waterpipe Tobacco Use: Getting the Public Health Message Just Right. Tob Use Insights 2017; 10:1179173X17696055. [PMID: 28579844 PMCID: PMC5428225 DOI: 10.1177/1179173x17696055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022] Open
Abstract
Many public health messages benchmark the harms of waterpipe tobacco against those of cigarettes, usually using numerical magnitudes of risk. This approach, although well intentioned, could be perceived as alarmist, damaging scientific credibility, and giving an unintended impression that one tobacco product is less harmful than the other. This commentary makes clear the harm waterpipe tobacco smoking poses to public health by describing its mechanism of use, consumption uptake, toxicologic profile, and documented health outcomes, as well as challenge existing thinking that toxicologic assessments are the most appropriate way to frame waterpipe tobacco health promotion messages. How can we describe the health effects of waterpipe tobacco without undermining its toxicity nor falling into the temptation of alarmist messaging? Several recommendations are provided.
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Affiliation(s)
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Kowitt SD, Meernik C, Baker HM, Osman A, Huang LL, Goldstein AO. Perceptions and Experiences with Flavored Non-Menthol Tobacco Products: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E338. [PMID: 28333107 PMCID: PMC5409539 DOI: 10.3390/ijerph14040338] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 11/16/2022]
Abstract
Although a few countries have banned flavored cigarettes (except menthol), flavors in most tobacco products remain unregulated across the globe. We conducted a systematic review of qualitative studies examining perceptions of and experiences with flavored non-menthol tobacco products. Of 20 studies on flavored tobacco products included in our qualitative systematic review, 10 examined hookah, six examined e-cigarettes, two examined little cigars and cigarillos (LCCs), and three examined other tobacco products, including cigarettes. The majority of studies, regardless of product type, reported positive perceptions of flavored tobacco products, particularly among young adults and adolescents. In six studies that assessed perceptions of harm (including hookah, LCCs, and other flavored tobacco products), participants believed flavored tobacco products to be less harmful than cigarettes. In studies that examined the role of flavors in experimentation and/or initiation (including three studies on e-cigarettes, one hookah study and one LCC study), participants mentioned flavors as specifically leading to their experimentation and/or initiation of flavored tobacco products. Given that many countries have not yet banned flavors in tobacco products, these findings add to existing research on why individuals use flavored tobacco products and how they perceive harm in flavored tobacco products, providing further support for banning non-menthol flavors in most tobacco products.
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Affiliation(s)
- Sarah D Kowitt
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
| | - Clare Meernik
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Hannah M Baker
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
| | - Amira Osman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
| | - Li-Ling Huang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
| | - Adam O Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
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