Waterpipe and cigarette smoking among college athletes in the United States

Evaluation of Oral Mucosal Lesions in Iranian Smokers and Non-smokers

BACKGROUND

Tobacco smoking statistics are alarming and the oral mucosa is the first human part of the body that is exposed to the toxic substances of smoking.

AIMS

Considering the high prevalence rate of tobacco-associated problems in the oral cavity and few studies on the Iranian population regarding the effects of smoking on the oral cavity, this study aimed to evaluate the relationship between smoking and oral lesions in the Iranian population.

MATERIALS AND METHODS

Observational study. In this observational study, the oral cavities of 200 participants (smokers = 100 and non-smokers = 100) were examined by a trained dental student under the supervision of an oral and maxillofacial medicine expert, and the presence of coated tongue, leukoedema, leukoplakia, smoker's palate, smoker's melanosis, erythroplakia, frictional hyperkeratosis, acute pseudomembranous candidiasis, and erythematous candidiasis were recorded. Xerostomia was evaluated based on participants' self-reporting through a questionnaire. All data were analyzed using T-test, Chi-square test, odd ratio, 95% confidence interval, Fisher's exact test, and Spearman's rank correlation coefficient.

RESULTS

The results of this study showed smoking is significantly associated with an increased risk of coated tongue (OR: 1.80, 95% CI: 1.32-3.54, P = 0.005), smoker's melanosis (OR: 6.176, 95% CI: 3.28-11.62, P = 0.00002), and frictional hyperkeratosis (OR: 1.33, 95% CI: 0.68-2.60, P = 0.005). However, no significant association was observed between smoking and leukoedema (OR: 1, 95% CI: 0.51-1.94, P = 1). None of the participants presented smoker's palate, erythroplakia, and candidiasis.

CONCLUSIONS

This study's results showed that smokers exhibited a greater chance of developing oral lesions compared to non-smokers.

Exposure to Electronic Waterpipes Increases the Risk of Occlusive Cardiovascular Disease in C57BL/6J Mice

INTRODUCTION

It is well documented that cardiovascular disease (CVD) is the leading cause of death in the US and worldwide, with smoking being the most preventable cause. Additionally, most smokers die from thrombotic-based diseases, in which platelets play a major role. To this end, because of the proven harm of smoking, several novel tobacco products such as electronic(e)-waterpipe have been gaining popularity among different sectors of the population, partly due to their "false" safety claims. While many investigators have focused on the negative health effects of traditional cigarettes and e-cigarettes on the cardiovascular system, virtually little or nothing is known about e-waterpipes, which we investigated herein.

METHODS AND MATERIALS

To investigate their occlusive CVD effects, we employed a whole-body mouse exposure model of e-waterpipe vape/smoke and exposed C57BL/6J male mice (starting at 7 weeks of age) for 1 month, with the controls exposed to clean air. Exposures took place seven times a week, according to the well-known Beirut protocol, which has been employed in many studies, as it mimics real-life waterpipe exposure scenarios; specifically, 171 puffs of 530 ml volume of the e-liquid at 2.6 s puff duration and 17 s puff interval.

RESULTS

The e-waterpipe exposed mice had shortened bleeding and occlusion times, when compared to the clean air controls, indicating a prothrombotic phenotype. As for the mechanism underlying this phenotype, we found that e-waterpipe exposed platelets exhibited enhanced agonist-triggered aggregation and dense granule secretion. Also, flow cytometry analysis of surface markers of platelet activation showed that both P-selectin and integrin GPIIb-IIIa activation were enhanced in the e-waterpipe exposed platelets, relative to the controls. Finally, platelet spreading and Akt phosphorylation were also more pronounced in the exposed mice.

CONCLUSION

We document that e-waterpipe exposure does exert untoward effects in the context of thrombosis-based CVD, in part, via promoting platelet hyperreactivity.

Association between alexithymia, emotional intelligence, smoking addiction, and alcohol use disorder among a sample of Lebanese adults

BACKGROUND

Alexithymia can be associated with worse addictive traits, while emotional intelligence is associated with better addictive outcomes. In Lebanon, the prevalence of cigarette and waterpipe smoking is on the rise, although people are aware of the associated harms. Also, around 11% of Lebanese adults have experienced alcohol use disorder (AUD). This study aimed to assess the association between alexithymia, emotional intelligence, smoking (cigarette and waterpipe), and AUD among a sample of Lebanese adults.

METHODS

A web-based cross-sectional study carried out between February and April 2020, during the lockdown period, enrolled 408 community-dwelling adults. The survey link was shared on social media to reach participants from all Lebanese districts/governorates.

RESULTS

Taking antidepressants (Beta = 4.37) was significantly associated with more cigarette dependence, while female gender (Beta = -1.52) and having a high vs. low monthly income (Beta = 1.02) were significantly associated with less cigarette dependence. None of the variables, including alexithymia, were significantly associated with waterpipe dependence. Female gender (Beta = -0.15) and higher emotional intelligence (Beta = -0.003) were significantly associated with less AUD, whereas higher alexithymia (Beta = 0.003) was significantly associated with more AUD.

CONCLUSION

This study could demonstrate a significant association between alexithymia and cigarette smoking and alexithymia and alcohol consumption. Future research is warranted to investigate the mediating effect of emotional intelligence and how these results may be used to meet the needs of alexithymic individuals with addictions.

Tobacco use among varsity athletes - why do they do it and how do we make it stop: a brief report

The current study explores the motivations underlying tobacco use among varsity athletes. A cross-sectional exploratory mixed method approach was used. Both tobacco users (TU) and non-tobacco users (NTU) completed an online survey of closed and open-ended questions. These questions focused on tobacco use, motivations for tobacco use, teammate and coaches' perceptions of athlete tobacco use, and self-perceived effects of tobacco use on health and athletic performance. Thirty-eight completed surveys were included of which 12 were TU and 26 were NTU. The majority of TU indicated that they used products during the off-season. Motivations for using tobacco products included social influences, stress-relief, and increasing energy. TU mostly indicated that there are negative effects on their health but not on their athletic performance, whereas NTU reported potential detrimental effects on their teammate's performance. Overall, varsity athletes who use tobacco products are aware of the health effects and negative opinions of their teammates.

Prevalence and predictors of waterpipe smoking initiation and progression among adolescents and young adults in waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study

BACKGROUND

Waterpipe tobacco (WPT) smoking has increased among the young population in the United States (US). This study assessed the extent and predictors of WPT smoking initiation and progression among US adolescents (12-17 years) and young adults (18-24 years) longitudinally.

METHODS

We analyzed data from 4 waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) study comprising 10,692 respondents (adolescents=5,428 and young adults=5,264). Kaplan-Meier survival method estimated probabilities of WPT initiation and progression. Cox proportional hazards regression models delineated predictors of the outcomes.

RESULTS

Between 2013 to 2018, 4.8% of adolescents initiated and 10.6% progressed WPT smoking. Among young adults, 18.5% initiated and 14.1% progressed WPT smoking during the same time interval. Predictors among adolescents included, WPT initiation: Hispanic ethnicity (adjusted odds ratio (aHR)=1.75, 95% confidence interval (CI)=1.23-2.49), lower harm perception (aHR=2.89, 95% CI=2.10-3.98), and other tobacco products use (aHR=3.97, 95% CI=2.73-5.78); WPT progression: illicit drug use (aHR=4.60, 95% CI=1.99-10.67). Predictors among young adults included, WPT initiation: non-Hispanic Black (aHR=2.31, 95% CI=1.78-3.00), Hispanic (aHR=1.77, 95% CI=1.34-2.33), lower harm perception (aHR=2.77, 95% CI=2.19-3.50), and other tobacco products use (aHR=3.14, 95% CI=2.25-4.38); WPT progression: non-Hispanic Black (aHR=1.51 95% CI=1.09-2.10), lower harm perception (aHR=1.80, 95% CI=1.41-2.30), and alcohol use (aHR=1.61, 95% CI=1.13-2.30).

CONCLUSIONS

Results indicate a high prevalence of WPT initiation and progression among adolescents and young adults over time, with minority racial/ethnic groups being at greater risk for both. WPT-specific risk communication interventions (e.g., educational campaigns and health warning labels) are warranted to limit WPT smoking among young people.

Overuse Injury, Substance Use, and Resilience in Collegiate Female Athlete

BACKGROUND

Overuse injury is a common stressor experienced by female collegiate athletes and is often underreported. In response, athletes may develop negative coping skills such as substance use. Alternatively, resilience is a modifiable trait that may positively influence response to musculoskeletal injuries and substance use.

PURPOSE

To provide an updated epidemiological profile of overuse injury and substance use and examine the relationship between resilience, overuse injury, and substance use among collegiate female athletes.

DESIGN

Cross-sectional study.

METHODS

Two-hundred and thirty female collegiate athletes were classified into overuse injury and resilience groups. Overuse injury, pain, and substance use incidence proportions (IP) were calculated. Kruskal-Wallis analyses were performed to investigate differences in substance use among resilience groups. Analyses of covariance were performed to evaluate differences in overuse injuries, substantial overuse injuries, and time loss injuries, among resilience groups.

RESULTS

IP for pain was 45.0% (95% CI: 38.2-51.9); Overuse injury 52.0% (45.1-58.9); Alcohol use 35.1% (28.6-41.6); Electronic cigarette use 19.5% (14.6-24.9); Cigarette use 2.8% (6-5.1); and Drug use 3.3% (0.9-5.8). No significant differences were found between resilience groups for the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC) variables (Pain: p=0.102; Overuse injury: p=0.331; Substantial overuse injury: p=0.084; Not playing: p=0.058), alcohol (p=0.723), or combined substance use (p=0.069).

CONCLUSIONS

Pain and overuse injury prevalence is high among female collegiate athletes. Alcohol followed by electronic cigarette use were the most commonly utilized substances. No significant differences were identified in substance use or overuse injury presentation between resilience groups, though further investigation is warranted.

LEVEL OF EVIDENCE

3.

Cigarette, waterpipe, and electronic cigarette use among college fraternity and sorority members and athletes in the United States

To examine the association between fraternity/sorority membership and athlete status with tobacco use by tobacco product type. Participants: Undergraduate college students who participated in the Spring 2017 National College Health Assessment-II Survey (n = 47,821). Methods: Prevalence of current (past-30 day) cigarette smoking, waterpipe tobacco smoking (WTS), and e-cigarette (ECIG) use was examined. Logistic regressions examined associations between fraternity/sorority membership and participation in collegiate athletics with tobacco use. Results: Fraternity/sorority members had the highest current use rates for cigarettes, waterpipe tobacco, and ECIGs and were nearly twice as likely to report cigarette smoking, WTS, and ECIG use relative to non-fraternity/sorority members. Relative to non-varsity athletes, varsity athletes were less likely to report cigarette smoking and WTS, but not ECIG use. Conclusions: Fraternity/sorority members appear to be at risk for use of multiple tobacco products. Varsity athlete status may be protective for some tobacco products, but does not appear no for ECIG use. ECIGs may appeal to groups typically at low risk for other tobacco products.

"It's beyond the pale to smoke hookah": perceptions of Iranian adolescents on social unacceptability of hookah smoking

Introduction

Globally, the popularity of hookah smoking, as a social and entertaining behavior, is increasing among adolescents and youths. The present study aimed to explore the perceptions of high school students on Social Unacceptability (Arabic/Persian term = Qabahat) of Hookah Smoking (SUoHS) in an Iranian context.

Methods

In this qualitative study, 31 student adolescents in Tabriz, Iran, were invited to participate in semi-structured individual interviews and focus group discussions (FGDs). Data were analyzed using interpretative thematic analysis.

Results

The unacceptability of hookah smoking was viewed at the “disreputability of hookah smoking and hookah smokers”. The students also explained SUoHS in the “incivility of hookah smoking and smokers in the society”, “disrespectfulness of hookah smokers and their families”, and “the consequences of hookah smoking”.

Conclusions

The SUoHS is rooted in the social values and norms within communities. To decrease hookah smoking levels among adolescents, school health nursing interventions should be tailored to bridge the gap between their recognition of SUoHS and subsequent behavior change through creating group dynamics highlighting the domains of social unacceptability of the behavior.

Smoking characteristics and lung functions among university athletes

Cigarette smoking has negative effects on the respiratory system, particularly pulmonary functions. This study aimed to determine smoking prevalence and characteristics among university athletes. We conducted a cross-sectional study of Thammasat University athletes in Thailand from July to October 2018. Demographic and smoking data were recorded. Exhaled carbon monoxide (CO) levels and lung function data were analysed. A total of 433 subjects (56% men) were included. Mean age was 19.8 ± 1.3 years. Asthma was reported in 5.5%. The prevalence of current cigarette smoking was 23.8%. Tobacco use was 3.0 ± 3.2 cigarettes per day. The Fagerstrom score for nicotine dependence was 0.76 ± 1.47. Compared to non-smokers, smokers were predominately males (70.6% vs 29.4%, P < 0.001), had higher exhaled CO levels (3.75 ± 3.08 ppm vs 2.18 ± 0.73 ppm, P < 0.001), higher FVC (89.65 ± 17.61% vs 83.22 ± 15.72%, P = 0.001), higher FEV₁ (92.60 ± 15.36% vs 87.77 ± 11.23%, P = 0.002), but lower FEV₁/FVC (78.21 ± 5.38% vs 79.70 ± 5.60%, P = 0.015). Moreover, athletes who smoke, were more likely to: drink alcohol, have a family member who smokes, have a friend who smokes or have a university instructor who smokes. In conclusion, smoking prevalence among university athletes was relatively high, although low nicotine addiction level and good lung functions were found. Home and institute environments had important influences on cigarette use in students.

Trial registration: TCTR20180917001

Subgrouping University Students Based on Substance Use Pattern: A Latent Class Analysis

Purpose

High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.

Aim

This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.

Methods

Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.

Results

Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.

Conclusion

This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.

Development of a Hookah Smoking Obscenity Measurement Scale for Adolescents

Background

The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents.

Methods

In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability.

Findings

The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ²/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively.

Conclusion

We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking prevention/cessation interventions among adolescents.

A critical review on sleep assessment methodologies in athletic populations: factors to be considered

A growing body of research focus on athletes' sleep in order to investigate the effects of sleep in sports performance and recovery or the prevalence of sleep disorders in athletes. At the same time, several sleep monitoring tools have been developed and used in athletic populations for fulfilling these purposes. This review aimed to provide critical assessment to the most used by athletes' methodological approaches and compared them with the gold standard approach. Advantages and disadvantages of the various sleep monitoring tools were critically discussed. Literature related to aspects of athletes' sleep was reviewed. From the shortlisted studies, several factors that seem to affect sleep in athletes were identified using objective methods such as polysomnography/electroencephalography and actigraphy. These factors were associated to sleep (eg such as sleep environment, familiarization procedures and napping) and daily habits (eg nutrition, fluid consumption, alcohol and caffeine intake, tobacco use). The selected studies that evaluated sleep objectively were screened according the reporting rates of these variables. The majority of the screened studies were found to underreport these variables. Practical issues were addressed and recommendations about reporting sleep-related factors were made in order to improve studies' quality assessment and allow for more robust comparisons between studies.

Waterpipe Tobacco Smoking and Associated Risk Factors among Bangladeshi University Students: An Exploratory Pilot Study

Over the past two decades, there has been a global rise in the prevalence of waterpipe tobacco smoking. Waterpipe tobacco smoking involves the inhalation of heated tobacco smoke after passing through water, and it has been associated with an identified dependence effect similar to that found with cigarette smoking. Despite the popularity of waterpipe tobacco among youth (and in particular, university students) in many countries, detailed data of its usage are lacking in Bangladesh. Therefore, the present study was conducted to explore waterpipe tobacco smoking behavior and normative beliefs among university students in Bangladesh and to assess the factors associated with waterpipe tobacco use. A quantitative cross-sectional survey was carried out among 340 Bangladeshi university students (64.4% male; mean age 21.6 years). Among participants, 13.5% reported they had ever smoked tobacco from a waterpipe and 9.4% had it in past 30 days. Among past 30-day users, 72% were categorized as having waterpipe smoking dependence (n = 23). No females in the sample had ever smoked using a waterpipe. Maternal occupation, monthly expenditure, and regular smoking status were major predominant factors associated with waterpipe smoking behavior of the students. The study is of existential value given that there are no prior studies ever carried out in Bangladesh previously. Recommendations are provided based on the study’s findings, particularly in relation to what action is needed from universities in Bangladesh.

Determinants of Intentions toward Smoking Hookah in Iranian Adolescents Based on the Theory of Planned Behavior

BACKGROUND

Smoking hookah is considered a health problem among the adolescents, which currently has a high prevalence. The present study aimed to determine the reasons for tendency toward smoking hookah.

METHODS

Participants of this qualitative study were 24 adolescents from Tehran selected using purposeful sampling method in 2017. Data gathered through individual semi-structured interviews and two focus groups. Using directed content analysis approach 423 primary codes were categorized into 28 subcategories and 9 categories.

RESULTS

Most of the participants were 16 to 18 yr old (64%), male (58%) and had high school degree (58%) and 75% of them were student. In Theory of Planned Behavior, attitude toward smoking hookah contained categories of replacement for cigarette, the pleasurableness of hookah, easy access and spending the leisure times. Subjective norms contained the categories of family, friends and society. The construct of behavioral control contained the categories of personal and social factors.

CONCLUSION

Our Results could be helpful in policy-making and planning toward improving the awareness and changing the attitude and performance of the adolescents toward smoking hookah.

Evaluation of Cerebral Blood Flow Alterations and Acute Neuronal Damage due to Water-Pipe Smoking

Background:

Although water-pipe smoking is a great public health problem, data regarding the acute and chronic effects and the degree of toxin exposure are limited. While water pipe-related malignancy, pulmonary, infectious, cardiac effects, infertility, and biological effects have been described in a meta-analysis, there are no studies in the literature about its neurologic effects.

Aims:

To evaluate water pipe-related acute neurological effects and cerebral blood flow through transcranial Doppler ultrasonography and serum S100 calcium binding protein calcium binding protein level measurements.

Study Design:

Prospective observational study.

Methods:

Vital signs and baseline carboxyhemoglobin and S100 calcium binding protein levels, cerebral flood changes with transcranial Doppler ultrasound were evaluated and recorded before and after water-pipe smoking.

Results:

The mean age of the 31 volunteers was 30.61 (±5.67) years, and 24 of them (77.42%) were male. A statistically significant difference was determined in heart rate, oxygen saturation, systolic and diastolic arterial pressure values before and after water-pipe smoking (p<0.001, p=0.035, p=0.009, p=0.021, respectively). Mean carboxyhemoglobin level was 2.68% (±1.68) before, 14.97% (±4.83) after water-pipe smoking (p<0.001). The S100 calcium binding protein level was 25.05 μ/mL (±8.34) at the beginning, 40.71 μ/mL (±14.06) after water-pipe smoking (p<0.001). An increase was determined in peak, and median middle, anterior and posterior cerebral artery blood flow rates, and a decrease was determined in both the pulsatility index and resistivity index values after water-pipe smoking using transcranial Doppler ultrasound.

Conclusion:

Cerebral vasodilation develops due to the increase in cerebral blood flow rate and the decrease in pulsatility index, resistivity index values, and the elevation in carboxyhemoglobin, S100 calcium binding protein level indicates that water-pipe smoking leads to neuronal damage in the acute period.

Waterpipe Tobacco Smoking: A Mini-review

The waterpipe tobacco smoking is an ancient form of smoking that is present in the society since centuries. The majority of consumers of this exotic activity are still unaware of the serious consequences that this type of smoking has on the health of the smoker. The paucity of data related to the prevalence and extent of this habit in the society is still not available. In this present short review, the authors try to highlight this serious health issue and suggest preventive measures.

Hookah Use Among College Students: Recent Use, Knowledge of Health Risks, Attitude and Reasons for Use

Notwithstanding the efforts of health educators and other health professionals regarding tobacco and smoking cessation, research indicates that hookah smoking among college students remains a health concern. Research shows an upward trend in college students' hookah use. The purpose of this study was to identify and describe potential patterns/differences in college students' hookah use, and the relations among attitudes toward and knowledge about hookah use and use of this drug. A four-page, 20-item survey was used to collect data from participants (N = 403) and to measure participants 'recent use, knowledge of health risks, attitudes and reasons for hookah use among college students. Results indicated increased prevalence rates (53.8%) among participants of this study. Participants' recent hookah use was consistent with that of current research. Study findings supports current research, which found that college students have low negative perceptions of the health risks (addictive and detrimental properties) of hookah use. Analyses also determined that college students' attitudes toward hookah was associated with use of this drug. Regarding reasons why students may use hookah, data analysis indicated statistical significance in lifetime hookah use based on reasons for use. Study provide information for health educators creating hookah risk awareness educational programs aimed at reducing rates of hookah smoking among college students.

The prevalence and trends of waterpipe tobacco smoking: A systematic review

INTRODUCTION

Waterpipe tobacco smoking is harmful to health however its prevalence estimates remain uncertain. We aimed to systematically review the medical literature on waterpipe tobacco prevalence and trends.

METHODS

We searched Medline, Embase and ISI Web of Science for 'waterpipe' and its synonyms, without using language or date restrictions. We included any measure of waterpipe tobacco smoking prevalence in jurisdictionally representative populations. We stratified findings by prevalence measure (past 30 day, ever, regular or occasional, daily, other or unspecified) and age (adults or youth).

RESULTS

We included 129 studies reporting 355 estimates for 68 countries. In general, prevalence estimates among adults were highest in the Eastern Mediterranean, and among youth were about equal between Eastern Mediterranean and European regions. Past 30 day use was highest among Lebanese youth (37.2% in 2008), ever use was highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%), regular or occasional use was highest in among Iranian university students (16.3% in 2005), and daily use was highest among Egyptian youth (10.4% in 2005). Trend data were limited but most studies reported increased use over time, ranging from 0.3-1.0% per year among youth in the US to 2.9% per year among youth in Jordan (both for past 30 day use). Results were similar for ever use trends. Turkey (2.3% in 2008 to 0.8% in 2010) and Iraq (6.3% in 2008 and 4.8% in 2012) both witnessed decreased waterpipe use.

CONCLUSION

Waterpipe tobacco smoking is most prevalent in Eastern Mediterranean and European countries, and appears higher among youth than adults. Continued surveillance will be important to assess and inform policy measures to control waterpipe tobacco use.

Descriptive and injunctive norms of waterpipe smoking among college students

INTRODUCTION

Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample.

METHODS

Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS.

RESULTS

Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university.

DISCUSSION

The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students.

Adolescent Sports Participation, E-cigarette Use, and Cigarette Smoking

INTRODUCTION

Although sport participation among adolescents has been found to lower the risk of traditional cigarette smoking, no studies to date have assessed if this type of physical activity lowers the risk of e-cigarette use among adolescents.

METHODS

National data from the 2014 and 2015 Monitoring the Future study of 12th-grade students were used and analyses were conducted in 2016. Measures for past 30-day e-cigarette use and traditional cigarette smoking were used to assess differences between adolescents who participated in at least one competitive sport during the past year and adolescents who did not. Differences in e-cigarette use and traditional cigarette smoking were assessed between 13 different sports to determine which sports were associated with a greater or lower risk of these behaviors.

RESULTS

Adolescents who participated in at least one competitive sport were less likely to engage in past 30-day traditional cigarette smoking (AOR=0.73, 95% CI=0.538, 0.973) and past 30-day dual use of traditional cigarettes and e-cigarettes (AOR=0.66, 95% CI=0.438, 0.982) when compared with their nonparticipating peers. Adolescents who participated in baseball/softball and wrestling were at greatest risk of e-cigarette use. Of the 13 assessed sports, none were found to lower the odds of e-cigarette use.

CONCLUSIONS

No significant evidence was found that participation in a sport was a protective factor against e-cigarette use. Certain types of athletes are at an elevated risk of e-cigarette use, and prevention efforts targeted at these specific sports should be considered by school administrators.

Psychometric evaluation of an abbreviated version of the intragroup marginalization inventory

Tobacco and marijuana use among U.S. young adults is a top public health concern, and racial/ethnic minorities may be at particular risk. Past research examining cultural variables has focused on the individual in relation to the mainstream U.S. culture; however, an individual can also experience within-group stress, or intragroup marginalization. We used the 2014 San Francisco Bay Area Young Adult Health Survey to validate an abbreviated measure of intragroup marginalization and identify associations between intragroup marginalization and tobacco and marijuana use among ethnic minority young adults (N = 1,058). Exploratory factor analysis was conducted to identify factors within the abbreviated scale, and logistic regressions were conducted to examine relationships between intragroup marginalization and tobacco and marijuana use. Two factors emerged from the abbreviated scale. The first factor encompassed items related to belonging and membership, capturing whether individuals experienced marginalization due to not fitting in because of physical appearance or behavior. The second factor encompassed whether individuals shared similar hopes and dreams to their friends and family members. Factor 1 (membership) was associated with increased odds of marijuana use (OR = 1.34, p < .05) and lower odds of using cigars (OR = 0.79, p < .05), controlling for sociodemographic factors. Results suggest that young adults may use marijuana as a means to build connection and belonging to cope with feeling marginalized. Health education programs focused on ethnic minority young adults are needed to help them effectively cope with intragroup marginalization without resorting to marijuana use.

Comparison of the effect of educational methods on students' knowledge, attitude and behavior about hookah smoking

INTRODUCTION

Smoking tobacco by hookah may seriously affect the health of smokers and those exposed to smoke. This study aimed to compare the effect of educational digital media versus pamphlets on the reduction of hookah use among male high school students in Zahedan, Iran.

METHODS

A semi-experimental study was conducted on 200 male high school students of Zahedan using multi-stage random sampling for three months in 2014. The samples were divided into two groups - the test (educated using digital films) and the control (educated using pamphlets) groups, and measurement was performed before and after intervention. The data collection instrument was a 53-item questionnaire consisting of demographic, knowledge, attitude, behavior and self-efficacy questions. Its validity and reliability were confirmed. The results before and after the intervention were analyzed using SPSS version 18, Mann-Whitney U test, Pearson-product moment correlation coefficient and Chi square test as well as one directional variance analysis.

RESULTS

There was no significant relation between demographic and basic variables before intervention (p>0.05); however, the mean scores of knowledge, attitude, self-efficacy, and hookah using preventive behavior were significantly different between the two groups after the intervention (p<0.05). Moreover, there was a meaningful relation among the demographic characteristics including age and attitude- the previous educational year's GPA and self-efficacy; and there was a significant relation between father education and self-efficacy. Moreover, there was a significant relation between the main variables of the study, concerning the relation of knowledge and attitude- knowledge and self-efficacy, and attitude and self-efficacy.

CONCLUSION

Educational digital media is more efficient than the pamphlet in the reduction of hookah use among the students; and that the media may be applied to prevent of hookah use among students.

The effect of habitual waterpipe tobacco smoking on pulmonary function and exercise capacity in young healthy males: A pilot study

BACKGROUND

Evidence regarding the health effects of habitual waterpipe smoking is limited, particularly in young smokers. Respiratory health and cardiopulmonary exercise tests were compared in young male habitual waterpipe smokers (WPS) versus non-smokers.

METHODS

69 WPS (≥3 times/week for three years) and 69 non-smokers were studied. Respiratory health was assessed through the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78) adult questionnaire. Pulmonary function and cardiopulmonary exercise tests were performed. Self-reported respiratory symptoms, forced expiratory volume in first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, forced expiratory flow between 25 and 75% of FVC (FEF25-75%), peak expiratory flow (PEF), exercise time, peak end-tidal CO2 tension (PetCO2), subject-reported leg fatigue and dyspnea; peak O2 uptake (VO2 max), and end-expiratory lung volume (EELV) change from baseline (at peak exercise) were measured.

RESULTS

WPS were more likely than non-smokers to report respiratory symptoms. WPS also demonstrated: shorter exercise time; lower peak VO2; higher perceived dyspnea at mid-exercise; lower values of the following: FEV1, FVC, PEF, and EELV change.

CONCLUSION

Habitual waterpipe tobacco smoking in young seemingly healthy individuals is associated with a greater burden of respiratory symptoms and impaired exercise capacity.

Sexual temptation: substance abuse, no sex, safe sex, risky sex, and STDs

Background University students' substance abuse and risky sex contribute to sexually transmitted diseases (STDs). Purpose We develop and empirically test a formative theoretical model of sexual temptation involving substance abuse (cigarettes, alcohol, and marijuana), safe sexual behavior (use of condom/barrier for oral and vaginal intercourse), risky sexual behavior (unprotected sex and multiple sexual partners), and STDs: gonorrhea, HIV, and genital herpes. We simultaneously explore these constructs, controlling membership in social groups (fraternity/sorority, varsity athlete, and club sports) and perceived norm of substance abuse. Methods A total of 687 American university students completed the National College Health Assessment (NCHA). We use structural equation modeling (SEM) to test the goodness of fit between our formative theoretical model and actual data. Results Results reveal the following discoveries: membership in campus social groups is positively associated with STDs, whereas perceived norm of peer substance abuse is negatively related to STDs. Under the influence of substance abuse, we test three outcomes of sexual temptation as related to STDs. Those who have no sex do not contract STDs. For those who fall into temptation and have sex, substance abuse is more strongly related to risky sex which leads to STDs than safe sex which does not. Those engaging in risky sex have significantly higher cognitive impairment than those practicing safe sex. Conclusions Substance abuse contributes to STDs through risky sex only. Those having risky sex suffer higher cognitive impairment than those practicing safe sex. We provide novel implications to policy makers, practitioners, and researchers.

Tobacco Use and Its Health Effects among Professional Athletes in Qatar

The objective of the study was to determine the effects of tobacco use on selected markers of health and lung function in professional athletes. A total of 108 male professional athletes participated in the study from ten ball game teams in the same sport league in Qatar (age = 26.4 ± 5.1 yrs, height = 190.6 ± 11.9 cm, and weight = 91.5 ± 16.4 kg). The athletes have been playing professionally for about 6.3 years on average. In addition to demographic and tobacco use status, the following clinical variables were measured: resting blood pressure, heart rate, FVC, FEV₁ sec, and PEF. The prevalence of tobacco use among the athletes was 27.7%. The FVC, FVC%, and FEV₁% were significantly lower among the smokers compared to the nonsmokers (p = 0.003, 0.044, and 0.001, resp.). There were no significant differences between cigarettes smokers and nonsmokers in BP, HR, FEV₁, FEV₁/FVC, PEF, and PEF%. Similarly, those who smoked shisha had lower FEV₁% values as compared to those who did not smoke shisha (p = 0.001). The decrease of FEV₁ and FVC among smokers compared to nonsmokers is similar to what has been reported in the literature about other populations.

Correlates of nicotine dependence among adolescent waterpipe smokers

INTRODUCTION

Waterpipe smoking is addictive and its use is increasing globally among youth, yet little is known about the factors associated with nicotine dependence (ND) among waterpipe smokers. We investigated the factors associated with ND symptoms among a sample of Lebanese adolescents who smoke a waterpipe.

METHODS

We collected data on factors potentially associated with ND (individual, socio-demographic, environmental, smoking patterns) among 160 current (past 30days) waterpipe smokers recruited from 8th and 9th school grades in Lebanon. We assessed the loss of autonomy over tobacco using the Hooked on Nicotine Checklist (HONC), ND using the International Classification of Diseases, 10th revision (ICD-10), and the number of ND symptoms endorsed.

RESULTS

Depressive symptoms, lower self-esteem, and having at least one sibling who smokes a waterpipe were associated with the presence of ND symptoms, while enrollment in public schools, smoking a waterpipe ≥30min per session, and believing that cigarette smoking is harmful to health were associated with endorsement of a higher number of ND symptoms. Smoking a whole waterpipe head without sharing and being in 9th grade in this study were associated with the presence and endorsement of a higher number of ND symptoms.

CONCLUSIONS

We identified specific social and psychological characteristics, waterpipe smoking patterns, and beliefs about harmful effects of smoking associated with the presence of ND among adolescent waterpipe smokers. Considering these factors when planning policies to prevent ND among waterpipe smokers is warranted.

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

Correlates of waterpipe smoking among Iranian university students and the role of religiosity

Waterpipe smoking among youth and adolescents in Iran has gained in popularity. The aim of this study was to investigate the relationship between waterpipe smoking and different dimensions of religiosity in a sample of students attending two major universities in South East Iran. A total of 682 students completed a waterpipe and cigarette smoking questionnaire along with the Duke University Religion Index. The lifetime prevalence of dual cigarette and waterpipe use was 48.3%, with prevalence of current use (within the last 30 days) of 24.9%. The proportions of lifetime and current waterpipe-only users were 27.0% and 18.8%, respectively. Students who participated more often in private religious activities were less likely to report engaging in waterpipe smoking (odds ratio: 0.82; 95% confidence interval: 0.71-0.98). A higher level of attendance of religious services was negatively associated with dual cigarette and waterpipe smoking (odds ratio: 0.71; 95% confidence interval: 0.54-0.93). Waterpipe-only use was significantly higher among males, students who had lower grade point averages, those who reported having a close friend or a family member who was a waterpipe smoker. To conclude, it is possible that religious observance may have a protective role in lowering waterpipe usage among Iranian university students.

A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes

BACKGROUND

Waterpipe smoking (WPS) is a social custom common in many Middle Eastern, North African, and Asian countries and has become increasingly popular in the US, especially among youth; however, WPS smoking may be increasing in the US adult population as well. There is a common belief among waterpipe (WP) smokers that WPS is less harmful than smoking cigarettes. Thus, this review aims to systematically explore the literature on the effects of WP tobacco smoking with a particular focus on cardiovascular and respiratory health outcomes as well as on oxidative stress, immunity, and cell cycle interference health outcomes.

METHODOLOGY

We conducted a systematic review, guided by the criteria of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using the following online databases MEDLINE, CINAHL, ScienceDirect, PMC, and Cochrane Library. Results were summarized qualitatively.

RESULTS

Forty studies met the inclusion criteria established for this review. Based on the existing evidence, several cardiovascular and respiratory physiologic health indicators and conditions have been shown to be negatively affected by WPS. In addition to the effects of nicotine and chemical toxicant exposures, WPS was significantly associated with an increase in heart rate, blood pressure, and lower pulmonary function test results, as well as a number of health conditions such as lung cancer, alterations in oxidative stress, immunity, and cell cycle interference.

CONCLUSION

The current literature provides evidence that WPS is associated with a number of negative health indicators and outcomes. There is need for more research related to WPS and its effects on health so that appropriate campaigns and prevention interventions can be implemented to control the epidemic increase of WPS in the US.

Prevalence of Hookah Smoking and Its Related Factors Among Students of Tehran University of Medical Sciences, 2012 - 2013

Background

Hookah smoking has increased worldwide, especially among young people.

Objectives

The aim of the present study was to determine the prevalence of hookah use and related factors in a sample of Iranian students of medical sciences.

Materials and Methods

A cross-sectional study was conducted on 1992 randomly selected sample of students of Tehran University of Medical Sciences during 2012 - 2013. A multistage sampling method was used and anonymous structured questionnaires were distributed to the students of each selected class. Chi-square test, Fisher's exact test and multiple binary logistic regression analyses were performed and P < 0.05 was considered as a significance level.

Results

Lifetime, last year and last month prevalence rates of hookah smoking were 26.6% (95% CI: 24.7 - 28.6), 17.8% (95% CI: 16.1 - 19.5) and 8.9% (95% CI: 7.7 - 10.2), respectively. The results of logistic regression model showed that male gender [odds ratio (OR) = 2.8, 95% CI: 1.86 - 4.21], cigarette smoking in the past year (OR = 5.6, 95% CI: 3.21 - 9.83), alcohol use in the past year (OR = 7.4, 95% CI: 4.01 - 13.06), cigarette or hookah smoking in the family members (OR = 1.7, 95% CI: 1.13 - 2.51), cigarette or hookah smoking among friends (OR = 4.4, 95% CI: 2.69 - 7.33), alcohol use by friends in the past year (OR = 1.9, 95% CI: 1.20 - 3.14), and illicit substance use among friends (OR = 2.2, 95% CI: 1.22 - 4.05) were associated with hookah smoking.

Conclusions

The results of our study indicate a relatively high prevalence of hookah smoking among Iranian students. The findings emphasize the importance of planning preventive interventions by considering different high-risk behaviors simultaneously.

Group Waterpipe Tobacco Smoking Increases Smoke Toxicant Concentration

INTRODUCTION

Waterpipe tobacco smoking is a global health concern. Laboratory research has focused on individual waterpipe users while group use is common. This study examined user toxicant exposure and smoke toxicant yield associated with individual and group waterpipe smoking.

METHODS

Twenty-two pairs of waterpipe smokers used a waterpipe individually and as a dyad. Before and after smoking, blood was sampled and expired carbon monoxide (CO) measured; puff topography was recorded throughout. One participant from each pair was selected randomly and their plasma nicotine and expired air CO concentrations were compared when smoking alone to when smoking as part of a dyad. Recorded puff topography was used to machine-produce smoke that was analyzed for toxicant content.

RESULTS

There was no difference in mean plasma nicotine concentration when an individual smoked as part of a dyad (mean = 14.9 ng/ml; standard error of the mean [SEM] = 3.0) compared to when smoking alone (mean = 10.0 ng/ml; SEM = 1.5). An individual smoking as part of as a dyad had, on average, lower CO (mean = 15.8 ppm; SEM = 2.0) compared to when smoking alone (mean= 21.3 ppm; SEM = 2.7). When two participants smoked as a dyad they took, on average, more puffs (mean = 109.8; SEM = 7.6) than a singleton smoker (mean = 77.7; SEM = 8.1) and a shorter interpuff interval (IPI; dyad mean = 23.8 seconds; SEM = 1.9; singleton mean = 40.8 seconds; SEM = 4.8). Higher concentrations of several toxicants were observed in dyad-produced smoke.

DISCUSSION

Dyad smoking may increase smoke toxicant content, likely due to the dyad's shorter IPIs and greater puff number. More work is needed to understand if group waterpipe smoking alters the health risks of waterpipe tobacco smoking.

IMPLICATIONS

This study is the first to measure toxicants in smoke generated from a waterpipe when used by a dyad. Relative to smoke generated by a singleton, dyad smoke had higher concentration of some toxicants. These differences may be attributed to differences in puffing behavior, specifically the shorter IPI and greater puff number observed in the dyad condition. Relative to singleton smokers, dyad smokers were exposed to less CO, but nicotine exposure did not differ. More work is needed to assess the health effects of inhalation of more toxicant-laden smoke during group waterpipe use.

Sex Differences in Hookah-Related Images Posted on Tumblr: A Content Analysis

Hookah tobacco smoking is prevalent, widespread, and associated with large amounts of toxicants. Hookah tobacco smoking may be viewed differently by males and females. For example, females have been drawn to types of tobacco that are flavored, milder, and marketed as more social and exotic. Individuals often use the growing segment of anonymous social networking sites, such as Tumblr, to learn about potentially dangerous or harmful behaviors. We used a systematic process involving stratification by time of day, day of week, and search term to gather a sample of 140 Tumblr posts related to hookah tobacco smoking. After a structured codebook development process, 2 coders independently assessed all posts in their entirety, and all disagreements were easily adjudicated. When data on poster sex and age were available, we found that 77% of posts were posted by females and 35% were posted by individuals younger than 18. The most prominent features displayed in all posts were references to or images of hookahs themselves, sexuality, socializing, alcohol, hookah smoke, and tricks performed with hookah smoke. Compared with females, males more frequently posted images of hookahs and alcohol-related images or references. This information may help guide future research in this area and the development of targeted interventions to curb this behavior.

Utilization and limitations of the American College Health Association's National College Health Assessment instrument: A systematic review

OBJECTIVE

To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II.

PARTICIPANTS AND METHODS

The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses.

RESULTS

The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers.

CONCLUSIONS

Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.

Waterpipe tobacco smoking: A new smoking epidemic among the young?

Waterpipe (hookah, narghile) tobacco smoking (WTS) is becoming prevalent worldwide and is one of the most popular forms of tobacco use among youth. WTS prevalence has increased dramatically among youth in the United States within the past decade. Misperceived as less harmful than cigarette smoking, WTS is associated with many of the same chronic health effects such as lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, bronchitis, and asthma. Much of this risk is due to the fact that a single WTS session exposes users to large volumes of smoke that contain toxic chemicals such as carbon monoxide, cancer-causing polycyclic aromatic hydrocarbons, and volatile aldehydes. Unlike cigarette smoking, WTS poses unique risks of acute negative health outcomes including carbon monoxide poisoning and the spread of communicable diseases such as herpes and tuberculosis. Because waterpipe tobacco smoke contains the addictive chemical nicotine, youth who smoke tobacco from a waterpipe may be at risk for dependence. As a result, many youth may initiate WTS and continue to use despite negative health effects. Considering many of the potential negative health effects associated with WTS affect the pulmonary system, pulmonologists and primary care providers may treat patients who are waterpipe tobacco smokers and should be aware of the risk associated with WTS. The purpose of this review is to describe a waterpipe, the prevalence and correlates of WTS, the toxicants found in waterpipe tobacco smoke, the health effects of WTS, and implications for pulmonologists and other clinicians.

Misuse of prescription stimulant medication in a sample of college students: examining differences between varsity athletes and non-athletes

BACKGROUND

The misuse of prescription stimulants (MPS) has been identified as an adverse health behavior among college students. Because stimulant medication is often taken to increase focus and decrease reaction time, these substances have the potential to enhance athletic performance. However, the role that athlete status (varsity athlete vs. non-athlete) has on MPS has rarely been examined in the college student population.

OBJECTIVES

To examine whether there are differences in past-year MPS and MPS-related motivations between college varsity athletes and non-athletes.

METHODS

A sample of 682 (482 non-athletes; 200 athletes) college students between the ages of 18 and 25 completed a paper-based questionnaire to assess MPS, MPS-related motivations, and other potential MPS correlates (e.g., gender, energy drink consumption, tobacco use, heavy episodic drinking). Then, we conducted bivariate and multivariate analyses to examine potential correlates of MPS, including athlete status. Finally, we examined differences in MPS-related motivations between varsity athletes and non-athletes.

RESULTS

Overall, 98 (13.9%; 16.6% non-athletes v. 7.5% varsity athletes) respondents reported past-year MPS and varsity athletes were significantly less likely (p<0.05) to do so. Past-year MPS was also significantly associated with energy drink consumption, tobacco use, and heavy episodic drinking in our sample. Concerning MPS-related motivations, athletes more often cited a need to enhance athletic performance as the impetus for their misuse.

CONCLUSIONS

MPS was prevalent among the sample. Varsity athletes were significantly less likely to engage in past-year MPS and were motivated to do so for different reasons.

Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study

OBJECTIVES

Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults.

METHODS

Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah.

RESULTS

Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors.

CONCLUSIONS

For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.

Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional

INTRODUCTION

When asserting the right of individuals to be free to smoke a hookah (waterpipe [WP]) in public places, the "cultural" importance of the practice is often cited. The purpose of this study was to explore the cultural significance of WP smoking.

METHODS

Qualitative methods were used to elicit the views of groups of WP smokers from different cultural backgrounds.

RESULTS

Sixteen group discussion sessions with a total of 75 WP smokers aged between 18 and 30 were conducted. A few participants saw culture as a factor supporting WP smoking initiation and maintenance. The vast majority indicated that WPs being perceived as "healthier" than cigarettes, and the availability of flavored shisha as important factors in their initiation and ongoing use. Most started smoking before the age of 18 calling it a "high school thing" and admitted that they had easy access to WP cafés. Many indicated that they did not know if they were smoking tobacco or a "herbal" substance.

CONCLUSION

Peer influence, availability of flavored products and facile access to WP cafés are major factors in WP initiation. Ethno-cultural traditions play only a minor role. The assertion that cultural traditions and practice are inherent in WP smoking as implied by media and marketing was not supported by our findings. Contemporary use of WP is spreading among new non-traditional users. Lack of knowledge about the harms of WP smoking indicates a need for education and regulation to require packaging and health warning labels and restrictions on access, especially to minors.

Waterpipe Smoking and Regulation in the United States: A Comprehensive Review of the Literature

BACKGROUND

Researchers in tobacco control are concerned about the increasing prevalence of waterpipe smoking in the United States, which may pose similar risks as cigarette smoking. This review explores the prevalence of waterpipe smoking in the United States as well as the shortcomings of current U.S. policy for waterpipe control and regulation.

METHODS

Researchers conducted a literature review for waterpipe articles dated between 2004 and 2015 using five online databases: MEDLINE, CINHAHL, ScienceDirect, PMC, and Cochrane Library.

RESULTS

To date, few studies have explored the marketing and regulation of waterpipe smoking in the U.S., which has increased in the last ten years, especially among women, adolescents, and young adults. Data indicate that the majority of waterpipe smokers are unaware of the potential risks of use. In addition, current tobacco control policies do not address waterpipe smoking, enabling tobacco companies to readily market and sell waterpipe products to young adults, who are at risk for becoming lifelong smokers.

CONCLUSION

Policy makers in the area of public health need to update existing tobacco regulations to include waterpipe smoking. Similarly, public health researchers should develop public health campaigns and interventions to address the increasing rates of waterpipe smoking in the United States.

The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally

Objective

The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review.

Data sources

The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms.

Study selection

Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years.

Data extraction

Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results.

Data synthesis

The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels.

Conclusions

The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.

Hookah Use Predicts Cigarette Smoking Progression Among College Smokers

INTRODUCTION

Hookah use is increasingly common among U.S. college students, but little is known regarding the relationship between hookah and cigarette use. The purpose of this study was to test the hypothesis that the added nicotine exposure from hookah use may accelerate the uptake of cigarettes.

METHODS

An ethnically diverse sample of college students (n = 256; 43% female) who had smoked cigarettes in the past month completed 2 in-person interviews over 6 months. This study was a secondary analysis of data collected for a longitudinal study of young adult cigarette smoking patterns. Analyses examined 6-month changes in past 30 day cigarettes smoked and number of days smoking, controlling for age, nicotine dependence, marijuana use, and the respective baseline variable for each outcome.

RESULTS

Current hookah use (any use in past 30 days) was endorsed by 34% of participants at baseline, while 94% reported lifetime use. Change in past 30 day number of cigarettes (p = .043) and number of smoking days (p = .040) differed significantly between those who did or did not report recent hookah use at baseline. Hookah users reported a greater number of cigarettes smoked at the 6-month follow-up, while nonusers decreased their smoking quantity. For number of smoking days in the past 30, hookah users reported a smaller decrease than nonusers.

CONCLUSIONS

Recent hookah use predicted increased cigarette smoking over 6 months in a college sample. These are the first prospective data demonstrating this relationship, indicating the value of developing strategies to prevent hookah use among college students.

Exploring Demographic and Substance Use Correlates of Hookah Use in a Sample of Southern California Community College Students

BACKGROUND AND PURPOSE

Hookah smoking is a growing young adult phenomenon, particularly among college students. Many users feel that it is safer than other tobacco products, although its health threats are well documented. Little is known about hookah use rates in community colleges that are attended by nearly half of all US college students. This study examined hookah use in a diverse convenience sample of students attending two southern California community colleges.

METHODS

In fall 2011, a cross-sectional, in-classroom survey was administered to 1,207 students. A series of fully adjusted multivariate logistic regressions were conducted to explore demographic, other substance use, and attitudinal correlates of lifetime and current hookah use.

RESULTS

Lifetime hookah use (56%) was higher than lifetime cigarette use (49%). Gender and personal socioeconomic status were not related to hookah use. Current use (10.8%) was associated with current use of alcohol, cigars, and cigarettes. Compared to African-Americans, Whites were 2.9 times more likely to be current users, and students who perceive hookah to be more socially acceptable were 21 times more likely to currently use.

CONCLUSION

Since hookah use rates are high, colleges should offer health education programs to inform incoming students about the health risks of hookah and cessation programs.

Non-cigarette tobacco and the lung

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.

Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis

OBJECTIVE

Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.

METHODS

A school-based cohort of all 7th grade students (N=1781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1243).

RESULTS

During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: odds ratio 7.41; 95% confidence interval 4.05-12.92 and girls: 8.48; 4.34-16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80-51.53 and girls: 11.49; 6.42-20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14-4.64) or teachers (2.07; 1.12-3.84) who smoked and girls if they had friends (2.96; 1.59-5.54) who smoked.

CONCLUSION

There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.

The LWDS-10J: reliability and validity of the Lebanon Waterpipe Dependence Scale among university students in Jordan

INTRODUCTION

While the Lebanon Waterpipe Dependence Scale (LWDS-11) has shown promise in assessing dependence on waterpipe tobacco smoking (WTS) in Lebanon among adult users, it would be valuable to identify WTS addiction earlier and to explore reliability and validity of these items in other populations.

METHODS

In 2010-2012, we conducted a multiyear survey of 5,853 students from 4 Jordanian universities. We measured WTS, sociodemographic data, and the LWDS-11 items. We conducted exploratory factor analysis with half of the sample and confirmed the resulting model using confirmatory factor analysis with the other half. We examined construct validity with regression models assessing associations between the modified scale and 5 constructs conceptually expected to be associated with dependence.

RESULTS

WTS rates were 35% in the past 30 days and 56% ever. Principal-components analysis of LWDS items in the first half of the sample yielded 10 items representing 3 factors labeled physical dependence, relaxation/pleasure, and social aspects. Cronbach's α was .77 for the total scale and was .75, .70, and .67 for each individual subscale. Confirmatory factor analysis in a structural equation modeling framework confirmed good fit (root mean squared error of approximation = 0.068, and comparative fit index = 0.937). Dependence according to the resulting scale (LWDS-10J) was strongly associated with each of the 5 expected constructs, whether the dependent variable was treated as categorical or continuous.

CONCLUSIONS

The LWDS-11 items exhibited a different factor structure in our sample. However, the modified scale (LWDS-10J) showed promising reliability and construct validity in this population.

An observational study of group waterpipe use in a natural environment

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.

Associations between race, ethnicity, religion, and waterpipe tobacco smoking

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.

A multiyear assessment of hookah use prevalence among Florida high school students

INTRODUCTION

The purpose of this study was to assess the prevalence of hookah use among Florida high school students over time. Alternative tobacco products, including hookah, pose a public health threat to tobacco prevention efforts, especially among adolescents.

METHODS

Florida Youth Tobacco Survey data, representing all public high school students in the state, were analyzed to assess the prevalence of lifetime and current hookah use and were compared by demographic groups. Multiple years of data (2007-2012) were examined to assess changes over time.

RESULTS

During the past 6 years, there was an increase in lifetime hookah use among Florida high school students. While males remained at a higher rate overall, female adolescents increased at a faster rate. Hispanic and non-Hispanic White respondents reported increased trends as well. Current use trends did not change over 4 years, remaining at about 8%.

CONCLUSIONS

Hookah is a new tobacco product in the United States that appears attractive to youth, with dramatic increases among the state population. While cigarette use among youth is declining in Florida, the increasing uptake of alternative tobacco products may lessen the overall public health gains for tobacco use. There is a need for continued monitoring of hookah use among the adolescent population, for both prevention and cessation efforts as well as policy interventions to address this emerging trend.