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Fakunle AG, Okekunle AP, Asowata OJ, Akpa O, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Adeoye AM, Tiwari HK, Uvere EO, Akinyemi J, Jenkins C, Arulogun O, Ibinaiye P, Appiah LT, Bello T, Singh A, Yaria J, Calys-Tagoe B, Ogbole G, Chukwuonye I, Melikam C, Adebayo P, Mensah Y, Adebayo O, Adeniyi S, Oguike W, Donna A, Akinyemi R, Ovbiagele B, Owolabi M. Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study. Nicotine Tob Res 2024; 26:589-596. [PMID: 38015428 DOI: 10.1093/ntr/ntad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. METHODS A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05. RESULTS Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. CONCLUSIONS NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. IMPLICATIONS A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.
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Affiliation(s)
- Adekunle Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Abiodun M Adeoye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ezinne O Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Carolyn Jenkins
- Department of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Philip Ibinaiye
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Lambert T Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Temilade Bello
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Yaria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | | | - Chidinma Melikam
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Philip Adebayo
- Department of Internal Medicine, Aga-Khan University, Dar es Salaam, Tanzania
| | - Yaw Mensah
- Department of Radiology, University of Ghana Medical School, Accra, Ghana
| | - Oladimeji Adebayo
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Wisdom Oguike
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Arnett Donna
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Rufus Akinyemi
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Lebanese American University, Beirut, Lebanon
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Bagherpour‐Kalo M, Jones ME, Darabi P, Hosseini M. Water pipe smoking and stroke: A systematic review and meta-analysis. Brain Behav 2024; 14:e3357. [PMID: 38376055 PMCID: PMC10761326 DOI: 10.1002/brb3.3357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/30/2023] [Accepted: 11/26/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Despite the damaging effects of water pipe on physical health, there is little information about the potential harmful effects of this tobacco on stroke. This study aims to investigate the relationship between water pipe smoking and stroke. METHOD A systematic review was conducted including Ovid SP, Embase, Pubmed, Web of Science, Scopus, and Google Scholar databases with focus on cohort, case-control, and cross-sectional studies. We reviewed all studies reporting on water pipe smoking and stroke. The funnel plot and the Egger regression test were used to assess publication bias. RESULTS In the four eligible studies, there were a total of 2759 participants that 555 patients had at least once experienced stroke. Meta-analysis revealed positive association between water pipe smoking and stroke with pooled adjusted OR 2.79 (95% CI: 1.74-3.84;I 2 = 0 , p = . 741 ${I^2}\; = \;\;0,{\mathrm{\;}}p\;\; = {\mathrm{\;\;}}.741$ ) and the funnel plot shows asymmetry publication bias. CONCLUSIONS We found a higher effect of water pipe smoking on stroke compared to cigarette smoking and concluded that water pipe increases the risk of stroke by 2.79. Hence, because most of the water pipe consumer society is young, especially women, policies and decisions need to be taken to control the supply of this tobacco to the market and more provide education on the health problem of water pipe smoking. IMPLICATIONS This study provides a higher effect of water pipe smoking on stroke. Physicians and researchers who intend to study in the field of stroke should better examine the effects of water pipe (including time of use, dose-response, long-term effects, and risk factors) on stroke.
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Affiliation(s)
- Mehrdad Bagherpour‐Kalo
- Department of Epidemiology and BiostatisticsSchool of Public Health, Tehran University of Medical SciencesTehranIran
| | - Michael E Jones
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Parvaneh Darabi
- Department of BiostatisticsSchool of Public HealthIran University of Medical SciencesTehranIran
| | - Mostafa Hosseini
- Department of Epidemiology and BiostatisticsSchool of Public Health, Tehran University of Medical SciencesTehranIran
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Peeva S, Nikolova V, Nikolov N, Popova V. Assessment of heavy metal levels in roll-your-own cigarette and water pipe tobacco blends. BIO WEB OF CONFERENCES 2023. [DOI: 10.1051/bioconf/20235801021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
The increased consumption of roll-your-own (RYO) cigarettes and water pipe (hookah), both globally and in Bulgaria, necessitated the current investigation aimed at the assessment of heavy metal levels in the tobacco blends used in those products. The concentrations of Mn, Zn, Cu, Cd, Pb, and Ni were determined by AAS in five brands of RYO tobacco (R1-R5) and seven brands of water pipe tobacco (W1- W7), all distributed on Bulgarian market. The average heavy metal contents (mg/kg) in the two types of tobacco blends, RYO and water pipe, respectively, were as follows: Mn - 214.20 and 37.89; Zn - 31.90 and 134.87; Cu - 12.06 and 10.07; Cd - 0.80 and 1.33; Pb - 1.60 and 3.57; Ni - 1.36 and 0.80. RYO cigarette tobaccos contained higher concentration of Mn, Cu and Ni, while water pipe tobaccos - Zn, Cd and Pb. Strong correlations were found between Cu and Zn (r=0.81), Cu and Cd (r=0.90) in RYO tobacco blends, and between Cu and Zn (r=0.86) - in water pipe blends, respectively. The results from the study give reason to recommend that this information be provided to the consumers, who consider the regarded tobacco products as a safer alternative to conventional cigarettes.
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Darawshy F, Abu Rmeileh A, Kuint R, Berkman N. Waterpipe smoking: a review of pulmonary and health effects. Eur Respir Rev 2021; 30:200374. [PMID: 33980668 PMCID: PMC9488736 DOI: 10.1183/16000617.0374-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/27/2021] [Indexed: 01/19/2023] Open
Abstract
Waterpipe smoking is an old form of tobacco smoking, originating in Persia and the Middle East. The popularity of the waterpipe is increasing worldwide, particularly among young adults, and there are widespread misconceptions regarding its negative health effects. The inhaled smoke of the waterpipe contain several toxic and hazardous materials including nicotine, tar, polyaromatic hydrocarbons and heavy metals, all of which are proven to be related to lung diseases and cancer. Regular waterpipe smoking is associated with respiratory symptoms, a decrease in pulmonary function and increased risk for lung disease such as COPD. Additional negative health effects include increased risk for arterial stiffness, ischaemic heart disease and several cancer types including lung cancer. This review summarises the negative health effects of waterpipe smoking, with emphasis on cardiorespiratory complications. Increased awareness and knowledge amongst healthcare professionals will hopefully help identify waterpipe smokers and promote patient education. Applying World Health Organization (WHO) regulations will provide a synergistic effect in reducing waterpipe use and associated disease.
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Affiliation(s)
- Fares Darawshy
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ayman Abu Rmeileh
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rottem Kuint
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Neville Berkman
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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