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Le NT, Phan CV, Pham YTH, Le PH, Dao HV, Nguyen LC, Yuan JM, Luu HN. Waterpipe Tobacco Smoking and Risk of Cancer Mortality. JAMA Oncol 2024:2821031. [PMID: 38990578 PMCID: PMC11240226 DOI: 10.1001/jamaoncol.2024.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 07/12/2024]
Abstract
Importance There has been an increasing trend of using noncigarette products, including waterpipe tobacco (WTP), worldwide. While cigarette smoking is a well-established risk factor for numerous cancers, little is known about the association between WTP smoking and cancer mortality. Objective To assess the association between WTP smoking and risk of cancer mortality in Vietnam. Design, Setting, and Participants This cohort study was based on data from the Hanoi Prospective Cohort Study, an ongoing study with a median (range) follow-up of 11.0 (0.1-11.6) years for participants aged 15 years or older in Northern Vietnam from 2007 through 2019. Data were analyzed from June 1 to September 1, 2023. Exposures Tobacco smoking and WTP smoking statuses. Main Outcomes and Measures Overall and site-specific cancer mortality. Cox proportional regression models were used to calculate the hazard ratio (HR) and 95% CIs for the associations between WTP smoking alone, cigarette smoking alone, and dual WTP and cigarette smoking and the risk of cancer death. Results A total of 554 cancer deaths were identified among the 39 401 study participants (mean [SD] age, 40.4 [18.8] years; 20 616 females [52.3%]). In multivariable models, compared with never smokers, ever smokers had a significantly increased risk of cancer mortality (HR, 1.87; 95% CI, 1.48-2.35). Exclusive WTP smokers had the highest risk of cancer mortality compared with never smokers (HR, 2.66; 95% CI, 2.07-3.43). Risk of cancer mortality was higher for dual smokers of WTP and cigarettes (HR, 2.06; 95% CI, 1.53-2.76) than for exclusive cigarette smokers (HR, 1.86; 95% CI, 1.41-2.45). As most smokers (95.6% [8897 of 9312]) were male, these patterns were more apparent in male participants. Compared with never smokers, exclusive WTP smoking among males was associated with an elevated risk of death from liver cancer (HR, 3.92; 95% CI, 2.25-6.85), lung cancer (HR, 3.49; 95% CI, 2.08-5.88), nasopharyngeal carcinoma (HR, 2.79; 95% CI, 1.27-6.12), and stomach cancer (HR, 4.11; 95% CI, 2.04-8.27). For exclusive WTP smokers, the risk of cancer mortality was highest among those who smoked 11 to 15 sessions per day (HR, 3.42; 95% CI, 2.03-5.75), started smoking at age 26 to 30 years (HR, 4.01; 95% CI, 2.63-6.11), smoked for 9 to 20 years (HR, 4.04; 95% CI, 2.16-7.56), and smoked 61 to 160 sessions annually (HR, 3.68; 95% CI, 2.38-5.71). For males, the risk of cancer death was lower for those who had quit smoking for more than 10 years, compared with those who quit smoking within 1 year (HR, 0.27; 95% CI, 0.11-0.66; P for trend < .001). Conclusion and Relevance In this cohort study in Vietnam, WTP smoking alone or in combination with cigarette smoking was associated with an increased risk of cancer death due to liver cancer, lung cancer, nasopharyngeal carcinoma, and stomach cancer. A tailored program to control WTP smoking is warranted in Vietnam and low- and middle-income countries with a high prevalence of smoking and modest resources to address smoking-related issues.
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Affiliation(s)
- Ngoan Tran Le
- Institute of Research and Development, Duy Tan University, Da Nang City, Vietnam
- Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Ha Noi City, Vietnam
- Center for Health Promotion and Research, Hanoi Prospective Cohort Study, Hanoi City, Vietnam
| | - Can Van Phan
- Center for Health Promotion and Research, Hanoi Prospective Cohort Study, Hanoi City, Vietnam
- Center for Population Health Sciences, Hanoi University of Public Health, Ha Noi City, Vietnam
| | - Yen Thi-Hai Pham
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phuoc Hong Le
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hang Viet Dao
- Department of Internal Medicine, Hanoi Medical University, Ha Noi City, Vietnam
| | - Long Cong Nguyen
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Ha Noi City, Vietnam
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hung N. Luu
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wise JTF, Hein DW. N-acetyltransferase metabolism and DNA damage following exposure to 4,4'-oxydianiline in human bronchial epithelial cells. Toxicol Lett 2024; 398:65-68. [PMID: 38906436 PMCID: PMC11299505 DOI: 10.1016/j.toxlet.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024]
Abstract
Waterpipe smoking is increasingly popular and understanding how chemicals found in hookah smoke may be harmful to human bronchial epithelial cells is of great importance. 4,4'-Oxydianiline (ODA), is an aromatic amine which is present at comparatively high levels in hookah smoke. The metabolism and the subsequent toxicity of ODA in human bronchial epithelial cells remains unknown. Given that ODA is an aromatic amine, we hypothesized that ODA is N-acetylated and induces DNA damage following exposure to immortalized human bronchial epithelial cells (BEP2D cells). We measured the N-acetylation of ODA to mono-acetyl-ODA and the N-acetylation of mono-acetyl-ODA to diacetyl-ODA by BEP2D cells following separation and quantitation by high performance liquid chromatography. For ODA, the apparent KM in cells was 12.4 ± 3.7 µM with a Vmax of 0.69 ± 0.03 nmol/min/106 cells, while for mono-acetyl-ODA, the apparent KM was 111.2 ± 48.3 µM with a Vmax of 17.8 ± 5.7 nmol/min/106 cells ODA exposure for 24 h resulted in DNA damage to BEP2D cells following concentrations as low as 0.1 µM as measured by yH2Ax protein expression These results demonstrate that ODA, the most prevalent aromatic amine identified in hookah smoke, is N-acetylated and induces DNA damage in human bronchial epithelial cells.
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Affiliation(s)
- James T F Wise
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA; Wise Laboratory of Nutritional Toxicology and Metabolism, School of Nutrition and Food Sciences, Louisiana State University Agricultural Center, Baton Rouge, LA 70803, USA; School of Nutrition and Food Sciences, College of Agriculture, Louisiana State University, Baton Rouge, LA 70803, USA
| | - David W Hein
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
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Dashti H, Sundaram D. The association between nicotine stomatitis and waterpipe smoking. Tob Induc Dis 2024; 22:TID-22-118. [PMID: 38933523 PMCID: PMC11201228 DOI: 10.18332/tid/189600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/15/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Waterpipe smoking (WPS) is gaining popularity worldwide, especially in the Middle East, and significantly affects oral health. Nicotine stomatitis (NS) is an inflammatory response of the palate to the heat and chemical irritation caused by tobacco. The high temperatures of hot beverages have been found to have a synergistic effect. This study investigated the association of NS among waterpipe smokers and hot beverage drinkers. METHODS This cross-sectional study was conducted in several public locations in Kuwait. Demographic data, smoking habits, and hot beverage intake were recorded using questionnaires. An oral examination was performed with informed consent, and the occurrence of NS was recorded. Data were analyzed using IBM SPSS statistics version 28.0 (IBM Inc., Chicago, IL, USA). RESULTS Of the 211 participants, 55 subjects (26.1%) presented with NS. All the patients with NS drank hot beverages, while 37 (67.3%) patients with NS were waterpipe smokers and hot beverage drinkers. Smokers with NS smoked significantly more tobacco heads (Z= -2.606; p=0.009) and for more hours per day (Z= -2.222; p=0.026). CONCLUSIONS This study explored the association between WPS and NS in Kuwait. Waterpipe smokers and males were more likely to present with NS. Also, the number of tobacco heads and the number of hours of WPS were found to correlate with the presence of lesions. Effective strategies to reduce WPS need to be implemented. Further studies are recommended to investigate the cause-andeffect relationships.
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Affiliation(s)
- Hussain Dashti
- Department of Diagnostic Sciences, College of Dentistry, Kuwait University, Safat, Kuwait
| | - Devipriya Sundaram
- Department of Diagnostic Sciences, College of Dentistry, Kuwait University, Safat, Kuwait
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Yan YY, Ye F, Ho MH, Yeung KCY, Lee JJ. Biomarkers of Waterpipe Tobacco Smoke Exposure: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:655-662. [PMID: 38157415 DOI: 10.1093/ntr/ntad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/01/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prevalence of waterpipe tobacco smoking is increasing globally. Biomarkers of waterpipe tobacco smoke (WTS) exposure are less studied. AIMS AND METHODS To identify the types of biomarkers of WTS exposure and estimate changes in biomarker concentrations pre- to post-WTS exposure. PubMed, Embase, Web of Science, CINAHL Plus, PsycINFO, and Cochrane Library were searched for studies up to April 24, 2023. The types of biomarkers were identified. Random-effects models were used to estimate changes in biomarker concentrations pre- to post-WTS exposure. RESULTS Seventy-three studies involving 3755 participants exposed to WTS (49% male, mean age: 24.8 years) and 11 types of biomarkers of WTS exposure were identified. The biomarkers included tobacco alkaloids, expired carbon monoxide (eCO), carboxyhemoglobin (COHb), tobacco-specific nitrosamines, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), heavy metals, unmetabolized VOCs, unmetabolized PAHs, furan metabolites, and heterocyclic aromatic amines. Compared with pre-WTS exposure, eCO (breath; mean difference [MD] 27.00 ppm; 95% confidence interval [CI]: 20.91 to 33.08), COHb (blood; MD 4.30%; 95%CI: 2.57 to 6.03), COHb (breath; MD 7.14%; 95%CI: 4.96 to 9.31), nicotine (blood; MD 8.23 ng/mL; 95%CI: 6.27 to 10.19), and cotinine (urine; MD 110.40 ng/mL; 95%CI: 46.26 to 174.54) significantly increased post-WTS exposure. CONCLUSIONS Biomarkers of WTS exposure were systematically identified. The similarity between the biomarkers of WTS exposure and those of cigarette smoke and higher concentrations of some biomarkers post-WTS exposure underscore the need for further research on applying biomarkers in surveillance, interventions, and regulations to mitigate the harms of waterpipe tobacco smoking. IMPLICATIONS This study provides the first comprehensive overview of biomarkers investigated and available for assessing WTS exposure and their concentration changes in the human body. Researchers can use biomarkers such as eCO, COHb, nicotine, and cotinine to measure the health risks associated with WTS exposure and objectively evaluate the effectiveness of public health interventions aimed at reducing waterpipe tobacco smoking. Public health policymaking can also be informed through increased biomarker concentrations following WTS exposure, to implement regulations and public health education campaigns on limiting or preventing waterpipe tobacco smoking.
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Affiliation(s)
- Yong Yang Yan
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Fen Ye
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Mu-Hsing Ho
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | | | - Jung Jae Lee
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
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Maraqa B, Nazzal Z, Baker NA, Khatib H, Zeyad M, Aburayyan O. Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:164. [PMID: 38378525 PMCID: PMC10880219 DOI: 10.1186/s12909-024-05156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Waterpipe smoking (WPS) has been associated with a variety of adverse health effects, consequences, and symptoms of nicotine dependence. This study aims to determine the prevalence of WPS dependence among Palestinian university waterpipe smoking students, their normative beliefs about WPS, and their relationship to dependence. METHODS A cross-sectional study of current WPS university students at five major Palestinian universities was conducted from September to December 2022. Participants were recruited using convenient sampling, and data collection was carried out via an interviewer-administered questionnaire. We assessed students' WPS dependence using the Lebanese Waterpipe Dependence Scale. We used the Poisson regression model with robust variance to analyze factors independently associated with high WPS dependence. RESULTS The study included 746 current WPS university students. Results revealed a high prevalence of WPS dependence, with 69.4% (95%CI: 66.0-72.7%) exhibiting high dependence. Factors contributing to high WPS dependence included dual cigarette smoking (aPR: 1.18; 95%CI: 1.12-1.25), studying medical sciences (aPR: 1.13; 95%CI: 1.10-1.18), friends' approval of WPS (aPR: 1.25; 95%CI: 1.17-1.34), daily WPS frequency (aPR: 1.98; 95%CI: 1.39-2.23), spending more than 50% of daily allowance on WPS (aPR: 1.37; 95%CI: 1.10-1.64), and morning WPS sessions (aPR: 1.97; 95%CI: 1.31-2.27). The study highlighted the influence of social factors, such as peers' approval and perceived prevalence, on WPS dependence. CONCLUSIONS WPS dependence is prevalent among university students, and it is associated with morning WPS, dual smoking, and increased WPS frequency. Notably, peer and cultural factors are essential primary motivators. As a result, it is critical to incorporate WPS considerations into Palestine's antismoking health promotion program. Therefore, it is vital to incorporate WPS into the Palestinian antismoking health promotion policy, and the health education of adolescents regarding the dangers of WPS should coincide with antismoking initiatives.
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Affiliation(s)
- Beesan Maraqa
- Department of Medicine, Faculty of Medicine, Hebron University, Hebron, Palestine
- Primary HealthCare, Ministry of Health, Hebron, Palestine
| | - Zaher Nazzal
- Community Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Noor Abu Baker
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Heyam Khatib
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Marwa Zeyad
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Omar Aburayyan
- Department of Medicine, Faculty of Medicine and Health Sciences, Al-Quds University, Al-Quds, Palestine
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Chami HA, Diab M, Zaouk N, Arnaout S, Mitchell GF, Isma'eel H, Shihadeh A. Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use. Chest 2023; 164:1481-1491. [PMID: 37541338 DOI: 10.1016/j.chest.2023.07.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants. RESEARCH QUESTION Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults? STUDY DESIGN AND METHODS We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48% female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vs before exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression. RESULTS Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13 mm Hg [95% CI, 1.91-6.36 mm Hg]; aortic systolic BP by 2.31 mm Hg [95% CI, 0.28-4.33 mm Hg]; brachial diastolic BP by 3.69 mm Hg [95% CI, 1.62-5.77 mm Hg]; aortic diastolic BP by 3.03 mm Hg [95% CI, 0.74-5.33 mm Hg]; and HR by 7.75 beats/min [95% CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02% vs 3.06%; P = .03), including after adjusting for BMI and family history of cardiovascular disease (β = 6.12; 95% CI, 0.55-11.69; P = .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day × water-pipe use duration) in water-pipe-years (β = 2.51/water-pipe-year; 95% CI, 0.10-4.92/water-pipe-year; P = .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS. INTERPRETATION In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.
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Affiliation(s)
- Hassan A Chami
- School of Medicine, Johns Hopkins University, Baltimore, MD; School of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Maya Diab
- University of Michigan, Ann Arbor, MI
| | - Nour Zaouk
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samir Arnaout
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Alan Shihadeh
- School of Engineering, American University of Beirut, Beirut, Lebanon
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Ngahane BHM, Magouanet T, Bitchong EC, Endale LM, Barche B, Budzi MN, Mbele OC, Assob JC. Prevalence, knowledge and factors associated with shisha smoking among university students in Cameroon. Int J Tuberc Lung Dis 2023; 27:606-611. [PMID: 37491753 PMCID: PMC10365552 DOI: 10.5588/ijtld.22.0683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: Young adults consider shisha (water-pipe) less harmful than other smoking methods, but it has been reported to expose its users to excess levels of tobacco. This study sought to determine the prevalence, knowledge and factors associated with shisha use among university students in Buea, Cameroon.METHODS: Consenting participants were included in a cross-sectional study. Knowledge was assessed using a knowledge summary score and logistic regression used to identify factors associated with shisha smoking. P < 0.05 was considered statistically significant.RESULTS: There were 1,008 student participants; 509 (50.9%) were female. The mean age was 22.9 ± 3.1 years. The prevalence of shisha smoking was 26% (95% CI 23.3-28.8). Most respondents had good knowledge about shisha (59.2%). Poor knowledge about shisha (adjusted odds ratio [aOR] 2.37, 95% CI 1.57-3.59)], living in a hostel (aOR 2.00, 95% CI 1.29-3.11), friends' use of shisha (aOR 5.41, 95% CI 3.03-10.43) and alcohol consumption (aOR 1.91, 95% CI 1.24-2.94) were associated with shisha smoking.CONCLUSION: The prevalence of shisha smoking among university students in Buea is high; about one-quarter of the students have poor knowledge about its harmful health effects. There is an increasing need for sensitisation of these young adults to the harmful effects of tobacco smoking.
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Affiliation(s)
- B H Mbatchou Ngahane
- Internal Medicine Department, Douala General Hospital, Douala, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Environmental and Lung Health Association, Douala
| | - T Magouanet
- Faculty of Health Sciences, University of Buea, Buea
| | - E C Bitchong
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Jamot Hospital, Yaounde
| | - L M Endale
- Faculty of Health Sciences, University of Buea, Buea, Hôpital Laquintinie, Douala, Cameroon
| | - B Barche
- Hôpital Laquintinie, Douala, Cameroon
| | - M N Budzi
- Faculty of Health Sciences, University of Buea, Buea
| | - O C Mbele
- Internal Medicine Department, Douala General Hospital, Douala, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala
| | - J C Assob
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala
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Cetkovic Pecar T, Haveric A, Caluk Klacar L, Haveric S, Dzaferspahic A, Mehanovic M, Durmisevic I, Dzaferspahic S, Hadzic Omanovic M. Genotoxicity of waterpipe smoking in young adults from Sarajevo, Bosnia & Herzegovina. Heliyon 2023; 9:e17073. [PMID: 37332975 PMCID: PMC10276226 DOI: 10.1016/j.heliyon.2023.e17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Background Waterpipe, also known as a hookah or narghile, is a type of tobacco products consumption device. Recently it has been increasingly popular in Bosnia and Herzegovina and the region. Waterpipe consumers are predominantly adolescents and young adults. Many of them believe in slighter harmful effects of waterpipes, compared to cigarettes. We aimed to determine the DNA damage in oral leukocytes and buccal cells of young individuals who have smoked a waterpipe for more than one year. Methods The study group consisted of 40 cigarette non-smokers who regularly smoked a waterpipe on average of once per week. As a control, 40 non-smoking individuals were selected to match smokers for age. All participants in the study were healthy male and female adults from Bosnia and Herzegovina, 18-30 years of age. Before sampling, detailed survey and informed consent have been provided by each participant. Comet assay in oral leukocytes and buccal micronucleus cytome (BMCyt) assay in exfoliated buccal cells were applied. Results Almost half of waterpipe smokers (WPS) tasted waterpipe at 15-16 years of age. Comet assay analysis showed increased tail intensity, tail length, and tail moment values among WPS compared to non-smokers (NS) (p = 0.0001, p = 0.0067, and p = 0.0001, respectively). Frequencies of the micronucleated (p = 0.0004), binucleated (p = 0.01), karyorrhectic, (p = 0.0036), and pycnotic cells (p = 0.03) were significantly higher in WPS compared to NS group. Conclusions Genotoxicity and DNA damage biomarkers were increased in oral leukocytes and exfoliated buccal cells of young waterpipe smokers from Bosnia and Herzegovina, compared to NS group.
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Affiliation(s)
- Tamara Cetkovic Pecar
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Anja Haveric
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Lejla Caluk Klacar
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Sanin Haveric
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Alen Dzaferspahic
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Mahira Mehanovic
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Irma Durmisevic
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Selma Dzaferspahic
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
| | - Maida Hadzic Omanovic
- University of Sarajevo, Institute for Genetic Engineering and Biotechnology, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
- Genetic Association in Bosnia and Herzegovina, Zmaja Od Bosne 8, Sarajevo, 71000, Bosnia and Herzegovina
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Chami HA, Zaouk N, Makki M, Tamim H, Shaya M, Talih F. Varenicline Treatment for Waterpipe Smoking Cessation. Nicotine Tob Res 2023; 25:111-119. [PMID: 35789389 DOI: 10.1093/ntr/ntac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Waterpipe smoking is increasing worldwide with no proven interventions for cessation. We compared abstinence rates with 12-week varenicline therapy versus placebo among habitual waterpipe smokers willing to quit. METHODS This double-blind placebo-controlled single-center trial, randomized waterpipe smokers from Lebanon who did not smoke other tobacco products to receive varenicline or placebo for 12 weeks. All participants also received three structured 30-minute individual behavioral intervention sessions. The primary outcome was repeated point prevalence abstinence assessed by self-report and verified by exhaled carbon monoxide three times during 12 weeks and analyzed with the intention to treat. End of treatment urine cotinine, weight, blood pressure, anxiety, depression, withdrawal, and adverse symptoms were also assessed. RESULTS In total, 152 waterpipe smokers (mean age 38 years [SD = 13], 39% females) willing to quit, who smoked waterpipe exclusively (average 2.3 per day [SD = 1.6] for 16.8 years [SD = 10.8]) were randomized. Seventy-nine participants (52%) with any missing abstinence assessment were considered to have relapsed. Repeat point prevalence abstinence rate was numerically higher among the varenicline group compared to placebo, but the difference did not reach statistical significance when assessed by self-report (16.9 vs. 13.6%, respectively, p = .6) and when further verified by exhaled carbon monoxide (14.1% vs. 9.9%, respectively, p = .4). Abstinence rates were similar in both groups when further verified by urine cotinine at end of treatment. No serious adverse events were reported, adverse symptoms and other outcomes were similar in the varenicline and placebo arms. CONCLUSIONS Varenicline for 12 weeks was not more effective than placebo to achieve abstinence among daily waterpipe smokers. IMPLICATIONS Varenicline in combination with a behavioral intervention did not significantly enhance the quit rate among exclusive waterpipe smokers compared to behavioral intervention plus placebo. We experienced difficulty enrolling exclusive waterpipe smokers willing to quit and observed high dropout rates among participants demonstrating the difficulties of waterpipe smoking cessation.
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Affiliation(s)
- Hassan A Chami
- School of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nour Zaouk
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Monique Shaya
- School of Public Health, American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- School of Medicine, American University of Beirut, Beirut, Lebanon
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10
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Discussion of waterpipe tobacco smoking on reddit. Heliyon 2022; 8:e10635. [PMID: 36177232 PMCID: PMC9513777 DOI: 10.1016/j.heliyon.2022.e10635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aimed to examine public discussions of waterpipe tobacco smoking, as well as the potential associations of different waterpipe flavors with health symptoms, using Reddit data. Study design This is an observational infodemiology study. Methods Using keywords such as “waterpipe”, “hookah”, and “shisha”, Reddit posts were extracted from Reddit Archive (pushshift.io) between February 1, 2016, and December 31, 2020. Temporal analysis was used to understand the longitudinal trend of the discussions about waterpipe tobacco smoking. Topic modeling using the Latent Dirichlet Allocation (LDA) model was performed to examine the topics on waterpipe tobacco. We estimated the conditional probability of having each health problem for each given waterpipe flavor. Results The discussion of waterpipe on Reddit was slowly decreasing from 2016 to 2018 and surged until May 2020. The fruit was the most popular waterpipe flavor and the neurological symptom was the most mentioned health category in waterpipe-related Reddit posts. The most popular topics included “Friends spending time together at night with waterpipe smoking”, “Playing games and smoking waterpipe at a hookah bar”, and “Discussing waterpipe flavors and related products”. Some waterpipe flavors were more associated with certain health problems than others. For example, mint/menthol flavor had a high probability to be associated with symptoms related to throat and mouth. Conclusion This study provided longitudinal surveillance of waterpipe tobacco smoking discussed on Reddit. We showed the potential relationship between waterpipe flavors and health symptoms, which provides preliminary evidence about the potential health effects of waterpipe tobacco smoking.
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11
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Kraus L, Möckl J, Lochbühler K, Rauschert C, Seitz NN, Olderbak S. Changes in the Use of Tobacco, Alternative Tobacco Products, and Tobacco Alternatives in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:535-541. [PMID: 36384922 PMCID: PMC9677538 DOI: 10.3238/arztebl.m2022.0252] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Due to the increasing use of alternative tobacco products (waterpipes, heat-not-burn) and tobacco alternatives (e-cigarettes), we studied recent changes in the prevalence of conventional tobacco use and alternative products. METHODS Data come from ten waves of the Epidemiological Survey of Substance Abuse (ESA) from 1995 to 2021, with representative samples collected via paperpencil questionnaires, telephone interviews, or online. We compared the prevalence of conventional tobacco use and alternative products by gender and age (18-24, 25-39, 40-59 years). RESULTS In all age groups, the use of conventional tobacco products decreased. The prevalence of the exclusive use of one of the three alternative products differed statistically significantly between age groups and in 2021 was higher for ages 18-24 (females: 11.1%, males: 12.4%) compared to ages 25-39 (females: 2.9%; males: 4.9%) and ages 40-59 (females: 1.4%; males: 2.0%). The use of alternative products was mainly due to the exclusive use of waterpipes among individuals aged 18 to 24 and 25 to 39 and the exclusive use of e-cigarettes among individuals aged 40 to 59. CONCLUSION The higher prevalence of alternative product use among young adults implies a turning point that needs to be considered in prevention. Because of the addictive potential of these products, young adults can be expected to maintain their use into middle and older adulthood. There is a need to monitor the use of alternative products, identify the risks associated with them, and develop effective prevention and cessation interventions for adults.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany,Department of Public Health Sciences, Stockholm University, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,*IFT Institut für Therapieforschung Leopoldstr. 175, 80804 Munich, Germany
| | - Justin Möckl
- IFT Institut für Therapieforschung, Munich, Germany
| | | | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich, Germany,Psychology Department, University of Arizona, Tucson, USA
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12
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Gautam P, Sharma E, Ebrahimi Kalan M, Li W, Ward KD, Sutherland MT, Cano MA, Li T, Maziak W. 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. Nicotine Tob Res 2022; 24:1281-1290. [PMID: 35196383 DOI: 10.1093/ntr/ntac051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Prem Gautam
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, 20850, USA
| | - Mohammad Ebrahimi Kalan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Wei Li
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, Aleppo, P.O.Box: 16542, Syria.,School of Public Health, University of Memphis, 3720 Alumni Ave, Memphis, TN 38152, USA
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11101 S.W. 13 ST., Miami, FL 33199, USA
| | - Miguel Angel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St AHC5, 4th Floor, Miami, FL, 33199, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA.,Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, Aleppo, P.O.Box: 16542, Syria
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13
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Jalili S, Naderi NJ. Comparison of Repair Index in Cigarette and Waterpipe Smokers: A Bio-Monitoring Assessment Using Human Exfoliated Buccal Mucosa Cells. Int J Prev Med 2022; 13:27. [PMID: 35392320 PMCID: PMC8980829 DOI: 10.4103/ijpvm.ijpvm_10_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Repair index (RI) using DNA changes reveals the activity of carcinogenesis. Cigarette and waterpipe smoking are important contributors to oral cavity malignancy. The RI in cigarette and waterpipe smokers has not been compared so far. The aim of this study was to compare the RI in cigarette and waterpipe smokers using the human exfoliated buccal mucosa cells. METHODS The exfoliated buccal mucosa cells of 60 cigarette and waterpipe smokers and 20 nonsmokers were evaluated in a case-control study. The number of micronuclei (MN), broken egg (BE), karyorrhexis (KR), and karyolysis (KL) were counted in 1000 cells from randomly selected fields. The RI = (KL + KR)/(MN + BE) was calculated and compared between subjects and controls. Data were analyzed by one-way analysis of variance (ANOVA), Tukey's Honest Significant Difference (HSD), and Spearman's correlation coefficient test at P < 0.05 probability level. RESULTS The difference of MN (P < 0.0001), BE (P < 0.0001), KR (P < 0.0001), and KL (P < 0.0001) count was significant between cigarette smokers, waterpipe smokers, and nonsmokers. The RI was significantly different between groups (P = 0.007). The RI was significantly higher in cigarette smokers compared to waterpipe smokers (P = 0.04) and nonsmokers (P = 0.009). CONCLUSIONS The RI was significantly higher in cigarette smokers compared to waterpipe smokers. The finding suggests that due to higher interrupted cellular hemostasis, the risk of carcinoma in waterpipe smokers can be greater than that in cigarette smokers.
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Affiliation(s)
- Sana Jalili
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Shahed University, Tehran, Iran
| | - Noushin Jalayer Naderi
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Shahed University, Tehran, Iran,Address for correspondence: Drs. Noushin Jalayer Naderi, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Shahed University, Tehran, Iran. E-mail:
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14
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Alarabi AB, Lozano PA, Khasawneh FT, Alshbool FZ. The effect of emerging tobacco related products and their toxic constituents on thrombosis. Life Sci 2022; 290:120255. [PMID: 34953893 PMCID: PMC9118784 DOI: 10.1016/j.lfs.2021.120255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
Although conventional cigarette smoking is declining, emerging tobacco related products (ETRPs) are currently gaining ground, especially among the youth. These products include electronic cigarettes, waterpipes/hookah, cigars/cigarillo, smokeless tobacco, and heat-not-burn cigarettes. The observed increase in the use of ETRPs is multifactorial and complex but appears to be mainly driven by efforts from the major tobacco companies to reinvent themselves, and present more appealing and allegedly safe(r) tobacco products. However, it is becoming apparent that these products produce substantial amounts of toxic chemicals, many of which have been shown to exert negative health effects, including in the context of the cardiovascular system. Thus, there has been research efforts, albeit limited in general, to characterize the health impact of these products on occlusive/thrombotic cardiovascular diseases (CVD). In this review, we will discuss the potential impact of ETRPs on thrombosis-based CVD. Specifically, we will review how these products and the major chemicals they produce and/or emit can trigger key players in the process of thrombosis, namely inflammation, oxidative stress, platelets, coagulation, and the vascular endothelium, and the relationship between these effects.
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Affiliation(s)
- Ahmed B Alarabi
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Patricia A Lozano
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Fadi T Khasawneh
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
| | - Fatima Z Alshbool
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
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15
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Nimma V, Lingam AS, Gaffar AS, Kadam S, Ramaswami E, Ramchandani A. Perception and assumptions of young waterpipe smokers in Mumbai, India. Ann Afr Med 2022; 21:410-414. [PMID: 36412343 PMCID: PMC9850880 DOI: 10.4103/aam.aam_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hookah smoking has been on raise all over the world, including India, especially among youngsters. There is growing evidence suggesting the high school children experimenting this form of tobacco. Objective The objective of this study was to investigate the characteristics, behavior, and perceptions related to hookah smoking among the hookah smokers in Mumbai. Materials and Methods A cross-sectional survey was conducted among 200 randomly selected young adults between the age group of 15-35 years in Mumbai who visited different dental clinics. The questionnaire was distributed as Google Forms online in the month of November and December 2019 and those who submitted completed responses were included in the study. Results Only 114 participants returned with the completed forms in the time period of 2 months. The results showed that the majority of participants were between 20 and 24 age, comprising 58% who were having the habit of hookah smoking. Among which 24% females, 76% males had history of hookah habit. Eight percent of males started smoking hookah from very young age. Males (29.89%) shared one hookah pot with four members. Forty percent of the participants stated that they are interested to smoke again because of hookah flavor. Conclusion Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among youngsters. Most products are being sold without any warnings, and there is no means to control the selling of the products to minors. Educational intervention is urgently needed to create awareness among youth about the harmful effects of hookah smoking.
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Affiliation(s)
- Vijayalaxmi Nimma
- Department of Oral Medicine and Radiology, Government Dental College, Mumbai, Maharashtra, India
| | - Amara Swapna Lingam
- Department of Surgical and Diagnostic Sciences, Dar Al Uloom College of Dentistry, Riyadh, Saudi Arabia,Address for correspondence: Dr. Amara Swapna Lingam, Department of Surgical and Diagnostic Sciences, Dar al Uloom University, Riyadh, Saudi Arabia. E-mail:
| | - Aibani Saddik Gaffar
- Department of Oral Medicine and Radiology, Government Dental College, Mumbai, Maharashtra, India
| | - Sonali Kadam
- Department of Oral Medicine and Radiology, Government Dental College, Mumbai, Maharashtra, India
| | - Easwaran Ramaswami
- Department of Oral Medicine and Radiology, Government Dental College, Mumbai, Maharashtra, India
| | - Amit Ramchandani
- Department of Oral Medicine and Radiology, Government Dental College, Mumbai, Maharashtra, India
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16
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Piyankarage SC, McGahee E, Feng J, Blount BC, Wang L. Automated Solid Phase Extraction and Polarity-Switching Tandem Mass Spectrometry Technique for High Throughput Analysis of Urine Biomarkers for 14 Tobacco-related Compounds. ACS OMEGA 2021; 6:30901-30909. [PMID: 34841133 PMCID: PMC8613820 DOI: 10.1021/acsomega.1c02543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/28/2021] [Indexed: 05/03/2023]
Abstract
Tobacco use is the leading preventable cause of premature disease and death in the United States. Approximately, 34 million U.S. adults currently smoke cigarettes. We developed a method for automated sample preparation and liquid chromatography-tandem mass spectrometry quantitation of 14 tobacco-related analytes: nicotine (NICF), cotinine (COTF), trans-3'-hydroxycotinine (HCTF), menthol glucuronide (MEG), anabasine (ANBF), anatabine (ANTF), isonicoteine (ISNT), myosmine (MYOS), beta-nicotyrine (BNTR), bupropion (BUPR), cytisine (CYTI), varenicline (VARE), arecaidine (ARD), and arecoline (ARL). The method includes automated solid-phase extraction using customized positive-pressure functions. The preparation scheme has the capacity to process a batch of 96 samples within 4 h with greater than 88% recovery for all analytes. The 14 analytes, separated within 4.15 min using reversed-phase liquid chromatography, were determined using a triple-quadrupole mass spectrometer with atmospheric-pressure chemical ionization and multiple reaction monitoring in negative and positive ionization modes. Wide quantitation ranges, within 1.2-72,000 ng/mL, were established especially for COTF, HCTF, MEG, and NICF to quantify the broad range of biomarker concentrations found in the U.S. population. The method accuracy is above 90% while the overall imprecision is below 7%. Finally, we tested urine samples from 90 smokers and observed detection rates of over 98% for six analytes with urinary HCTF and MEG concentrations ranging from 200-14,100 and 60-57,100 ng/mL, respectively. This high throughput analytical process can prepare and analyze a sample in 9 min and along with the 14-compound analyte panel can be useful for tobacco-exposure studies, in smoking-cessation programs, and for detecting changes in exposure related to tobacco products and their use.
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17
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Xiong Y, Xi S, Gara SK, Shan J, Gao J, Zhang M, Shukla V, Wang R, Hoang CD, Chen H, Schrump DS. Hookah Smoke Mediates Cancer-Associated Epigenomic and Transcriptomic Signatures in Human Respiratory Epithelial Cells. JTO Clin Res Rep 2021; 2:100181. [PMID: 34790904 PMCID: PMC8479631 DOI: 10.1016/j.jtocrr.2021.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Although communal smoking of hookah by means of water pipes is perceived to be a safe alternative to cigarette smoking, the effects of hookah smoke in respiratory epithelia have not been well characterized. This study evaluated epigenomic and transcriptomic effects of hookah smoke relative to cigarette smoke in human respiratory epithelial cells. Methods Primary normal human small airway epithelial cells from three donors and cdk4 and hTERT-immortalized small airway epithelial cells and human bronchial epithelial cells were cultured for 5 days in normal media with or without cigarette smoke condensates (CSCs) or water pipe condensates (WPCs). Cell count, immunoblot, RNA sequencing, quantitative real-time reverse-transcriptase polymerase chain reaction, methylation-specific polymerase chain reaction, and quantitative chromatin immunoprecipitation techniques were used to compare effects of hookah and cigarette smoke on cell proliferation, global histone marks, gene expression, and promoter-related chromatin structure. Results CSC and WPC decreased global H4K16ac and H4K20me3 histone marks and mediated distinct and overlapping cancer-associated transcriptome signatures and pathway modulations that were cell line dependent and stratified across lung cancer cells in a histology-specific manner. Epiregulin encoding a master regulator of EGFR signaling that is overexpressed in lung cancers was up-regulated, whereas FILIP1L and ABI3BP encoding mediators of senescence that are repressed in lung cancers were down-regulated by CSC and WPC. Induction of epiregulin and repression of FILIP1L and ABI3BP by these condensates coincided with unique epigenetic alterations within the respective promoters. Conclusions These findings support translational studies to ascertain if hookah-mediated epigenomic and transcriptomic alterations in cultured respiratory epithelia are detectable and clinically relevant in hookah smokers.
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Affiliation(s)
- Yin Xiong
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sichuan Xi
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sudheer Kumar Gara
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jigui Shan
- The Biomedical Informatics and Data Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - James Gao
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Mary Zhang
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Vivek Shukla
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Ruihong Wang
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Chuong D Hoang
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Haobin Chen
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - David S Schrump
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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18
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Almogbel YS, Aladhadh T, Alammar A, Aloraini A, Alghofaili S, Almutairi A, AlAmri A. Predictors of waterpipe smoking among university students in the Qassim region, Saudi Arabia. Tob Induc Dis 2021; 19:67. [PMID: 34531711 PMCID: PMC8404266 DOI: 10.18332/tid/140092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/30/2021] [Accepted: 07/08/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Waterpipe smoking has gained global popularity among adolescents and young adults. This study aimed to identify the predictors of waterpipe smoking among university students in the Qassim region of Saudi Arabia. METHODS A cross-sectional study was conducted using a pre-tested, validated, and self-administered questionnaire to identify the predictors of waterpipe smoking among university students aged >18 years in the Qassim region. RESULTS Of the 1158 questionnaires distributed, 928 were returned with complete responses. Of these 928 participants, 820 were men (88.7%) and the majority were unmarried (95.6%). The risk of waterpipe smoking was significantly higher in students aged >26 years (OR=3.39; 95% CI: 1.30– 8.80), those who had a brother who smoked (OR=1.78; 95% CI: 1.13–2.79), and those who were married (OR=3.21; 95% CI: 1.36–7.59). Furthermore, participants who had smoked cigarettes (OR=3.18; 95% CI: 1.89–5.34) or other tobacco products (OR=6.39; 95% CI: 3.69–11.07) within the past 30 days, and students who believed that waterpipe smoking was less harmful than cigarette smoking (OR=2.61; 95% CI: 1.54–4.41) had a higher risk of engaging in waterpipe smoking. However, the risk was lower among students receiving a monthly financial aid of more than US$264 (OR=0.34; 95% CI: 0.13–0.89). CONCLUSIONS This study revealed that higher age, being male, being married, low student financial aid, waterpipe smoker sibling, cigarette and other types of tobacco smoking in the past 30 days, and believing waterpipe smoking to be less harmful than cigarette smoking, were significant predictors of waterpipe smoking. Educational programs targeted at improving awareness of the adverse effects of waterpipe smoking should be considered for early prevention in young adults.
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Affiliation(s)
- Yasser S Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Thara Aladhadh
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Atheer Alammar
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - Atheer Aloraini
- Saudi Pharmaceutical Industries and Medical Appliances Corporation, Buraidah, Saudi Arabia
| | - Sumayyah Alghofaili
- The Pharmacy Department, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | - Abdullah Almutairi
- Department of Periodontology and Oral Medicine, College of Dentistry, Qassim University, Buraidah, Saudi Arabia
| | - Abdulrahman AlAmri
- Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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19
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Chami HA, Isma'eel H, Mitchel GF, Tamim H, Makki M, Berbari A, Al Mulla A. The association of waterpipe smoking with arterial stiffness and wave reflection in a community-based sample. Blood Press 2021; 30:300-309. [PMID: 34236258 DOI: 10.1080/08037051.2021.1947778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The evidence linking waterpipe smoking to cardiovascular disease is limited. We evaluated the association of waterpipe smoking (WPS) with arterial stiffness and wave reflection measured by augmentation pressure (AP), augmentation index (AIx), and carotid-femoral pulse wave velocity (CFPWV), which are validated predictors of cardiovascular disease. MATERIALS AND METHODS Community-based, cross-sectional study including 205 exclusive waterpipe smokers and 199 matched never-smokers aged 35 years or older (mean age 51.7 ± 8.9 years, 36% females). Smoking and its extent were assessed using a validated questionnaire and urine cotinine levels. CFPWV, AP, AIx (AP/aortic pulse pressure) and heart rate adjusted AIx (AIx@75) were determined using tonometry and compared between smokers and non-smokers, and the association of WPS with tonometry measures was assessed using linear regression adjusting for possible confounders. RESULTS Waterpipe smokers and non-smokers had similar mean age and sex distribution. Compared to non-smokers, waterpipe smokers had significantly higher adjusted AP (10.5 ± 3.9 vs. 9.4 ± 3.9 mmHg respectively; p = 0.01), AIx (28.1 ± 8.4 vs. 25.7 ± 8.5% respectively; p = 0.01) and AIx@75 (24.2 ± 8.7 vs. 21.8 ± 8.9% respectively; p = 0.01). AIx was significantly associated with WPS extent, measured by a number of waterpipe smoked/day (β = 1.04/waterpipe, 95%CI:[0.50-1.58]), duration of waterpipe smoking (β = 0.77/10-years, 95%CI:[0.16-1.38]), their products in waterpipe-years (β = 0.30/10-waterpipe-year, 95%CI:[0.12-0.47]) and plasma cotinine (β = 0.56/100 ng/ml, 95%CI:[0.14-0.98]), adjusting for possible confounders, and so were AP and AIx@75. CFPWV however, was not associated with waterpipe smoking. CONCLUSION In a community-based sample, exclusive WPS and its extent were associated with a dose-dependent increase in AIx and AP, accounting for other risk factors, suggesting that waterpipe smokers are at increased risk of cardiovascular disease.
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Affiliation(s)
- Hassan A Chami
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Hani Tamim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Adel Berbari
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmad Al Mulla
- Tobacco Control Center-WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Al-Delaimy AK, Al-Ani WAT. Prevalence of hookah smoking and associated factors among male high school students in Iraq. BMC Public Health 2021; 21:1317. [PMID: 34225683 PMCID: PMC8256481 DOI: 10.1186/s12889-021-11386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of the hookah-smoking device is increasing at a large scale in the Eastern Mediterranean region. Hookah users are exposed to an array of chemical compounds and may suffer several chronic diseases as a result. The purpose of this study was to determine the prevalence of hookah use among male high school students in the region and to study different associated factors in order to provide local tobacco control officials with an understanding of this public health problem. METHODS A convenient non-probability sampling study was conducted among students in three high schools in Al-Karkh district, Baghdad. The study period was from October 2017 till January 2019 and included 847 male students aged 15-18 years old. Using a simple random technique to select the high schools from a list of schools we chose one school from each directorate. Descriptive, chi-square test of significance, bivariate, and multivariate logistic regression analyses of data were carried out for identifying the risk factors associated with hookah smoking among these high school adolescent males. RESULTS The overall prevalence of hookah smoking in the last 30 days among male high school students was 46.1% while in the past 6 months it was as high as 85.7%. More than two-thirds (70.6%) of the students thought that hookah smoking was more socially acceptable than cigarette smoking. Factors such as having first heard about it from friends, the media, or the presence of a hookah café near their residence were significantly associated (p > 0.05) with hookah smoking among the students. Similarly, being surrounded by friends who used hookah was also found to be significantly associated with hookah smoking, with an odds ratio of 0.18, 95% CI (0.087-0.394). Hookah smokers were less likely than non-hookah smokers to report its use as forbidden in Islam and more likely to say it is allowed in Islam. CONCLUSIONS We found an alarmingly high use of hookah smoking among male high school students in this study. Family members and peers had an important role in the prevention of hookah smoking among these students. There is a need for students to be educated about the toxicity of hookah tobacco smoking and its direct effect on their health.
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Affiliation(s)
- Ahmed K Al-Delaimy
- Family & Community Medicine Department / Anbar Medical College, University of Anbar, Ramadi, Iraq.
| | - Waleed A T Al-Ani
- Family & Community Medicine Department Al-Mustansiriya Medical College, University of Al-Mustansiriya, Baghdad, Iraq
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21
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Stroup AM, Branstetter SA. Comparing Immediate Physiological Responses and Future Intentions of Use between Combustible and Electronic Waterpipe Users. Addict Behav 2021; 115:106741. [PMID: 33387978 DOI: 10.1016/j.addbeh.2020.106741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/28/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
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Erythropel HC, Garcia Torres DS, Woodrow JG, de Winter TM, Falinski MM, Anastas PT, O’Malley SS, Krishnan-Sarin S, Zimmerman JB. Quantification of Flavorants and Nicotine in Waterpipe Tobacco and Mainstream Smoke and Comparison to E-cigarette Aerosol. Nicotine Tob Res 2021; 23:600-604. [PMID: 32598451 PMCID: PMC7885788 DOI: 10.1093/ntr/ntaa114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Waterpipe use remains popular among youth with the availability of flavored shisha tobacco being one of the main drivers of waterpipe use. Although waterpipe mainstream toxicant emissions are well understood, less is known about the carryover of flavorants such as vanillin, benzaldehyde, and eugenol. In this study, flavored waterpipe tobacco was analyzed for flavorants and nicotine, and subsequent carryover to mainstream smoke. METHODS Flavorants vanillin, benzaldehyde, and eugenol, and nicotine were quantified in vanilla-, cherry-, and cinnamon-flavored shisha tobacco by gas chromatography/flame ionization detector and subsequently in waterpipe mainstream smoke generated by a smoking machine. The setup allowed for sampling before and after the water-filtration step. RESULTS Flavorant and nicotine content in smoke was reduced 3- to 10-fold and 1.4- to 3.1-fold, respectively, due to water filtration. Per-puff content of filtered waterpipe mainstream smoke ranged from 13 to 46 µg/puff for nicotine and from 6 to 55 µg/puff for flavorants. CONCLUSIONS Although water filtration reduced flavor and nicotine content in waterpipe mainstream smoke, the detected flavorant concentrations were similar or higher to those previously reported in e-cigarette aerosol. Therefore, users could be drawn to waterpipes due to similar flavor appeal as popular e-cigarette products. Absolute nicotine content of waterpipe smoke was lower than in e-cigarette aerosol, but the differential use patterns of waterpipe (>100 puffs/session) and e-cigarette (mostly <10 puffs/session, multiple session throughout the day) probably result in higher flavorant and nicotine exposure during a waterpipe session. Strategies to reduce youth introduction and exposure to nicotine via waterpipe use may consider similar flavor restrictions as those for e-cigarettes. IMPLICATIONS Although waterpipe mainstream smoke is well characterized for toxicants content, little is known about carryover of molecules relevant for appeal and addiction: flavorants and nicotine. This study shows that flavorant content of waterpipe mainstream smoke is comparable or higher than e-cigarette aerosol flavorant content. Regulatory action to address tobacco use behaviors targeting the availability of flavors should also include other tobacco products such as flavored shisha tobacco.
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Affiliation(s)
- Hanno C Erythropel
- Yale Tobacco Center of Regulatory Science (TCORS), Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | | | | | - Tamara M de Winter
- Yale Tobacco Center of Regulatory Science (TCORS), Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- School of Forestry and Environmental Studies, Yale University, New Haven, CT
| | - Mark M Falinski
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | - Paul T Anastas
- School of Forestry and Environmental Studies, Yale University, New Haven, CT
- School of Public Health, Yale University School of Medicine, New Haven, CT
| | - Stephanie S O’Malley
- Yale Tobacco Center of Regulatory Science (TCORS), Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Suchitra Krishnan-Sarin
- Yale Tobacco Center of Regulatory Science (TCORS), Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Julie B Zimmerman
- Yale Tobacco Center of Regulatory Science (TCORS), Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
- School of Forestry and Environmental Studies, Yale University, New Haven, CT
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Damiri B, Safarini OA, Nazzal Z, Abuhassan A, Farhoud A, Ghanim N, Al Ali R, Suhail M, Qino M, Zamareh M, Thabaleh A, Zahran J. Eating Disorders and the Use of Cognitive Enhancers and Psychostimulants Among University Students: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2021; 17:1633-1645. [PMID: 34079261 PMCID: PMC8164711 DOI: 10.2147/ndt.s308598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU). METHODS In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests. RESULTS The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value<0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value<0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059). CONCLUSION Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help.
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Affiliation(s)
- Basma Damiri
- Medicine & Health Sciences Faculty, Drug, and Toxicology Division, An-Najah National University, Nablus, 00970, Palestine
| | - Omar A Safarini
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Zaher Nazzal
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Ahmad Abuhassan
- An-Najah National University Hospital, Department of Neurology, An-Najah National University, Nablus, 00970, Palestine
| | - Ahmad Farhoud
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Nesma Ghanim
- Medicine & Health Sciences Faculty, Department of Public Health, An-Najah National University, Nablus, 00970, Palestine
| | - Rayyan Al Ali
- Medicine & Health Sciences Faculty, Forensic Medicine Institute, An-Najah National University, Nablus, 00970, Palestine
| | - Mirvat Suhail
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Mohammad Qino
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Mohammad Zamareh
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Ammar Thabaleh
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Jihad Zahran
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
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Hessami Z, Samira C, Jamaati H, Masjedi MR, Sharifi H, Aryanpur M. Water-pipe Smoking Addiction in Iran; Evaluation of Reliability and Validity of Lebanon Water-pipe Dependence Scale Among Iranian Water-pipe Tobacco Smokers. Int J Prev Med 2020; 11:196. [PMID: 33815720 PMCID: PMC8000159 DOI: 10.4103/ijpvm.ijpvm_555_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/29/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Water-pipe smoking is increasing around the world. However, there is no comprehensive information on nicotine addiction in water-pipe smokers. This study was carried out to translate and validate the Lebanon Water-pipe Dependence Scale- into Persian language; besides, tobacco dependence was evaluated in Iranian water-pipe smokers. METHODS A forward-backward translation procedure was done to provide the Iranian version of the questionnaire. Our subjects were current water-pipe smokers who were known in prevalence study that conducted in Tehran. Psychometric properties of the instrument including validity (content, face and construct validity) and reliability (internal consistency and test-retest analysis), were evaluated. RESULTS A total of 465 participants took part in this study, of whom 298 (64%) were male. The mean age was 30 (standard deviation 10.2). Fifty three percent of subjects got score more than 10 on LWDS questionnaire that indicating dependence. The internal consistency of the LWDS (Persian Version) was 0.85. The physiologic dependence, psychological craving, and negative reinforcement domains had acceptable reliability (Cronbach's alpha was 0.94, 0.81, 0.77 respectively), but reliability was low (alpha = 0.45) in the positive reinforcement domain. External consistency of the LWDS was assessed by test retest. Intra class correlation (ICC) was calculated for all items (n = 20) and ICC for all of them was >0.7 and the mean ICC was 0.9. Content validity was acceptable; all of obtained content validity indexes (CVIs) were above 80%. The result of goodness of fit shows an adequate model (Comparative Fit Index (CFI = 0.94), Root Mean Square Error of approximation (RMSE) = 0.08). CONCLUSIONS The study revealed strong documents for the reliability and validity of the LWDS for use in Iran. However, further study may be required to improve the reliability results in the positive reinforcement domain.
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Affiliation(s)
- Zahra Hessami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Chaibakhsh Samira
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
- Departments of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hooman Sharifi
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Aryanpur
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Perceptions of Waterpipe Smoking among Young Adults: A Phenomenological Study. Dent J (Basel) 2020; 8:dj8040134. [PMID: 33321834 PMCID: PMC7763057 DOI: 10.3390/dj8040134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/11/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Waterpipe tobacco smoking is becoming increasingly popular in the West among young people. Given the associated health risks of this behaviour, we aimed to investigate why young adults take up waterpipe tobacco smoking and their attitudes to the associated risks. METHODS This was a qualitative study, with a phenomenological perspective. Focus groups and face-to-face semi-structured interviews were conducted among waterpipe smokers aged 20-30 years living in London, UK. Transcripts were analysed using constant comparison and cycling between the data and analysis. Data collection continued until thematic saturation was achieved. RESULTS Sixteen smokers attended focus groups and face-to-face interviews. Seven main themes emerged encompassing four main dimensions relating to: lack of knowledge, perceived risk, affordability, and social addiction. Waterpipe was perceived to be safer than cigarette smoking due to the pleasant odour, fruity flavours, and belief that water filtered the toxins. The waterpipe had become a "social addiction" enhancing group atmosphere, was cheap and did not have the dangers of violence or hallucinations associated with other addictions like alcohol and drugs. Because of their intermittent smoking patterns and the lack of statutory warnings, none felt they were not at risk of any adverse side effects. CONCLUSIONS Waterpipe smoking is a growing public health problem; the social environment associated with its use is perceived to be a positive outlet by smokers who do not consider it harmful to their health. These perceptions need to be addressed urgently by anti-smoking policies.
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26
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Ebrahimi Kalan M, Bahelah R, Bursac Z, Ben Taleb Z, DiFranza JR, Tleis M, Nakkash R, Jebai R, Alam MM, Cano MÁ, Sutherland MT, Fenni K, Asfar T, Eissenberg T, Ward KD, Maziak W. Predictors of nicotine dependence among adolescent waterpipe and cigarette smokers: A 6-year longitudinal analysis. Drug Alcohol Depend 2020; 217:108346. [PMID: 33075692 PMCID: PMC7861130 DOI: 10.1016/j.drugalcdep.2020.108346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Identifying the factors associated with nicotine dependence (ND) is essential to prevent initiation and continued use, and to promote cessation among youth. This study aims to document the predictors of the appearance of initial ND symptoms and full ND syndrome among adolescent waterpipe (WP) and cigarette smokers. METHODS A 6-year longitudinal study was conducted among 8th and 9th graders from 38 schools in Lebanon. The analysis sample included exclusive-WP (n = 228) and exclusive-cigarette smokers (n = 139). Weighted Cox proportional hazards models were used to characterizing predictors of initial ND symptoms and full ND syndrome. RESULTS Predictors of experiencing initial ND symptoms among WP smokers included low maternal educational level, having a sibling who smoked WP, low physical activity, high body mass index (BMI), smoking initiation at a younger age. For cigarette smokers these were being male, younger, having lower BMI, having a sibling who smoked cigarettes, living in a crowded household, and smoking daily. Among WP smokers, predictors of developing full ND syndrome include being younger, believing that WP smokers have more friends, depression, high levels of impulsivity, and initiating smoking at a younger age. For cigarette smokers, predictors of full ND syndrome were being younger and initiating smoking at a younger age. CONCLUSION Smoking cessation and prevention interventions targeting youth should address modifiable, and tobacco use-specific factors that influence the development of ND among young WP and cigarette smokers. They also need to start at a younger age to target those most vulnerable to developing life-long addiction to tobacco products.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA.
| | - Raed Bahelah
- School of Health Sciences, Baldwin Wallace University, Kamm Hall, 191 E Center St, Berea, OH 44017, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, 11200 SW 8th St AHC5, 4th Floor, Miami, FL, 33199, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 411 S. Nedderman Drive Box 19407, Arlington, Texas 76019-0407, USA
| | - Joseph R DiFranza
- Reliant Medical Group, 225 New Lancaster Rd, Leominster, MA 01453, USA
| | - Malak Tleis
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Bliss Street. P.O. Box 11-0236. Beirut, Lebanon
| | - Rima Nakkash
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Bliss Street. P.O. Box 11-0236. Beirut, Lebanon
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Mohammad Masudul Alam
- Center for the Study of Tobacco, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11101 S.W. 13 ST., Miami, FL 33199, USA
| | - Kristopher Fenni
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road Sarasota, FL 34243, FL, USA
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 120 NW 14th Street, CRB 919, Miami, FL 3313, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136, USA; Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria; Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, 100 W. Franklin St. Suite 200, Richmond, VA 23220, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria; School of Public Health, University of Memphis, 3720 Alumni Ave, Memphis, TN 38152, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA; Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria
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Khani Jeihooni A, Afzali Harsini P. The Effect of an Educational Intervention Based on PRECEDE Model on Oral Cancer Prevention Behaviors in Hookah Users. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1250-1260. [PMID: 31359373 DOI: 10.1007/s13187-019-01591-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Educational intervention about oral cancer prevention is essential for all people, especially in hookah users. The aim of this study is investigating the effect of an educational intervention based on PRECEDE model on oral cancer prevention in hookah users living in Fasa, Fars Province, Iran, in 2017-2018. In this quasi-experimental study, 360 hookah users were selected and divided into experimental and control groups (180 subjects for each group). Educational intervention was performed for experimental group in 12 sessions. A questionnaire consisting of items evaluating demographic information and PRECEDE model constructs (knowledge, attitude, self-efficacy, enabling factors, and reinforcing factors) was used to measure oral cancer prevention behaviors and nicotine dependency of subjects before and 6 months after intervention. Obtained data were analyzed by SPSS-22 software through paired t test, independent t test, and chi-square test at significance level of P < 0.05. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, reinforcing factors, oral cancer prevention behaviors, and reduction of nicotine dependency compared with control group. This study showed the efficiency of educational intervention based on PRECEDE model in adoption of oral cancer prevention behaviors and reduction of nicotine dependency of hookah users 6 months after intervention.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran.
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Malhab SB, Hajj A, Lteif FHM, Salameh P, Khabbaz LR. Influence of genetic polymorphisms on waterpipe smoking phenotypes. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jaccard G, Tafin Djoko D, Korneliou A, Belushkin M. Analysis of waterpipe aerosol constituents in accordance with the ISO standard 22486. Toxicol Rep 2020; 7:1344-1349. [PMID: 33102137 PMCID: PMC7569180 DOI: 10.1016/j.toxrep.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
ISO 22486 to be complemented with real conditions for the evaluation of waterpipe. Charcoal is the main contributor to CO and BaP in waterpipe aerosols. Correlation between sugars content in tobaccos and formaldehyde yields in aerosols.
This study analyzed commercial waterpipe tobacco products in accordance with the newly developed ISO 22486 as well as with commercial waterpipes and charcoals using the ISO 22486 puffing regime for comparison. The aerosols from these products were analyzed for their nicotine, humectant, tobacco specific nitrosamine, carbonyl, benzo[a]pyrene, and metal yields. Significant differences were observed among the waterpipe tobacco products when analyzed in accordance with the ISO standard 22486 and with different commercial waterpipes and charcoals. The concentrations of CO and benzo[a]pyrene observed in the consumers’ configuration using the ISO 22486 puffing regime (with lit charcoal) were higher than those obtained with the ISO standard using electrical heating, with the yields for carbonyl compounds being lower or higher. The use of the recently published ISO standard for generating water pipe tobacco aerosols should be complemented with analysis by using the consumers’ configuration. The necessity for this was demonstrated by the differences in CO and benzo[a]pyrene yields in the present work. It appears that the temperature (280°C) selected for electrical heating of waterpipe tobacco products in ISO 22486 is somewhat lower than that obtained with commercial charcoals, resulting in a generally lower yield of nicotine and total collected matter. In addition, there is a need to evaluate the contribution of commercial charcoals to the concentration of constituents in waterpipe aerosols. This is particularly true for compounds resulting from charcoal combustion, such as CO and benzo[a]pyrene.
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Key Words
- Aldehydes
- BaP, benzo[a]pyrene
- Charcoals for waterpipe
- Formaldehyde
- HPHC, harmful and potentially harmful constituents
- ISO 22486
- NAB, N’-nitrosoanabasine
- NAT, N’-nitrosoanatabine
- NNK, 4-(methylnitrosamino)-1-(3-bipyridyl)-1-butanone
- NNN, N’-nitrosonornicotine
- PAH, polyaromatic hydrocarbons
- PG, propyleneglycol
- RS, reducing sugars
- TA, total alkaloids
- TCM, total collected matter
- TSNA, tobacco specific nitrosamines
- Waterpipe
- Waterpipe aerosols
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Affiliation(s)
- Guy Jaccard
- PMI R&D, Philip Morris Products SA, Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Donatien Tafin Djoko
- PMI R&D, Philip Morris Products SA, Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Alexandra Korneliou
- PMI R&D, Philip Morris Products SA, Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Maxim Belushkin
- PMI R&D, Philip Morris Products SA, Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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30
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Alam MM, Ward KD, Bahelah R, Kalan ME, Asfar T, Eissenberg T, Maziak W. The Syrian Center for Tobacco Studies-13 (SCTS-13): Psychometric evaluation of a waterpipe-specific nicotine dependence instrument. Drug Alcohol Depend 2020; 215:108192. [PMID: 32738447 PMCID: PMC7860966 DOI: 10.1016/j.drugalcdep.2020.108192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/14/2020] [Accepted: 07/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Waterpipe tobacco smoking (WTS) has surged globally among young people and causes nicotine dependence (ND). No existing ND instruments are sensitive to waterpipe-specific features of ND and early stages of use. METHODS We conducted a psychometric scale evaluation among 192 current waterpipe smokers, initially averaging 15 years of age, recruited from schools in Beirut, Lebanon, and assessed 4 times, 6 months apart. Twenty eight self-report items tapping multiple features of ND were submitted to exploratory and confirmatory factor analyses (EFA and CFA) to reduce items and verify factor structure. Convergent validity was assessed with the Lebanese Waterpipe Dependence Scale and the Hooked on Nicotine Checklist, and discriminant validity with the Depressive Symptom Scale and Adolescent Life Events Stress Scale. Concurrent and predictive validity measures included smoking status and intensity (amount, frequency, session duration, and change in frequency), quitting interest and success, perceived addiction, and smoking alone. RESULTS The EFA yielded a single factor, 13 item solution (named the Syrian Center for Tobacco Studies [SCTS]-13) that explained 91% of variance in responses, was internally consistent (Cronbach's alpha and McDonald's omega = 0.87), and captured several positive reinforcement, negative reinforcement, and social/sensory-related features of ND. The CFA indicated good model fit. The SCTS-13 showed acceptable convergent and discriminant validity. Higher SCTS-13 scores predicted current waterpipe and dual (waterpipe and cigarette) smoking, greater intensity of use, less interest in quitting, shorter duration of abstinence, greater perceived addiction, and smoking alone (vs. socially). CONCLUSION The SCTS-13 is a promising brief, waterpipe-specific ND instrument.
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Affiliation(s)
- Mohammad Masudul Alam
- Center for the Study of Tobacco, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, United States; Syrian Center for Tobacco Studies, Aleppo, Syria.
| | - Raed Bahelah
- Department of Public Health & Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, OH, United States
| | - Mohammad Ebrahmi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Public Health Sciences, University of Miami Miller School of Medicine, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
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Water-Pipe Smoking Exposure Deregulates a Set of Genes Associated with Human Head and Neck Cancer Development and Prognosis. TOXICS 2020; 8:toxics8030073. [PMID: 32961854 PMCID: PMC7560251 DOI: 10.3390/toxics8030073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
Water-pipe smoking (WPS) is becoming the most popular form of tobacco use among the youth, especially in the Middle East, replacing cigarettes rapidly and becoming a major risk of tobacco addiction worldwide. Smoke from WPS contains similar toxins as those present in cigarette smoke and is linked directly with different types of cancers including lung and head and neck (HN) carcinomas. However, the underlying molecular pathways and/or target genes responsible for the carcinogenic process are still unknown. In this study, human normal oral epithelial (HNOE) cells, NanoString PanCancer Pathways panel of 770 gene transcripts and quantitative real-time polymerase chain reaction (qRT-PCR) analysis were applied to discover differentially expressed genes (DEG) modulated by WPS. In silico analysis was performed to analyze the impact of these genes in HN cancer patient’s biology and outcome. We found that WPS can induce the epithelial–mesenchymal transition (EMT: hallmark of cancer progression) of HNOE cells. More significantly, our analysis of NanoString revealed 23 genes deregulated under the effect of WPS, responsible for the modulation of cell cycle, proliferation, migration/invasion, apoptosis, signal transduction, and inflammatory response. Further analysis was performed using qRT-PCR of HNOE WPS-exposed and unexposed cells supported the reliability of our NanoString data. Moreover, we demonstrate those DEG to be upregulated in cancer compared with normal tissue. Using the Kaplan–Meier analysis, we observed a significant association between WPS-deregulated genes and relapse-free survival/overall survival in HN cancer patients. Our findings imply that WPS can modulate EMT as well as a set of genes that are directly involved in human HN carcinogenesis, thereby affecting HN cancer patients’ survival.
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Jafari AJ, Asl YA, Momeniha F. Determination of metals and BTEX in different components of waterpipe: charcoal, tobacco, smoke and water. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:243-251. [PMID: 32399236 PMCID: PMC7203304 DOI: 10.1007/s40201-020-00459-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND The main objective of this study was to evaluate the concentrations of heavy metals and BTEX (benzene, toluene, ethylbenzene and xylene) in smoke and water bowl of 5-most commonly used tobacco brand in waterpipe in Tehran, the capital of Iran. METHODS Five types of conventional tobacco in Tehran were investigated. Heavy metals and BTEX were analyzed in waterpipe smoke, tobacco, charcoal and water bowl prior to and after smoking by using ICP-OES and GC-MS, respectively. RESULTS Our results indicated that Khansar and Al Fakher brands had the maximum and minimum concentrations of metals among tobacco consumed, respectively. The results showed that there was a significant difference between content of heavy metals in burned and unburned tobacco. The highest and lowest concentrations of metals were related to Fe and Hg, respectively. CONCLUSION Results showed that tobacco, charcoal and smoke of waterpipe contained significant contents of toxic metals and BTEX, and exposure to these components could be the main reason for the concerns about waterpipe smoking.
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Affiliation(s)
- Ahmad Jonidi Jafari
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Momeniha
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Lee JJ, Wu Y, Wang MP, Yeung KCY, Wong JYH, Smith R. Waterpipe smoking among university students in Hong Kong: a cross-sectional study. BMC Public Health 2020; 20:543. [PMID: 32316942 PMCID: PMC7175508 DOI: 10.1186/s12889-020-08686-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/13/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Waterpipe smoking has gained global popularity in recent years, especially among young people. However, there is a lack of empirical investigation into waterpipe smoking in East Asia. This study aimed to investigate the demographical and psycho-social characteristics and patterns of waterpipe smoking (WPS) among university students in Hong Kong. METHODS A cross-sectional survey was conducted via online questionnaires administered to 1288 Hong Kong university students (mean age: 22.4 [SD = 3.8]). Logistic regressions were used to compute adjusted odd ratios (aOR) for waterpipe ever-smoking in relation to respondents' characteristics. Moreover, multinomial logistic regression yielded adjusted RR (aRR) for four different smoking status (i.e., never, waterpipe-only, cigarette-only, and dual smoking) regarding the characteristics. RESULTS 23.8% of participants reported having ever smoked a waterpipe (vs. cigarette ever-smoking: 21.1%). Factors including being female (aOR:1.57; 95% CI: 1.22-2.02), older age (≥24 years: 4.17; 1.35-12.93), frequent alcohol consumption (>monthly: 26.02; 10.91-62.09), and higher sensation-seeking behaviours (high level: 2.98;1.46-6.08) were associated with waterpipe ever-smokers. The study also identified that demographical and psycho-social characteristics were variably associated with students' smoking status. Particularly, more frequent alcohol consumption was most significantly associated with waterpipe-only smoking (aRR:45.73; 95% CI:11.44-182.73) (vs. cigarette-only smoking: 3.01; 1.76-5.14). CONCLUSIONS WPS is the most common form of tobacco smoking among university students in Hong Kong, and characteristics unique to the population were identified. There is no legislation of relevant policies on WPS despite its concerning significance in public health among young people, therefore immediate action to monitor and control WPS is needed in Hong Kong.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Karly Cheuk-Yin Yeung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Janet Yuen-Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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Allegrini AG, Verweij KJH, Abdellaoui A, Treur JL, Hottenga JJ, Willemsen G, Boomsma DI, Vink JM. Genetic Vulnerability for Smoking and Cannabis Use: Associations With E-Cigarette and Water Pipe Use. Nicotine Tob Res 2020; 21:723-730. [PMID: 30053134 DOI: 10.1093/ntr/nty150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/17/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cigarette smoking and cannabis use are heritable traits and share, at least in part, a common genetic substrate. In recent years, the prevalence of alternative methods of nicotine intakes, such as electronic cigarette (e-cigarette) and water pipe use, has risen substantially. We tested whether the genetic vulnerability underlying cigarettes smoking and cannabis use explained variability in e-cigarette and water pipe use phenotypes, as these vaping methods are alternatives for smoking tobacco cigarettes and joints. METHODS On the basis of the summary statistics of the International Cannabis Consortium and the Tobacco and Genetics Consortium, we generated polygenic risk scores (PRSs) for smoking and cannabis use traits, and used these to predict e-cigarette and water pipe use phenotypes in a sample of 5025 individuals from the Netherlands Twin Register. RESULTS PRSs for cigarettes per day were positively associated with lifetime e-cigarette use and early initiation of water pipe use, but only in ex-smokers (odds ratio = 1.43, R2 = 1.56%, p = .011) and never cigarette smokers (odds ratio = 1.35, R2 = 1.60%, p = .013) respectively. CONCLUSIONS Most associations of PRSs for cigarette smoking and cannabis use with e-cigarette and water pipe use were not significant, potentially due to a lack of power. The significant associations between genetic liability to smoking heaviness with e-cigarette and water pipe phenotypes are in line with studies indicating a common genetic background for substance-use phenotypes. These associations emerged only in nonsmokers, and future studies should investigate the nature of this observation. IMPLICATIONS Our study showed that genetic vulnerability to smoking heaviness is associated with lifetime e-cigarette use and age at initiation of water pipe use. This finding has implications for the current debate on whether alternative smoking methods, such as usage of vaping devices, predispose to smoking initiation and related behaviors.
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Affiliation(s)
- Andrea G Allegrini
- Department of Developmental Psychopathology, Behavioural Science Institute, Faculty of Social Sciences, Radboud University, Nijmegen, The Netherlands
| | - Karin J H Verweij
- Department of Developmental Psychopathology, Behavioural Science Institute, Faculty of Social Sciences, Radboud University, Nijmegen, The Netherlands.,Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdel Abdellaoui
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorien L Treur
- Department of Developmental Psychopathology, Behavioural Science Institute, Faculty of Social Sciences, Radboud University, Nijmegen, The Netherlands
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Jacqueline M Vink
- Department of Developmental Psychopathology, Behavioural Science Institute, Faculty of Social Sciences, Radboud University, Nijmegen, The Netherlands
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DehghanNezhad M, Jalayer Naderi N, Semyari H. Micronucleus Assay of Buccal Mucosa Cells in Waterpipe (Hookah) Smokers: A Cytologic Study. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:75-80. [PMID: 32215022 DOI: 10.30699/ijp.2020.101701.2010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/23/2020] [Indexed: 01/10/2023]
Abstract
Background & Objective Micronucleus assay of buccal mucosa cells is a simple bio- monitoring method for diagnosing the genetic damages of toxic agents. The aim was to study the genotoxic effect of waterpipe smoking on buccal mucosa cells using micronucleus assay. Methods This was a case control. A total of 30 male waterpipe smokers and 30 non-smokers were included in the study. The exfoliated buccal mucosa cells were scrapped using wooden spatula and were spread over glass slides. The mean number of micronuclei was determined using Feulgen-stained slides. The number of micronuclei per 1000 cells was calculated and compared between the two groups of smokers and non-smokers. Results The mean number of micronuclei in waterpipe smokers and non-smokers was 1.94±0.39 and 1.68±0.35, respectively. The micronuclei count in waterpipe smokers was significantly higher than non-smokers (P=0). The difference between the number of waterpipe smoking and micronuclei count was significantly different (P=0). Conclusion The mean number of micronuclei in buccal mucosa cells of waterpipe smokers was significantly higher than non-smokers. The genotoxicity effect of waterpipe was dose-dependent.
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Affiliation(s)
| | | | - Hassan Semyari
- Department of Periodontics, Faculty of Dentistry, Shahed University
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Nemmar A, Al-Salam S, Beegam S, Yuvaraju P, Zaaba NE, Yasin J, Ali BH. Waterpipe Tobacco Smoke Inhalation Triggers Thrombogenicity, Cardiac Inflammation and Oxidative Stress in Mice: Effects of Flavouring. Int J Mol Sci 2020; 21:E1291. [PMID: 32075078 PMCID: PMC7072969 DOI: 10.3390/ijms21041291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 12/26/2022] Open
Abstract
The consumption of water-pipe smoking (WPS) has been promoted by the use of flavoured tobacco. However, little is known about the impact of flavouring on the cardiovascular toxicity induced by WPS inhalation. Here, we compared the cardiovascular effects and underlying mechanism of actions of plain (P) (unflavoured) versus apple-flavoured (AF) WPS (30 minutes/day, 5 days/week for 1 month) in mice. Control mice were exposed to air. Both P- and AF-WPS inhalation induced an increase in systolic blood pressure, thrombogenicity and plasma concentration of fibrinogen and von Willebrand factor. In heart homogenates, AF-WPS inhalation caused an increase of 8-isoprostane and a decrease in the levels of reduced glutathione (GSH) and superoxide dismutase (SOD). Nevertheless, P-WPS decreased only the activity of SOD. The concentrations of tumour necrosis factor α and interleukin 1β were increased only in heart homogenates of mice exposed to AF-WPS. Although both P- and AF-WPS increased the concentration of troponin I in heart homogenates and induced DNA damage, the concentration of cleaved caspase 3 was only increased in mice exposed to AF-WPS. Immunohistochemical analysis of the hearts showed that both P- and AF- WPS inhalation decreased the expression of SOD. Moreover, the expression of nuclear factor erythroid-derived 2-like 2 at nuclear level in the heart was higher in both AF-WPS and P-WPS compared with control group, and the effect observed in AF-WPS group was more significant than that seen in P-WPS group. Likewise, the concentration of heme oxygenase-1 was significantly increased in both P-WPS and AF-WPS groups compared with control group, and the effect seen in AF-group was higher than that observed in P-WPS group. In conclusion, our findings showed that both P- and AF-WPS induce thrombogenicity and cardiac injury, and that this toxicity is potentiated by the presence of flavouring.
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Affiliation(s)
- Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE; (S.B.); (P.Y.); (N.E.Z.)
- Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE
| | - Suhail Al-Salam
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE;
| | - Sumaya Beegam
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE; (S.B.); (P.Y.); (N.E.Z.)
| | - Priya Yuvaraju
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE; (S.B.); (P.Y.); (N.E.Z.)
| | - Nur Elena Zaaba
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE; (S.B.); (P.Y.); (N.E.Z.)
| | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666 Al Ain, UAE;
| | - Badreldin H. Ali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Muscat 123, Al-Khod, Oman;
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Maziak W, Osibogun O, Asfar T. Waterpipe smoking: the pressing need for risk communication. Expert Rev Respir Med 2019; 13:1109-1119. [PMID: 31519113 PMCID: PMC7004232 DOI: 10.1080/17476348.2019.1668271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023]
Abstract
Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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Haik MY, Ashour AA, Alahmad YFM, Al-Ishaq FA, Saad MM, Hussein MM, Mubarak RS, Mohamed WA, Moustafa AEA. Water-pipe smoking and serum testosterone levels in adult males in Qatar. Tob Induc Dis 2019; 17:19. [PMID: 31582930 PMCID: PMC6751991 DOI: 10.18332/tid/99572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Water-pipe (WP) smoking is the most common method of tobacco consumption in the Middle-East and is rapidly spreading on a global scale. Although, water-pipe smoking is linked to various diseases, such as emphysema and various types of cancers, its effect on testosterone levels has yet to be investigated. This study explores the effect of water-pipe smoking on serum testosterone levels in males in Qatar. METHODS In this cross-sectional sample within a cohort study, we retrieved data for a total of 1000 male volunteers from the Qatar BioBank (QBB) project. A self-reported questionnaire was used to determine the water-pipe smoking status of participants. Moreover, participants were stratified based on the frequency of smoking. Total testosterone and sex hormone binding globulin (SHBG) were measured clinically, whereas free testosterone and bioavailable testosterone were calculated using Vermeulen’s equation. Hormone values of 541 males (277 water-pipe smokers and 264 non-smokers) were compared using multiple regression analysis based on water-pipe smoking status after adjusting for confounding factors. RESULTS No statistically significant difference was observed between WP smokers and non-water-pipe smokers in the likelihood of having lower or higher total testosterone, after adjustment for confounding factors. Similar results were found in free testosterone, bioavailable testosterone, and sex hormone binding globulin (all p>0.05). When compared with the reference group, both light and heavy water-pipe smokers had a similar likelihood of circulating low total testosterone levels (OR=0.83, 95% CI: 0.46–1.49; and OR=0.80, 95% CI: 0.43–1.49; respectively). CONCLUSIONS Our results reveal, for the first time, that there is no significant change in total testosterone, free testosterone, bioavailable testosterone and sex hormone binding globulin in waterpipe smokers compared to non-water-pipe smokers. Therefore, we believe that further studies are needed to confirm the effect of water-pipe smoking on testosterone in different populations.
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Affiliation(s)
| | | | | | | | - Mona M Saad
- College of Medicine, Qatar University, Doha, Qatar
| | | | | | | | - Ala-Eddin Al Moustafa
- College of Medicine, Qatar University, Doha, Qatar.,Biomedical Research Centre, Qatar University, Doha, Qatar
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40
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Jawad M, Cheeseman H, Brose LS. Waterpipe tobacco smoking prevalence among young people in Great Britain, 2013-2016. Eur J Public Health 2019; 28:548-552. [PMID: 29272388 DOI: 10.1093/eurpub/ckx223] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background One percent of adults in Great Britain use waterpipe tobacco at least monthly, however national epidemiological evidence among young people is absent. This study aims to assess waterpipe tobacco prevalence and correlates among young people in Great Britain. Methods Data were analyzed from online surveys conducted annually from 2013 to 2016 with weighted national samples of 11 to 18-year olds in Great Britain (annual n = 1936-2059). Primary outcome measures were at least monthly waterpipe tobacco use and lifetime waterpipe tobacco use. Binary logistic regression models tested the association between these outcomes and age, sex, country of residence and other tobacco consumption. Results Between 2013 and 2016, 1.7% (95% CI 1.5-2.1%) used waterpipe tobacco at least monthly and 9.9% (95% CI 9.2-10.7%) used waterpipe in their lifetime. There were no changes in prevalence over time. At least monthly use was associated with older age groups [16-18 years vs. 11-15 years, adjusted odds ratio (AOR) 2.63, 95% CI 1.55-4.46], male sex (AOR 1.82, 95% CI 1.23-2.71) and other tobacco consumption (e.g. lifetime cigarette use AOR 10.30, 95% CI 5.22-20.29). Lifetime use had similar correlates, but was not associated with male sex (AOR 0.97, 95% CI 0.80-1.17). Conclusions One in 10 young people in Great Britain have tried waterpipe tobacco, though more frequent use appears low. We found no evidence of increasing or decreasing prevalence of waterpipe use between 2013 and 2016. Being male, older and a concurrent user of other tobacco products were correlated with waterpipe tobacco use.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, London, UK
| | | | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Aanyu C, Kadobera D, Apolot RR, Kisakye AN, Nsubuga P, Bazeyo W, Ddamulira JB. Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda. Pan Afr Med J 2019; 32:61. [PMID: 31223353 PMCID: PMC6560999 DOI: 10.11604/pamj.2019.32.61.15184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. METHODS a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. RESULTS we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). CONCLUSION the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.
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Affiliation(s)
- Christine Aanyu
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Angela Nakanwagi Kisakye
- Makerere University School of Public Health, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
| | | | - William Bazeyo
- Makerere University School of Public Health, Kampala, Uganda
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Mahboub B, Mohammad AB, Nahlé A, Vats M, Al Assaf O, Al-Zarooni H. Analytical Determination of Nicotine and Tar Levels in Various Dokha and Shisha Tobacco Products. J Anal Toxicol 2018; 42:496-502. [PMID: 29750269 DOI: 10.1093/jat/bky029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
In the Middle East, there is no precise data and literature on tobacco-based products, such as dokha and shisha. The proposed study aims to quantify the levels of nicotine and tar in different kinds of dokha and shisha products that are sold in the local marketplace. The amount of nicotine in dokha and shisha products can be quantitatively determined using a combination of the "kissling" and "silicotungstic acid" method proposed by Robert M. Chapin. The tar residue from the smoke sample was collected on a glass wool placed before the stopcock (tap) of a separatory funnel as the smoke passes through the inlet of an electronically controlled vacuum pump. The nicotine levels in dokha and shisha samples ranged from 23.83 to 52.80 mg/g and 0.80 to 20.52 mg/g, respectively. The nicotine level varies between different tobacco products. It varies from 0.5 to 19.5 mg/g in cigarettes, from 10.3 to 23.1 mg/g in snuff tobacco, from 11 to 18 mg/g in electronic cigarettes and from 2.9 to 16.6 mg/g in chewing tobacco. The tar levels in the dokha and shisha samples ranged from 21.6 to 45.02 mg/g and 1.68 to 11.87 mg/g, respectively. Smokers are at a high risk of getting lung cancer, chronic obstructive pulmonary disease, emphysema and coronary artery disease owing to the high levels of nicotine and tar present in dokha and shisha tobacco products. These findings contradict the widespread belief among teenagers that dokha and shisha tobacco products are safer alternatives to cigarettes.
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Affiliation(s)
- Bassam Mahboub
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | | | - Ayssar Nahlé
- Department of Chemistry, College of Sciences, University of Sharjah, Sharjah, UAE
| | - Mayank Vats
- The Pulmonary and Sleep Medicine department, Rashid Hospital Dubai, UAE
| | - Omar Al Assaf
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Hamdan Al-Zarooni
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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Dogar O, Zahid R, Mansoor S, Kanaan M, Ahluwalia JS, Jawad M, Siddiqi K. Varenicline versus placebo for waterpipe smoking cessation: a double-blind randomized controlled trial. Addiction 2018; 113:2290-2299. [PMID: 30187978 DOI: 10.1111/add.14430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Waterpipe tobacco smoking is a growing public health concern. There is limited research using pharmacotherapy and no research using varenicline (established treatment for smoking cessation) in waterpipe smokers. We tested the efficacy of varenicline in achieving abstinence from all tobacco use among waterpipe smokers. DESIGN Two-arm, parallel group, placebo-controlled, double-blind, multi-centre (n = 4), individually randomized trial with follow-up to 25 weeks. SETTINGS District general hospitals and catchment communities within four districts of Punjab, Pakistan. PARTICIPANTS Adult daily waterpipe smokers (n = 510; 253 in varenicline and 257 in placebo arms), who were interested in quitting, were recruited and analysed between March and November 2016. Of these, 220 (87%) in the varenicline and 239 (93%) in the placebo arms completed all follow-ups. Participants were on average aged 49 [standard deviation (SD) = 15.2] years, daily smokers and smoked for the last 27 (SD = 15.9) years. More than half (261, 51.2%) also smoked cigarettes. INTERVENTION AND COMPARATOR All trial participants received two structured sessions of behavioural support (of 30 and 10 minutes) one at the time of registration and the other 1 week later. Participants were randomized to varenicline (active arm) and placebo (control arm) stratified on district, sex and concomitant cigarette smoking. Varenicline and placebo were dispensed as identical unlabelled tablets for 12 weeks: 0.5 mg for 1 week (once on days 1-3, twice on days 4-7) and 1 mg for the subsequent 11 weeks (twice daily). MEASUREMENTS The trial participants were followed-up for a period of 25 weeks post-randomization. The primary outcome was 7-day repeated point prevalence abstinence from all forms of tobacco, self-reported at each of weeks 5, 12 and 25, verified by carbon-monoxide cut-off < 10 parts per million. FINDINGS No evidence of statistically significant difference in repeated point prevalence abstinence between the varenicline (12 of 253; 4.7%) and placebo (11 of 257; 4.3%) arms (relative risk = 1.11, 95% confidence interval = 0.50-2.47, P = 0.80) was observed (Bayes factor = 0.048). Adverse events reported in 27 participants were 34 (15 in varenicline and 19 in placebo); none was serious. CONCLUSIONS Varenicline was not more effective than placebo in aiding cessation of tobacco use in long-term daily waterpipe smokers.
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Affiliation(s)
- Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | - Raana Zahid
- Orange Grove Farm, The Initiative, Pakistan, Islamabad, Pakistan
| | - Sonia Mansoor
- Orange Grove Farm, The Initiative, Pakistan, Islamabad, Pakistan
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | | | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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Whittaker PJ, Hoque H, Jones T. Shisha waterpipe use and awareness of health risks among young adults in a semi-rural deprived community in North West England. Tob Prev Cessat 2018; 4:31. [PMID: 32411857 PMCID: PMC7205078 DOI: 10.18332/tpc/94507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/30/2018] [Accepted: 08/22/2018] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Waterpipe smoking has become increasingly popular among young adults across the globe. Evidence suggests waterpipes have overtaken cigarettes in popularity among university students in the UK. This survey aimed to measure the prevalence of use, awareness of the tobacco content and associated health risks of waterpipes among young adults in a non-university semi-rural underprivileged community in England. METHODS A self-completed questionnaire was distributed by six schools and colleges to young adults aged 16–25 in Tameside, North West England. RESULTS A total of 210 young adults completed the survey, of these 12% smoked cigarettes and 16% smoked waterpipes. Of those that smoked waterpipes, 45% smoked at home and 88% smoked in shisha bars. Of the respondents, 62% did not know that shisha waterpipes contained tobacco and 18% believed that waterpipes were less harmful than smoking cigarettes. There was no difference in knowledge of tobacco content, or of the associated health risks, between those who smoked waterpipes and those that did not. The majority of respondents (81%) stated that if they wanted to know more about how shisha tobacco could affect their health they would access information via the internet. Social networking websites was by far the most popular route for communication for messages about the health risks associated with smoking shisha waterpipes. CONCLUSIONS These results suggest that waterpipes may have overtaken cigarettes as the method of choice for smoking tobacco among the young adult population in the UK.
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Affiliation(s)
| | - Happe Hoque
- Pennine Care NHS Foundation Trust, Lancashire, United Kingdom
| | - Tracy Jones
- Tameside Metropolitan Borough Council, United Kingdom
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Zaid K, Azar-Maalouf E, Barakat C, Chantiri M. p53 Overexpression in Oral Mucosa in Relation to Shisha Smoking in Syria and Lebanon. Asian Pac J Cancer Prev 2018; 19:1879-1882. [PMID: 30049200 PMCID: PMC6165666 DOI: 10.22034/apjcp.2018.19.7.1879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Shisha (waterpipe) smoking is becoming a very prevalent form of tobacco consumption in the Middle east and use is growing over the world. Smoking-related malignancies have a high genome-wide burden of mutations, including examples in the gene encoding p53. Aims To investigate alterations in p53 immunohistochemical expression in the normal, pre-malignant, malignant oral mucosa in relation to Shisha smoking habits. Materials and Methods A total of 105 paraffin embedded tissue sections of OSCCs (52 smokers,53 non-smokers), 96 of premalignant lesions (48 smokers,48 non-smokers) and 60 normal oral mucosa. Some 30 patients with a history of Shisha smoking daily for more than 5 years were also investigated for mutant expression of p53. Tissue samples were considered positive for p53 staining when any positive cells of epithelial origin could be detected. Results The majority (74.3%) of oral squamous cell carcinomas showed positive staining for p53 expression (83.1% and 65.5% with Shisha smokers and non-smokers, respectively). In the 96 premalignant lesions, about 23% from non-smokers and 41.7% from smokers showed p53 positivity. In normal epithelium, P53 positive cells were noted in 6.6% of non-smokers and 16.6% of smokers. Positive correlations with Shisha smoking were evident for the following groups: WDOSCC, MDOSCC, mild dysplasia G1, moderate dysplasia G2 and in normal mucosa using Student’s t- test, P value<0.05. Conclusion These results strongly suggest that p53 mutations are associated with Shisha smoking in OSCC, pre-malignant lesions and normal mucosa of the oral cavity.
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Affiliation(s)
- Khaled Zaid
- Faculty of Dentistry, Al-Sham Private University, Damascus, Syria.
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Omotehinwa OJ, Japheths O, Damascene IJ, Habtu M. Shisha use among students in a private university in Kigali city, Rwanda: prevalence and associated factors. BMC Public Health 2018; 18:713. [PMID: 29884163 PMCID: PMC5994055 DOI: 10.1186/s12889-018-5596-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All over the globe shisha smoking is fast growing among different age brackets. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. In Kigali, Rwanda's capital, reports indicate that shisha use is increasing among the youths, particularly the university students. The study aimed at determining the prevalence, and establishing factors associated with shisha use among students in a university in Kigali Rwanda, which will be a significant step in stemming shisha fame among youths in Rwanda as there was no previously documented evidence-based study. METHODS A total of 427 students were selected for this cross-sectional study using stratified sampling method. A questionnaire was used to collect data on shisha use, knowledge about shisha, attitude towards shisha, and factors associated with use of shisha. The association between the independent variables and shisha use was assessed using chi-square p value < 0.05. Binary logistic regression was used to determine variables that were independently associated with shisha smoking. RESULTS Prevalence of ever smoking shisha among the university students was 26.1% and that of those that smoked in the last month (30 days) was 20.8%. About 40 % (39.9%) of the participants that had heard about shisha before demonstrated low level of knowledge, and 41.6% of these reported shisha use in the last 30 days. Logistic regression revealed that the followings were independently associated with shisha smoking: always drink alcohol (p = 0.003); drink alcohol occasionally (p = 0.045); having friend(s) who smoke shisha (p = 0.001); being aware of shisha's availability in cafes, bars and restaurants in Kigali (p = 0.022); positive attitude towards shisha smoking (p < 0.001) and participants with age < 20 years (p = 0.039). CONCLUSIONS There is a relative high prevalence of shisha smoking and a poor knowledge about its impact on health among these university students. Regular medical education and health promotion targeting the youths could improve knowledge and practices about shisha use. Shisha laws and regulations should be enacted, and fines imposed on individuals or group who flout them.
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Affiliation(s)
- Omoboriowo Joad Omotehinwa
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | - Ogendi Japheths
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | | | - Michael Habtu
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
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Rezk-Hanna M, Benowitz NL. Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk. Nicotine Tob Res 2018; 21:1151-1161. [DOI: 10.1093/ntr/nty065] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Introduction
Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Hookah (ie, waterpipe) smoking is a centuries-old revived yet understudied global epidemic of tobacco use. Because of the traditional set-up of a hookah-pipe, in addition to inhaling tobacco-combustion products, smokers are also exposed to large amounts of charcoal combustion products from the burning charcoal briquettes used to heat the hookah flavored tobacco. Despite being heavily advertised and actively glamorized in the mass media as a healthier tobacco alternative, the toxicological constituents of hookah smoke—including nicotine, carbon monoxide, particulates, oxidants, heavy metals, phenols and flavorants—indicate the potential to cause adverse cardiovascular events.
Methods
Herein, we review evidence on hookah smoke toxicological constituents, cardiovascular effects and potential mechanisms by which hookah smoke aerosol could cause cardiovascular disease.
Results
The evidence reviewed here indicates that contrary to the widespread popular belief that hookah is a healthier tobacco alternative, the constituents of hookah smoke aerosol contains similar chemicals compared to cigarette smoke, many of which are known to be harmful to cardiovascular health and mediated by similar pathophysiologic processes. Because the burning charcoal briquettes are a unique source of toxicant emissions specific to hookah smoking, some constituents differ in their quantities from cigarettes with some of their cardiovascular effects unknown.
Conclusions
To date, much more is known about the constituents and their toxicology than about the effects of hookah smoking on human cardiovascular health. Further research on long-term consequences of hookah use is needed.
Implications
This review provides an overview on the potential impact of hookah smoking on cardiovascular health. Readers will gain an insight into evidence on its toxicological constituents, human health effects, and pathophysiological mechanisms by which hookah smoking might cause cardiovascular disease. The review also highlights current research gaps regarding the cardiovascular consequences of hookah smoking, specifically the long-term consequences in the United States and Europe among flavored-hookah tobacco users.
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Affiliation(s)
- Mary Rezk-Hanna
- School of Nursing, University of California, Los Angeles, CA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Neal L Benowitz
- Divsion of Clinical Pharmacology and Experimental Therapeutics, Departments of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
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Nicksic NE, Ly C, Loukas A, Perry CL. Hookah Use and Perceptions among Young Adult Hookah Users. ACTA ACUST UNITED AC 2018; 7. [PMID: 31692999 DOI: 10.4172/2324-9005.1000178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Despite declining cigarette use, hookah use has increased substantially among youth and young adults. This is alarming, as hookah can lead to the same health risks as cigarettes and expose users to a high amount of smoke, nicotine, and toxicants. Determining patterns of hookah use and perceptions in young adults is important in prevention efforts. Methods Structured in-person interviews were conducted for this qualitative study in June 2016. Twenty-three hookah users between the ages of 18 and 29 years living in Austin, TX who were not currently enrolled in a college or university completed the interview. NVivo 11 Pro was utilized to code transcribed transcripts for common themes among participants. Results When trying hookah for the first time, all participants had used flavored tobacco, with fruit flavors being most popular at initiation and for current use. Many participants initiated hookah use under the age of 18 years old. While only one participant initiated hookah use alone, one-third of participants had smoked hookah alone, not in the company of others. The majority of participants owned or previously owned their own hookah device. Common motivational factors for hookah use involved being social, taste, and the calming/relaxation effect. Participants perceived hookah use to be both harmful and addictive; however, many participants were unsure if hookah was more harmful to health than cigarettes. Conclusion Young adults who are not currently enrolled in college may have similar hookah use behaviors and risk perceptions as do college students, yet non-college students in this sample are using hookah alone and report owning a hookah device. This study supports the need for research on the effect of policy changes on hookah use, receptivity to warning labels, and programs to correct misperceptions.
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Affiliation(s)
- Nicole E Nicksic
- University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Suite 6.300, Austin, TX 78701, United States
| | - Christina Ly
- University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Suite 6.300, Austin, TX 78701, United States
| | - Alexandra Loukas
- University of Texas at Austin, Department of Kinesiology and Health Education, College of Education, 1912 Speedway, Stop D500, Austin, TX 78712, United States
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Suite 6.300, Austin, TX 78701, United States
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Leavens EL, Meier E, Tackett AP, Miller MB, Tahirkheli NN, Brett EI, Carroll DM, Driskill LM, Anderson MP, Wagener TL. The impact of a brief cessation induction intervention for waterpipe tobacco smoking: A pilot randomized clinical trial. Addict Behav 2018; 78:94-100. [PMID: 29128712 DOI: 10.1016/j.addbeh.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers. METHODS Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up. RESULTS Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p<0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p>0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10). CONCLUSIONS The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation.
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Kassem NOF, Kassem NO, Liles S, Jackson SR, Posis AIB, Chatfield DA, Hovell MF. Levels of Urine Cotinine from Hookah Smoking and Exposure to Hookah Tobacco Secondhand Smoke in Hookah Lounges and Homes. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2018; 7. [PMID: 29805963 PMCID: PMC5967845 DOI: 10.5812/ijhrba.67601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Nicotine, an addictive drug, is present in all forms of tobacco products, including hookah tobacco, which is not yet regulated in the United States. Objectives This study aimed to investigate the uptake of nicotine in hookah smokers and non-smokers exposed to secondhand smoke (SHS) at indoor hookah social events in natural settings where hookah tobacco was smoked exclusively. Patients and Methods We quantified cotinine, a metabolite of nicotine, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home. Results Following a social event where exclusively hookah tobacco was smoked, urinary cotinine levels increased significantly 8.5 times (geometric mean (GM): 16.0 ng/mg to 136.1 ng/mg) among hookah smokers, and 2.5 times (GM: 0.4 ng/mg to 1.0 ng/mg) among non-smokers exposed exclusively to hookah tobacco SHS. Among hookah smokers, the highest increase in urinary cotinine levels post a hookah event was found in occasional hookah smokers in which GM levels increased significantly 31.2 times post smoking (from 2.0 ng/mg to 62.3 ng/mg). Reported reasons for preference to smoke hookah at home by hookah smokers who attended a hookah social event in a private home included recreational purposes, socializing with friends and family, ‘Me’ time and relaxing at home, more comfortable to smoke hookah at home, owning a hookah and hookah tobacco, eating and drinking while smoking hookah, and saving money by smoking at home and not going to hookah lounges. Conclusions Hookah tobacco smoke is a source of substantial nicotine exposure. Our results call for protecting hookah smokers’ and non-smokers’ health by requiring accurate hookah tobacco labels, raising taxes on hookah tobacco, reducing the spread of hookah lounges, and encouraging voluntary bans on smoking hookah tobacco in private homes.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
- Corresponding author: Nada O F Kassem, Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, United States. Tel: +1-6193707488,
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Alexander Ivan B Posis
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Dale A Chatfield
- Department of Chemistry, San Diego State University, San Diego, California, U.S.A
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
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