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Saad RK, Maiteh A, Nakkash R, Salloum RG, Chalak A, Abu-Rmeileh NME, Khader Y, Al Nsour M. Monitoring and Combating Waterpipe Tobacco Smoking Through Surveillance and Taxation. JMIR Public Health Surveill 2023; 9:e40177. [PMID: 36951907 PMCID: PMC10132023 DOI: 10.2196/40177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled "Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS)," was held as part of the 7th Eastern Mediterranean Public Health Network's regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively.
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Affiliation(s)
- Randa K Saad
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Adna Maiteh
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Florida, FL, United States
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Occupied Palestinian Territory
| | - Yousef Khader
- Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
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2
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Lee JJ, Yeung KCY, Wang MP, Thorne S, Tong HSC, Lai V. Circumventing tobacco control and safety policies to promote waterpipe use in smoking venues: the perspective of staff in waterpipe smoking venues. Tob Control 2021:tobaccocontrol-2021-056692. [PMID: 34753793 DOI: 10.1136/tobaccocontrol-2021-056692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand Hong Kong waterpipe smoking (WPS) sales and promotion, including strategies to avoid policy enforcement, from the perspective of WPS venue staff. METHODS Qualitative interviews and observations were guided by interpretive description. 20 WPS venue staff who were responsible for preparing and serving waterpipes to patrons and had worked at the bar for at least 3 months were recruited. In-depth semistructured interviews with WPS venue staff were conducted, in addition to covert and participant observations in 10 WPS venues in Hong Kong. Interpretive description involving constant comparative analysis of qualitative data was adopted to facilitate an inductive analytic approach to generate findings. RESULTS Two primary themes emerged from analyses of interview and observation data: strategies to avoid law enforcement, and perceived health and safety concerns linked to working and smoking in waterpipe venues. The findings suggest that many Hong Kong venues may be failing to comply with tobacco control policies and developing strategies to circumvent law enforcement. Moreover, waterpipe preparation, allowance of WPS and burning of charcoal in indoor areas were perceived as negatively affecting the health and safety of staff and customers. CONCLUSIONS The study provides preliminary evidence indicating the ineffectiveness of current tobacco control policy on WPS. Due to its risks to health and safety, and the need to sustain tobacco control efforts for their intended purpose, waterpipe-specific regulations and stricter surveillance on waterpipe sales and promotion are urgently required.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sally Thorne
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Vienna Lai
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong
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3
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Babaie J, Ahmadi A, Abdollahi G, Doshmangir L. Preventing and controlling water pipe smoking: a systematic review of management interventions. BMC Public Health 2021; 21:344. [PMID: 33632181 PMCID: PMC7908788 DOI: 10.1186/s12889-021-10306-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide. METHODS A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories. RESULTS After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels. CONCLUSION The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.
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Affiliation(s)
- Javad Babaie
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Abdollahi
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Department of Health Policy& Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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4
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Gardner K, Kearns R, Woodland L, Silveira M, Hua M, Katz M, Takas K, McDonald J. A Scoping Review of the Evidence on Health Promotion Interventions for Reducing Waterpipe Smoking: Implications for Practice. Front Public Health 2018; 6:308. [PMID: 30456210 PMCID: PMC6230676 DOI: 10.3389/fpubh.2018.00308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Waterpipe tobacco smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region (EMR), but its prevalence is growing worldwide, especially among young people. Although often perceived as less harmful than other methods of tobacco use because the smoke passes through water, accumulating evidence shows harmful effects and that some smokers become addicted. Interventions that deglamourise and denormalise use have been recommended but little is known about the range and impact of different health prevention and promotion interventions. Methods: A scoping review of literature was undertaken to explore the breadth of literature and assess the range and impact of community based health promotion interventions for waterpipe smoking. Searches were conducted in Medline, Embase, CINAHL, Psychinfo, and the Cochrane database of systematic reviews. Interventions were classified using a health promotion framework and data extracted on the aspects of prevention/promotion addressed; key strategies employed, evidence of effectiveness or impact on behavior change as well as barriers to implementation and perceived success factors. Results: Ten studies were included in the review. They include brief interventions to increase quit rates; community campaigns to raise awareness and increase knowledge; web based health education and skill development to increase perceived risks and intention to quit; as well as studies that evaluated product labeling and opportunities for policy interventions to create healthy environments. Conclusions: The evidence base is small but growing. Brief interventions for waterpipe users, community campaigns, and web based tailored information can modify perceptions of addiction and increase intentions to quit. Product labeling may be an effective policy tool to curb waterpipe smoking. A range of policy interventions have been identified but not evaluated.
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Affiliation(s)
- Karen Gardner
- Public Service Research Group, University of New South Wales Sydney, NSW, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Rachael Kearns
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Woodland
- South Eastern Sydney Local Health District, New South Wales Department of Health, Sydney, NSW, Australia
| | - Mariela Silveira
- South Eastern Sydney Local Health District, New South Wales Department of Health, Sydney, NSW, Australia
| | - Myna Hua
- South Eastern Sydney Local Health District, New South Wales Department of Health, Sydney, NSW, Australia
| | - Milena Katz
- South Eastern Sydney Local Health District, New South Wales Department of Health, Sydney, NSW, Australia
| | - Klara Takas
- South Eastern Sydney Local Health District, New South Wales Department of Health, Sydney, NSW, Australia
| | - Julie McDonald
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
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Waterpipe product packaging and labelling at the 3rd international Hookah Fair; does it comply with Article 11 of the Framework Convention on Tobacco Control? J Public Health Policy 2018. [PMID: 28630401 DOI: 10.1057/s41271-017-0078-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We assessed compliance of waterpipe product packaging and labelling with the Framework Convention on Tobacco Control's Article 11. We evaluated samples collected at a trade fair against ten domains: health warning location, size, use of pictorials, use of colour, and packaging information on constituents and emissions. We also evaluated waterpipe accessories (e.g., charcoal) for misleading claims. Ten of 15 tobacco products had health warnings on their principal display areas, covering a median of 22.4 per cent (interquartile range 19.4-27.4 per cent) of those areas. Three had pictorial, in-colour health warnings. We judged all packaging information on constituents and emissions to be misleading. Eight of 13 charcoal products displayed environmentally friendly descriptors and/or claims of reduced harm that we judged to be misleading. Increased compliance with waterpipe tobacco regulation is warranted. An improved policy framework for waterpipe tobacco should also consider regulation of accessories such as charcoal products.
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6
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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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Singh N, Jawad M, Darzi A, Lotfi T, Nakkash R, Hawkins B, Akl EA. Features of the waterpipe tobacco industry: A qualitative study of the third International Hookah Fair. F1000Res 2018; 7:247. [PMID: 30728948 PMCID: PMC6347030 DOI: 10.12688/f1000research.13796.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 10/06/2023] Open
Abstract
Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structured interviews with representatives of waterpipe companies participating in a trade exhibition in Germany. We used an inductive approach to identify emerging themes. Results: We interviewed 20 representatives and four themes emerged: industry growth, cross-industry overlap, customer-product relationship, and attitude towards policy. The industry was described as transnational, generally decentralized, non-cartelized, with ad hoc relationships between suppliers, distributors and retailers. Ties with the cigarette industry were apparent. The waterpipe industry appeared to be in an early growth phase, encroaching on new markets, and comprising of mainly small family-run businesses. Customer loyalty appears stronger towards the waterpipe apparatus than tobacco. There was a notable absence of trade unionism and evidence of deliberate breaches of tobacco control laws. Conclusion: The waterpipe industry appears fragmented but is slowly growing into a mature, globalized, and customer-focused industry with ties to the cigarette industry. Now is an ideal window of opportunity to strengthen public health policy towards the waterpipe industry, which should include a specific legislative waterpipe framework.
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Affiliation(s)
- Neil Singh
- Brighton and Sussex Medical School, Brighton, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Andrea Darzi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Benjamin Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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8
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Singh N, Jawad M, Darzi A, Lotfi T, Nakkash R, Hawkins B, Akl EA. Features of the waterpipe tobacco industry: A qualitative study of the third International Hookah Fair. F1000Res 2018; 7:247. [PMID: 30728948 PMCID: PMC6347030 DOI: 10.12688/f1000research.13796.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structured interviews with 20 representatives of waterpipe companies participating in a trade exhibition in Germany. We used an inductive approach to identify emerging themes. Results: We interviewed representatives and four themes emerged: industry globalisation, cross-industry overlap, customer-product relationship, and attitude towards policy. The industry was described as transnational, generally decentralized, non-cartelized, with ad hoc relationships between suppliers, distributors and retailers. Ties with the cigarette industry were apparent. The waterpipe industry appeared to be in an early growth phase, encroaching on new markets, and comprising of mainly small family-run businesses. Customer loyalty appears stronger towards the waterpipe apparatus than tobacco. There was a notable absence of trade unionism and evidence of deliberate breaches of tobacco control laws. Conclusion: The waterpipe industry appears fragmented but is slowly growing into a mature, globalized, and customer-focused industry with ties to the cigarette industry. Now is an ideal window of opportunity to strengthen public health policy towards the waterpipe industry, which should include a specific legislative waterpipe framework.
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Affiliation(s)
- Neil Singh
- Brighton and Sussex Medical School, Brighton, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Andrea Darzi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Benjamin Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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9
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Jawad M, McIver C. Waterpipe tobacco smoking prevalence and illegal underage use in waterpipe-serving premises: a cross-sectional analysis among schoolchildren in Stoke-on-Trent. Public Health 2017; 146:32-38. [DOI: 10.1016/j.puhe.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
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10
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Kim KH, Kabir E, Jahan SA. Waterpipe tobacco smoking and its human health impacts. JOURNAL OF HAZARDOUS MATERIALS 2016; 317:229-236. [PMID: 27285594 DOI: 10.1016/j.jhazmat.2016.05.075] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/23/2016] [Accepted: 05/25/2016] [Indexed: 05/12/2023]
Abstract
Waterpipe tobacco smoking (WTS, also known as hookah, shisha, narghile, and many other names) involves passing tobacco smoke through water prior to inhalation by the consumer. As the number of waterpipe smokers is rising rapidly, there is growing concern over the use of WTS, particularly as there has been a widely held misconception that WTS is free from health hazards. In reality, it is associated with a variety of adverse health outcomes on both a short- and long-term basis. Hence, it is desirable to develop advanced techniques for surveillance, intervention, and regulatory/policy frameworks specific to the production and use of waterpipe tobacco. This review is written to survey the types and extent of pollutants released from its use and their potential health risks. A review of the present regulation guidelines is also included.
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Affiliation(s)
- Ki-Hyun Kim
- Department of Civil and Environmental Engineering, Hanyang University, Seoul 04763, Republic of Korea.
| | - Ehsanul Kabir
- Department of Farm, Power, and Machinery, Bangladesh Agricultural University, Mymensingh, Bangladesh
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11
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Jawad M, Jawad S, Waziry RK, Ballout RA, Akl EA. Interventions for waterpipe tobacco smoking prevention and cessation: a systematic review. Sci Rep 2016; 6:25872. [PMID: 27167891 PMCID: PMC4863147 DOI: 10.1038/srep25872] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
Waterpipe tobacco smoking is growing in popularity despite adverse health effects among users. We systematically reviewed the literature, searching MEDLINE, EMBASE and Web of Science, for interventions targeting prevention and cessation of waterpipe tobacco smoking. We assessed the evidence quality using the Cochrane (randomised studies), GRADE (non-randomised studies) and CASP (qualitative studies) frameworks. Data were synthesised narratively due to heterogeneity. We included four individual-level, five group-level, and six legislative interventions. Of five randomised controlled studies, two showed significantly higher quit rates in intervention groups (bupropion/behavioural support versus placebo in Pakistan; 6 month abstinence relative risk (RR): 2.3, 95% CI 1.4-3.8); group behavioural support versus no intervention in Egypt, 12 month abstinence RR 3.3, 95% CI 1.4-8.9). Non-randomised studies showed mixed results for cessation, behavioural, and knowledge outcomes. One high quality modelling study from Lebanon calculated that a 10% increase in waterpipe tobacco taxation would reduce waterpipe tobacco demand by 14.5% (price elasticity of demand -1.45). In conclusion, there is a lack of evidence of effectiveness for most waterpipe interventions. While few show promising results, higher quality interventions are needed. Meanwhile, tobacco policies should place waterpipe on par with cigarettes.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Sena Jawad
- Nuffied Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Reem K. Waziry
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rami A. Ballout
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
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12
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Jawad M, Power G. Prevalence, correlates and patterns of waterpipe smoking among secondary school students in southeast London: a cross-sectional study. BMC Public Health 2016; 16:108. [PMID: 26830194 PMCID: PMC4736266 DOI: 10.1186/s12889-016-2770-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/22/2016] [Indexed: 12/02/2022] Open
Abstract
Background Waterpipe smoking is growing worldwide, but little is known of its epidemiology in the UK due to its absence from national health surveys. We sought to address this by calculating the prevalence of waterpipe smoking among secondary school students in southeast London. Methods We conducted a pooled secondary analysis of routine health surveillance surveys among 11–17 year olds in convenience-sampled secondary schools from three ethnically-diverse areas of southeast London. We calculated ever (lifetime) waterpipe use, and compared its sociodemographic correlates to ever (lifetime) cigarette use. In one area we collected data on patterns of waterpipe use. Results Of 2,098 respondents (mean age 14.1 ± 1.7 years, 55.7 % male, 46.6 % of black ethnicity), ever waterpipe use was 39.6 % (95 % CI 37.6–41.7 %) and was higher than that for ever cigarette use (32.4 %; 95 % CI 30.5–34.4). While waterpipe users were significantly and independently more likely to be male and of non-white ethnicities, at least 30 % of all age, gender and ethnic sub-groups had tried waterpipe smoking. In contrast, cigarette users were more likely to be older and of white ethnicity. In one of the three areas, over a quarter of waterpipe users were occasional or regular waterpipe smokers, and most were introduced to and currently used waterpipe in waterpipe-serving premises or friends’ homes. Conclusions Waterpipe smoking prevalence was high in southeast London, and users exhibited a different sociodemographic profile to cigarette users. Waterpipe should be included in national health surveys of young people. National surveillance is warranted to help develop suitable interventions to prevent uptake and promote cessation.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, UK. .,Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, SO16 6YD, UK.
| | - Gerald Power
- Community and Safety Enforcement on behalf of the South East London Illegal Tobacco Network, Southwark Council, London, SE1 2QH, UK
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13
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Jawad M, Choaie E, Brose L, Dogar O, Grant A, Jenkinson E, McEwen A, Millett C, Shahab L. Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners. PLoS One 2016; 11:e0146799. [PMID: 26745806 PMCID: PMC4706414 DOI: 10.1371/journal.pone.0146799] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking. METHODS We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly. RESULTS f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking. CONCLUSIONS While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Hampshire, SO16 6YD, United Kingdom
- * E-mail:
| | - Elham Choaie
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Leonie Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8BB, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom
| | - Aimee Grant
- Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, CF14 4YS, United Kingdom
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Andy McEwen
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
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Colditz JB, Ton JN, James AE, Primack BA. Toward Effective Water Pipe Tobacco Control Policy in the United States: Synthesis of Federal, State, and Local Policy Texts. Am J Health Promot 2016; 31:302-309. [PMID: 26730559 DOI: 10.4278/ajhp.150218-qual-736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS. APPROACH A systematic synthesis of content and legal interactions among federal, state, and local TCP documents. SETTING Pennsylvania, which represents a politically and demographically diverse microcosm of the United States. PARTICIPANTS No human subjects. METHOD Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs. RESULTS Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs. CONCLUSION Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.
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Affiliation(s)
- Jason B Colditz
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jessica N Ton
- 2 University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - A Everette James
- 2 University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - Brian A Primack
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Knowledge About the Waterpipe (Hookah), a Qualitative Assessment Among Community Workers in a Major Urban Center in Canada. J Community Health 2015; 41:689-96. [DOI: 10.1007/s10900-015-0143-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Al-Bakri A, Jawad M, Salameh P, al'Absi M, Kassim S. Opportunistic insights into occupational health hazards associated with waterpipe tobacco smoking premises in the United Kingdom. Asian Pac J Cancer Prev 2015; 16:621-6. [PMID: 25684497 DOI: 10.7314/apjcp.2015.16.2.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokefree laws aim to protect employees and the public from the dangers of secondhand smoke. Waterpipe premises have significantly increased in number in the last decade, with anecdotal reports of poor compliance with the smokefree law. The literature is bereft of information pertaining to waterpipe premise employees. This study aimed to opportunistically gather knowledge about the occupational health hazards associated with working in waterpipe premises in London, England. MATERIALS AND METHODS Employees from seven convenience-sampled, smokefree-compliant waterpipe premises in London were observed for occupational activities. Opportunistic carbon monoxide (CO) measurements were made among those with whom a rapport had developed. Observations were thematically coded and analysed. RESULTS Occupational hazards mainly included environmental smoke exposure. Waterpipe-serving employees were required to draw several puffs soon after igniting the coals, thereby providing quality assurance of the product. Median CO levels were 27.5 ppm (range 21-55 ppm) among these employees. Self-reported employee health was poor, with some suggestion that working patterns and smoke exposure was a contributory factor. CONCLUSIONS The smokefree law in England does not appear to protect waterpipe premise employees from high levels of CO. Continued concerns surrounding chronic smoke exposure may contribute to poor self-reported physical and mental wellbeing.
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Affiliation(s)
- Ali Al-Bakri
- Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, London, UK E-mail :
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Jawad M, Power G. Waterpipe tobacco and electronic cigarette use in a southeast London adult sample: a cross-sectional analysis. J Public Health (Oxf) 2015; 38:e114-21. [DOI: 10.1093/pubmed/fdv106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Impact of Waterpipe Tobacco Pack Health Warnings on Waterpipe Smoking Attitudes: A Qualitative Analysis among Regular Users in London. BIOMED RESEARCH INTERNATIONAL 2015; 2015:745865. [PMID: 26273642 PMCID: PMC4529913 DOI: 10.1155/2015/745865] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
Background. Despite the rise in prevalence of waterpipe tobacco smoking, it has received little legislative enforcement from governing bodies, especially in the area of health warning labels. Methods. Twenty regular waterpipe tobacco smokers from London took part in five focus groups discussing the impact of waterpipe tobacco pack health warnings on their attitudes towards waterpipe smoking. We presented them with existing and mock waterpipe tobacco products, designed to be compliant with current and future UK/EU legislation. Data were analysed using thematic analysis. Results. Participants felt packs were less attractive and health warnings were more impactful as health warnings increased in size and packaging became less branded. However, participants highlighted their lack of exposure to waterpipe tobacco pack health warnings due to the inherent nature of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health warnings at the point of consumption had more reported impact than health warnings at the point of sale. Conclusions. Waterpipe tobacco pack health warnings are likely to be effective if compliant with existing laws and exposed to end-users. Legislations should be reviewed to extend health warning labels to waterpipe accessories, particularly the apparatus, and to waterpipe-serving premises.
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Hammal F, Wild TC, Nykiforuk C, Abdullahi K, Mussie D, Finegan BA. Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional. Nicotine Tob Res 2015; 18:757-62. [PMID: 26187392 DOI: 10.1093/ntr/ntv152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/23/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION When asserting the right of individuals to be free to smoke a hookah (waterpipe [WP]) in public places, the "cultural" importance of the practice is often cited. The purpose of this study was to explore the cultural significance of WP smoking. METHODS Qualitative methods were used to elicit the views of groups of WP smokers from different cultural backgrounds. RESULTS Sixteen group discussion sessions with a total of 75 WP smokers aged between 18 and 30 were conducted. A few participants saw culture as a factor supporting WP smoking initiation and maintenance. The vast majority indicated that WPs being perceived as "healthier" than cigarettes, and the availability of flavored shisha as important factors in their initiation and ongoing use. Most started smoking before the age of 18 calling it a "high school thing" and admitted that they had easy access to WP cafés. Many indicated that they did not know if they were smoking tobacco or a "herbal" substance. CONCLUSION Peer influence, availability of flavored products and facile access to WP cafés are major factors in WP initiation. Ethno-cultural traditions play only a minor role. The assertion that cultural traditions and practice are inherent in WP smoking as implied by media and marketing was not supported by our findings. Contemporary use of WP is spreading among new non-traditional users. Lack of knowledge about the harms of WP smoking indicates a need for education and regulation to require packaging and health warning labels and restrictions on access, especially to minors.
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Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Candace Nykiforuk
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Dawit Mussie
- Calgary Chinese Community Services Association, Calgary, AB, Canada
| | - Barry A Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada;
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Jawad M, Nakkash RT, Hawkins B, Akl EA. Gaining Insights Into the Waterpipe Tobacco Industry: Participant Observation and a Cross-Sectional Survey of Products at a Trade Exhibition. Nicotine Tob Res 2015; 18:874-8. [PMID: 26175460 DOI: 10.1093/ntr/ntv155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/07/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The rise in waterpipe tobacco smoking has been accompanied by the emergence of a diverse range of products, such as "herbal" waterpipe tobacco substitutes and electronic waterpipes. The aims of this study were to assess the extent to which emerging waterpipe products are being developed by waterpipe tobacco companies themselves, to understand the key characteristics of the main market players, and to examine the connections between producers of different product categories. METHODS In 2014, one researcher attended an international waterpipe trade exhibition in Germany, conducting a survey of products at exhibition stands, and gathering qualitative data on exhibitors and products using participant observation. Cross-tabulations and chi-square tests identified the association between waterpipe tobacco, waterpipe tobacco substitutes, and electronic waterpipe products. We thematically analyzed field notes into information about exhibitors and products. RESULTS Of 97 exhibitors, 55 displayed waterpipe-related products. Of these, nearly half (45%) displayed electronic waterpipe products, 38% displayed waterpipe tobacco and 23% displayed waterpipe tobacco substitutes. There was an inverse association between the display of waterpipe tobacco and electronic waterpipe products, and a positive association between the display of waterpipe tobacco and waterpipe tobacco substitutes. We found that Japan Tobacco Inc, Philip Morris, and British American Tobacco were partnered or affiliated with exhibitors displaying waterpipe-related products. CONCLUSIONS Electronic waterpipe products were the main feature of this exhibition. Waterpipe tobacco substitutes are likely to be produced by the waterpipe tobacco industry whereas electronic waterpipes are not. There is a developing interest in waterpipe-related products by transnational tobacco corporations. Further industry surveillance is warranted.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom; Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom;
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ben Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Jawad M, Nakkash RT, Hawkins B, Akl EA. Waterpipe industry products and marketing strategies: analysis of an industry trade exhibition. Tob Control 2015; 24:e275-9. [PMID: 26149455 DOI: 10.1136/tobaccocontrol-2015-052254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/20/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Understanding product development and marketing strategies of transnational tobacco companies (TTCs) has been of vital importance in developing an effective tobacco control policy. However, comparatively little is known of the waterpipe tobacco industry, which TTCs have recently entered. This study aimed to gain an understanding of waterpipe tobacco products and marketing strategies by visiting a waterpipe trade exhibition. METHODS In April 2014, the first author attended an international waterpipe trade exhibition, recording descriptions of products and collecting all available marketing items. We described the purpose and function of all products, and performed a thematic analysis of messages in marketing material. RESULTS We classified waterpipe products into four categories and noted product variation within categories. Electronic waterpipe products (which mimic electronic cigarettes) rarely appeared on waterpipe tobacco marketing material, but were displayed just as widely. Claims of reduced harm, safety and quality were paramount on marketing materials, regardless of whether they were promoting consumption products (tobacco, tobacco substitutes), electronic waterpipes or accessories. CONCLUSIONS Waterpipe products are diverse in nature and are marketed as healthy and safe products. Furthermore, the development of electronic waterpipe products appears to be closely connected with the electronic cigarette industry, rather than the waterpipe tobacco manufacturers. Tobacco control policy must evolve to take account of the vast and expanding array of waterpipe products, and potentially also charcoal products developed for waterpipe smokers. We recommend that tobacco substitutes be classified as tobacco products. Continued surveillance of the waterpipe industry is warranted.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ben Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Jawad M, Lee JT, Millett C. Waterpipe Tobacco Smoking Prevalence and Correlates in 25 Eastern Mediterranean and Eastern European Countries: Cross-Sectional Analysis of the Global Youth Tobacco Survey. Nicotine Tob Res 2015; 18:395-402. [PMID: 25957438 DOI: 10.1093/ntr/ntv101] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/01/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking is highly prevalent among young people in some settings. There is an absence of nationally representative prevalence studies of waterpipe tobacco use and dual use with other tobacco products in young people. METHODS We conducted a secondary analysis of the Global Youth Tobacco Survey, a nationally representative cross-sectional study of students aged 13-15 years. Of 180 participating countries, 25 included optional waterpipe tobacco smoking questions: 15 Eastern Mediterranean and 10 Eastern European countries. We calculated the prevalence of current (past 30-day) waterpipe tobacco use, including dual waterpipe and other tobacco use, and used logistic regression models to identify sociodemographic correlates of waterpipe tobacco smoking. Individual country results were combined in a random effects meta-analysis. RESULTS Waterpipe tobacco smoking prevalence was highest in Lebanon (36.9%), the West Bank (32.7%) and parts of Eastern Europe (Latvia 22.7%, the Czech Republic 22.1%, Estonia 21.9%). These countries also recorded greater than 10% prevalence of dual waterpipe and cigarette use. In a meta-analysis, higher odds of waterpipe tobacco smoking were found among males (Adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] = 1.18% to 1.59%), cigarette users (AOR = 6.95, 95% CI = 5.74% to 8.42%), those whose parents (AOR = 1.54, 95% CI = 1.31% to 1.82%) or peers smoked (AOR = 3.53, 95% CI = 2.97% to 4.20%) and those whose parents had higher educational attainment (Father, AOR = 1.47, 95% CI = 1.14% to 1.89%; Mother, AOR = 1.62, 95% CI = 1.07% to 2.46%). We report on regional- and country income-level differences. CONCLUSIONS Waterpipe tobacco smoking, including dual waterpipe and cigarette use, is alarmingly high in several Eastern Mediterranean and Eastern European countries. Ongoing waterpipe tobacco smoking surveillance is warranted.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
| | - John Tayu Lee
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, United Kingdom
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Jawad M, El Kadi L, Mugharbil S, Nakkash R. Waterpipe tobacco smoking legislation and policy enactment: a global analysis. Tob Control 2014; 24 Suppl 1:i60-i65. [PMID: 25550418 PMCID: PMC4345984 DOI: 10.1136/tobaccocontrol-2014-051911] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE (1) To review how current global tobacco control policies address regulation of waterpipe tobacco smoking (WTS). (2) To identify features associated with enactment and enforcement of WTS legislation. DATA SOURCES (1) Legislations compiled by Tobacco Control Laws (www.tobaccocontrollaws.org). (2) Weekly news articles by 'Google Alerts' (www.google.com/alerts) from July 2013 to August 2014. STUDY SELECTION (1) Countries containing legislative reviews, written by legal experts, were included. Countries prohibiting tobacco sales were excluded. (2) News articles discussing aspects of the WHO FCTC were included. News articles related to electronic-waterpipe, crime, smuggling, opinion pieces or brief mentions of WTS were excluded. DATA ABSTRACTION (1) Two reviewers independently abstracted the definition of "tobacco product" and/or "smoking". Four tobacco control domains (smokefree law, misleading descriptors, health warning labels and advertising/promotion/sponsorship) were assigned one of four categories based on the degree to which WTS had specific legislation. (2) Two investigators independently assigned at least one theme and associated subtheme to each news article. DATA SYNTHESIS (1) Reviewed legislations of 62 countries showed that most do not address WTS regulation but instead rely on generic tobacco/smoking definitions to cover all tobacco products. Where WTS was specifically addressed, no additional legislative guidance accounted for the unique way it is smoked, except for in one country specifying health warnings on waterpipe apparatuses (2) News articles mainly reported on noncompliance with public smoking bans, especially in India, Pakistan and the UK. CONCLUSIONS A regulatory framework evaluated for effectiveness and tailored for the specificities of WTS needs to be developed.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Lama El Kadi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sanaa Mugharbil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Maziak W, Taleb ZB, Bahelah R, Islam F, Jaber R, Auf R, Salloum RG. The global epidemiology of waterpipe smoking. Tob Control 2014; 24 Suppl 1:i3-i12. [PMID: 25298368 PMCID: PMC4345835 DOI: 10.1136/tobaccocontrol-2014-051903] [Citation(s) in RCA: 363] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally. DATA SOURCES Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used. STUDY SELECTION The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking. DATA EXTRACTION Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review. DATA SYNTHESIS Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns. CONCLUSIONS Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Florida International University, Miami, Florida, USA Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Ziyad Ben Taleb
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Raed Bahelah
- Department of Epidemiology, Florida International University, Miami, Florida, USA Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rana Jaber
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Rehab Auf
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Ramzi G Salloum
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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