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Le PH, Van Phan C, Truong DTT, Ho NM, Shuyna I, Le NT. Waterpipe tobacco smoking and risk of all-cause mortality: a prospective cohort study. Int J Epidemiol 2024; 53:dyad140. [PMID: 37843876 DOI: 10.1093/ije/dyad140] [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: 12/26/2022] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Despite an increasing proportion of smokers who use non-cigarette products, the harmfulness of these is inconsistent. This study aimed to evaluate the impact of waterpipe tobacco (WTP) smoking on all-cause mortality. METHODS A prospective cohort study followed up on 35 646 participants from 2007 to 2019 in Northern Viet Nam. Data for each type of cigarette and WTP smoking were collected based on demographic lifestyle and semi-quantitative food frequency questionnaires. Smokers were categorized as current smokers and former smokers who were lifetime ever smokers but stopped smoking >6 months before the interview. Data on all-cause mortality (2449 deaths) were obtained from medical records at the state health facilities. The hazard ratios (HRs) and 95% CIs for mortality were estimated using a Cox proportional-hazards model. RESULTS Compared with non-smokers, ever smokers had a higher all-cause mortality risk (HR = 1.29, 95% CI = 1.16-1.43). Current WTP (HR = 1.37, 95% CI = 1.19-1.57), current cigarette (HR = 1.40, 95% CI = 1.22-1.60) and former WTP smokers (HR = 1.39, 95% CI = 1.10-1.76) showed an elevated risk of dying. The mortality risk was significantly elevated in dual smokers using WTP and cigarettes (HR = 1.55, 95% CI = 1.35-1.79) and exclusive WTP smokers (HR = 1.38, 95% CI = 1.21-1.57). Elevated risk was observed for the main targeted attractions of cancer, diabetes and heart diseases. Smoking cessation of >10 years decreased the risk of all-cause mortality (HR = 0.61, 95% CI = 0.44-0.85) and cancer (HR = 0.24, 95% CI = 0.11-0.52). CONCLUSIONS WTP smoking increases the risk of all-cause mortality. A unique programme to control exposure to WTP should be a high priority in Viet Nam and other countries.
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Affiliation(s)
- Phuoc Hong Le
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Can Van Phan
- Center for Population Health Sciences, Hanoi University of Public Health, Ha Noi City, Viet Nam
| | - Dung Thuy Thi Truong
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- Graduate School of Public Health, International University of Health and Welfare, Narita City, Japan
| | - Nguyet Minh Ho
- Department of Non-Communicable Disease Control, Ho Chi Minh City Center for Disease Control, Ho Chi Minh City, Viet Nam
| | - Ikeda Shuyna
- The Canon Institute for Global Studies, Tokyo, Japan
- Department of Public Health, School of Medicine, International University of Health and Welfare, Japan
| | - Ngoan Tran Le
- Institute of Research and Development, Duy Tan University, Da Nang City, Viet Nam
- Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Ha Noi, Viet Nam
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Hammoudi Halat D, Hallit S, Younes S, AlFikany M, Khaled S, Krayem M, El Khatib S, Rahal M. Exploring the effects of health behaviors and mental health on students' academic achievement: a cross-sectional study on lebanese university students. BMC Public Health 2023; 23:1228. [PMID: 37365573 DOI: 10.1186/s12889-023-16184-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students' nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students' academic achievement. METHODS A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS). RESULTS A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = - 0.06) and a higher number of days of eating out (Beta = - 0.07) were significantly associated with lower SAAS scores. CONCLUSIONS This is the first investigation on a Lebanese university students' academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.
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Affiliation(s)
- Dalal Hammoudi Halat
- Academic Quality Department, QU Health, Qatar University, Doha, Qatar
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Samar Younes
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Mira AlFikany
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Sanaa Khaled
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Maha Krayem
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology (GUST), Hawally, Kuwait
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
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Asfar T, Livingstone-Banks J, Ward KD, Eissenberg T, Oluwole O, Bursac Z, Ghaddar T, Maziak W. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev 2023; 6:CD005549. [PMID: 37286509 PMCID: PMC10245833 DOI: 10.1002/14651858.cd005549.pub4] [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] [Indexed: 06/09/2023]
Abstract
BACKGROUND While cigarette smoking has declined globally, waterpipe smoking is rising, especially among youth. The impact of this rise is amplified by mounting evidence of its addictive and harmful nature. Waterpipe smoking is influenced by multiple factors, including appealing flavors, marketing, use in social settings, and misperceptions that waterpipe is less harmful or addictive than cigarettes. People who use waterpipes are interested in quitting, but are often unsuccessful at doing so on their own. Therefore, developing and testing waterpipe cessation interventions to help people quit was identified as a priority for global tobacco control efforts. OBJECTIVES: To evaluate the effectiveness of tobacco cessation interventions for people who smoke waterpipes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Review Group Specialized Register from database inception to 29 July 2022, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language. SELECTION CRITERIA We sought randomized controlled trials (RCTs), quasi-RCTs, or cluster-RCTs of any smoking cessation interventions for people who use waterpipes, of any age or gender. In order to be included, studies had to measure waterpipe abstinence at a three-month follow-up or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from waterpipe use at least three months after baseline. We also collected data on adverse events. Individual study effects and pooled effects were summarized as risk ratios (RR) and 95% confidence intervals (95% CI), using Mantel-Haenszel random-effects models to combine studies, where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarized secondary outcomes narratively. We used the five GRADE considerations (risk of bias, inconsistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence for our primary outcome in four categories high, moderate, low, or very low. MAIN RESULTS This review included nine studies, involving 2841 participants. All studies were conducted in adults, and were carried out in Iran, Vietnam, Syria, Lebanon, Egypt, Pakistan, and the USA. Studies were conducted in several settings, including colleges/universities, community healthcare centers, tuberculosis hospitals, and cancer treatment centers, while two studies tested e-health interventions (online web-based educational intervention, text message intervention). Overall, we judged three studies to be at low risk of bias, and six studies at high risk of bias. We pooled data from five studies (1030 participants) that tested intensive face-to-face behavioral interventions compared with brief behavioral intervention (e.g. one behavioral counseling session), usual care (e.g. self-help materials), or no intervention. In our meta-analysis, we included people who used waterpipe exclusively, or with another form of tobacco. Overall, we found low-certainty evidence of a benefit of behavioral support for waterpipe abstinence (RR 3.19 95% CI 2.17 to 4.69; I2 = 41%; 5 studies, N = 1030). We downgraded the evidence because of imprecision and risk of bias. We pooled data from two studies (N = 662 participants) that tested varenicline combined with behavioral intervention compared with placebo combined with behavioral intervention. Although the point estimate favored varenicline, 95% CIs were imprecise, and incorporated the potential for no difference and lower quit rates in the varenicline groups, as well as a benefit as large as that found in cigarette smoking cessation (RR 1.24, 95% CI 0.69 to 2.24; I2 = 0%; 2 studies, N = 662; low-certainty evidence). We downgraded the evidence because of imprecision. We found no clear evidence of a difference in the number of participants experiencing adverse events (RR 0.98, 95% CI 0.67 to 1.44; I2 = 31%; 2 studies, N = 662). The studies did not report serious adverse events. One study tested the efficacy of seven weeks of bupropion therapy combined with behavioral intervention. There was no clear evidence of benefit for waterpipe cessation when compared with behavioral support alone (RR 0.77, 95% CI 0.42 to 1.41; 1 study, N = 121; very low-certainty evidence), or with self-help (RR 1.94, 95% CI 0.94 to 4.00; 1 study, N = 86; very low-certainty evidence). Two studies tested e-health interventions. One study reported higher waterpipe quit rates among participants randomized to either a tailored mobile phone or untailored mobile phone intervention compared with those randomized to no intervention (RR 1.48, 95% CI 1.07 to 2.05; 2 studies, N = 319; very low-certainty evidence). Another study reported higher waterpipe abstinence rates following an intensive online educational intervention compared with a brief online educational intervention (RR 1.86, 95% CI 1.08 to 3.21; 1 study, N = 70; very low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that behavioral waterpipe cessation interventions can increase waterpipe quit rates among waterpipe smokers. We found insufficient evidence to assess whether varenicline or bupropion increased waterpipe abstinence; available evidence is compatible with effect sizes similar to those seen for cigarette smoking cessation. Given e-health interventions' potential reach and effectiveness for waterpipe cessation, trials with large samples and long follow-up periods are needed. Future studies should use biochemical validation of abstinence to prevent the risk of detection bias. Finally, there has been limited attention given to high-risk groups for waterpipe smoking, such as youth, young adults, pregnant women, and dual or poly tobacco users. These groups would benefit from targeted studies.
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Affiliation(s)
- Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Olusanya Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Miami, FL, USA
| | - Tarek Ghaddar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Factors Predicting Dependence on Waterpipe Smoking Among Waterpipe Exclusive Smokers. J Addict Nurs 2023; 34:23-29. [PMID: 36857545 DOI: 10.1097/jan.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
ABSTRACT The current study targeted a sample of waterpipe (WP) exclusive smokers to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. A cross-sectional research design was employed with a community sample of 270 subjects who are currently WP exclusive smokers. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The unique significant predictors of WPS dependence were age, depression levels, age of starting WPS, duration of WPS, income, smoking WP daily, the belief of being attracted to WPS, and the desire to stop WPS. These predictors explained 35% of the variance in WPS dependence. WPS dependence was associated with increased depressive symptoms. Although few studies have been conducted, the WPS dependence prevalence appears to be alarmingly high among WP exclusive smokers. Factors associated with WPS dependence provide useful information that can be used to tailor WP prevention interventions.
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Alves MGO, Carvalho BFDC, Marques SS, Lopes MA, Almeida JD. Waterpipe tobacco smoking and oral health: what is important to know? Addiction 2022; 117:1493-1494. [PMID: 34873767 DOI: 10.1111/add.15776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Mônica Ghislaine Oliveira Alves
- Technology Research Center (NPT), Universidade Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil
- School of Medicine, Anhembi Morumbi University, São José dos Campos, São Paulo, Brazil
| | - Bruna Fernandes do Carmo Carvalho
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Sandra Silva Marques
- São Paulo State Reference Center on Alcohol, Tobacco and other Drugs- Secretary of Health, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Janete Dias Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
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Ebrahimi Kalan M, Bahelah R, Bursac Z, Ward KD, Ben Taleb Z, Tleis M, Jebai R, Asfar T, Eissenberg T, Maziak W. A Group-Based Modeling Approach to Identify Developmental Trajectories of Nicotine Dependence Among Lebanese Adolescents Waterpipe Smokers. Nicotine Tob Res 2021; 23:2056-2064. [PMID: 34125916 PMCID: PMC8825565 DOI: 10.1093/ntr/ntab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Adolescence represents a critical period in which nicotine dependence (ND) symptoms are developing. Little is known about waterpipe (WP) smoking and developmental trajectories of ND criteria across adolescence. AIMS AND METHODS Here, we aimed to identify ND trajectories from early- to late-adolescence in current (past 30 days) WP smokers and examine baseline correlates of each identified trajectory, using the International Classification of Diseases, 10th Revision (ICD-10). The analytical sample consisted of 278 current WP smokers from eight waves of an ongoing longitudinal cohort of eighth to ninth graders in Lebanon. Group-based trajectory modeling was estimated to identify trajectory classes for ICD-10-ND criteria over ages 11-18. RESULTS A group-based modeling approach yielded a four-class solution that best fit the data and reflected differences in the timing of ND onset during adolescence: no-onset of ND (43.9%), early-onset (16.2%), mid-onset (26.6%), and late-onset (13.3%) of ND criteria. Having a less-educated mother (adjusted odds ratio [aOR] = 4.08, 95% confidence interval [95% CI] = 1.01% to 16.53%) and siblings who smoke WP (aOR = 3.95, 95% CI = 1.08% to 14.42%), exposure to favorite WP-specific advertisements (aOR = 3.33, 95% CI = 1.03% to 10.85%), and being a novelty seeker (aOR = 1.12, 95% CI = 1.02% to 1.23%) were associated with early-onset of ND. Daily (aOR = 3.48, 95% CI = 1.08% to 11.23%) or weekly (aOR = 2.20, 95% CI = 1.05% to 4.62%) WP smokers (vs. monthly) and having higher stress level (aOR = 1.07, 95% CI = 1.00% to 1.14%) were associated with mid-onset trajectory. Believing that WP smoking is not harmful to health (aOR = 0.11, 95% CI = 0.02% to 0.82%) and spending less than 60 minutes on a WP smoking session (aOR = 5.62, 95% CI = 1.20% to 26.44%) were associated with late-onset ND trajectory class. CONCLUSIONS Monitoring the development of ND trajectories among WP smokers may identify an individual as belonging to one of these four groups with distinct individual and socioenvironmental factors and allow the individual and health care providers opportunities to inform initiate on-time WP-specific tailored prevention and cessation interventions. IMPLICATIONS The results from this study showed a four-class trajectory of ICD-10-ND criteria and suggested that every ND trajectory class during adolescence could have distinctive characteristics and therefore provides new insights into the process of ND in terms of when and what specific interventions are needed to curb the development of ND and long-term WP smoking among youth.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Raed Bahelah
- School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Malak Tleis
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Miami, FL, USA
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
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Tobacco Research in the Eastern Mediterranean Region: A Scoping Review of Published Studies from Seven Countries. J Community Health 2021; 46:225-231. [PMID: 32474805 DOI: 10.1007/s10900-020-00850-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While surveillance on a global scale has been showing a decline in tobacco smoking in the past decade, rates in the Eastern Mediterranean Region (EMR) remained stable with some countries showing rising trends. This study aimed to analyze the landscape of tobacco research in the EMR, present data on publication trends, and identify research gaps and opportunities to guide future tobacco research in the region. We conducted a scoping review of tobacco research in seven countries from January 2000 to December 2013. Three hundred and forty eight studies were identified, the majority of which were published in international journals and in English language. There was an increase in publications over time, with a significant positive linear trend (p = 0.03). Descriptive cross-sectional and case-control studies were the most common study designs (67.0%), and only 8% were longitudinal studies. Papers that reported, in part or solely, on waterpipe tobacco smoking (WTS) constituted 25.6% of the total publication pool. Tobacco consumption was treated as an exposure variable in half of the papers and mostly in relation to cancer and cardiovascular diseases, as an outcome measure in 37.7%, and as a confounding variable in 14.7% of the papers. Studies that examined associations of tobacco with other behaviors (5.3%) were lacking. The scarcity of high-evidence tobacco research in the EMR, together with the relatively deficient data on WTS and associations with other factors warrant the need for discussions on research priority setting and guidance on funding allocations in the region.
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Alomari MA, Al-sheyab NA, Shattnawi KK, Khabour OF. Gender-specific differences in plasma ferritin in adolescents smoking cigarettes versus waterpipe smoking: the Irbid-TRY Project. Arch Med Sci 2021; 20:806-812. [PMID: 39050182 PMCID: PMC11264140 DOI: 10.5114/aoms/115011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/02/2019] [Indexed: 07/27/2024] Open
Abstract
Introduction Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). Results The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. Conclusions The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp.
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Affiliation(s)
- Mahmoud A. Alomari
- Department of Physical Education, Qatar University, Doha, Qatar
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A. Al-sheyab
- Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Maternal and Child Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K. Shattnawi
- Department of Maternal and Child Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
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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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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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Santosh ABR, R. Collins J, Jones T, Brache M, Toro M, Tumanyan S, Walters C, White S, Elias-Boneta A. The SmoCar Study: A Caribbean-Based Multicenter Study on the Prevalence and Disparities Linked to Smoking and Gingival Health. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 40:321-330. [DOI: 10.1177/0272684x19895901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the SmoCar (Smoking in the Caribbean) study was to estimate the prevalence of smoking and the disparities in the smoking practices of three regions in the Caribbean: Jamaica, Dominican Republic, and Puerto Rico. The secondary objective was to assess the prevalence and severity of gingivitis in relation to the smoking practices. The study population comprised 1,847 (weighted N = 1,830) individuals (18 years and older) who were volunteer participants from the capitals of Jamaica, Dominican Republic, and Puerto Rico. A structured interview was used to assess the participants’ smoking behaviors. The gingival index was used to determine the extent of gingival inflammation. Polytomous regression was used to estimate the adjusted odds ratios (aORs) for smoking status (current, past, or never), according to risk factors (sex, age-group, education, marital status, tooth-brushing frequency, and city of residence). Logistic regression models were used to assess the associations between different smoking status variables and mild to moderate/severe gingivitis. The majority of the participants were never-smokers, with current smokers being found most commonly in Kingston (33.22%), followed by San Juan (12.76%) and Santo Domingo (8.8%). Both current (aOR = 2.22, 95% confidence interval [1.45, 3.40]) and past (aOR = 1.87, 95% confidence interval [1.19, 2.93]) smoking (vs. never smoking) was strongly associated with severe gingivitis. Smoking was the most prevalent in Jamaicans and the least prevalent in Dominicans. The study population of current smokers was found to have a fourfold increased risk of severe gingivitis and a twofold increased risk of moderate gingivitis.
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Affiliation(s)
| | - James R. Collins
- School of Dentistry, Pontificia Universidad Católica Madre y Maestra, Santo Domingo, Dominican Republic
| | - Thaon Jones
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Michael Brache
- School of Dentistry, Pontificia Universidad Católica Madre y Maestra, Santo Domingo, Dominican Republic
| | - Milagros Toro
- School of Dental Medicine, Universidad de Puerto Rico, San Juan, Puerto Rico
| | - Sona Tumanyan
- School of Dental Medicine, Universidad de Puerto Rico, San Juan, Puerto Rico
| | | | - Sharon White
- University of the West Indies, Mona Campus, Kingston, Jamaica
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Waterpipe Tobacco Smoking and Associated Risk Factors among Bangladeshi University Students: An Exploratory Pilot Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractOver the past two decades, there has been a global rise in the prevalence of waterpipe tobacco smoking. Waterpipe tobacco smoking involves the inhalation of heated tobacco smoke after passing through water, and it has been associated with an identified dependence effect similar to that found with cigarette smoking. Despite the popularity of waterpipe tobacco among youth (and in particular, university students) in many countries, detailed data of its usage are lacking in Bangladesh. Therefore, the present study was conducted to explore waterpipe tobacco smoking behavior and normative beliefs among university students in Bangladesh and to assess the factors associated with waterpipe tobacco use. A quantitative cross-sectional survey was carried out among 340 Bangladeshi university students (64.4% male; mean age 21.6 years). Among participants, 13.5% reported they had ever smoked tobacco from a waterpipe and 9.4% had it in past 30 days. Among past 30-day users, 72% were categorized as having waterpipe smoking dependence (n = 23). No females in the sample had ever smoked using a waterpipe. Maternal occupation, monthly expenditure, and regular smoking status were major predominant factors associated with waterpipe smoking behavior of the students. The study is of existential value given that there are no prior studies ever carried out in Bangladesh previously. Recommendations are provided based on the study’s findings, particularly in relation to what action is needed from universities in Bangladesh.
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Mostafa A, Mohammed HT, Hussein WM, Elhabiby M, Safwat W, Labib S, Aboul Fotouh A, Hoek J. Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses. Tob Control 2019; 28:475-478. [PMID: 29980654 PMCID: PMC6589487 DOI: 10.1136/tobaccocontrol-2018-054494] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS. METHODS We conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis. RESULTS Participants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users. CONCLUSIONS Our exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Tallah Mohammed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Wafaa Mohamed Hussein
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Elhabiby
- Department of Psychiatry Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wael Safwat
- Egyptian Tobacco Control Coalition, Cairo, Egypt
- Egypt Health Foundation, Cairo, Egypt
| | - Sahar Labib
- Tobacco Control Unit, Ministry of Health, Cairo, Egypt
| | - Aisha Aboul Fotouh
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, New Zealand
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14
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Khemiss M, Ben Fekih D, Ben Khelifa M, Ben Saad H. Comparison of Periodontal Status Between Male Exclusive Narghile Smokers and Male Exclusive Cigarette Smokers. Am J Mens Health 2019; 13:1557988319839872. [PMID: 30902035 PMCID: PMC6440045 DOI: 10.1177/1557988319839872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Studies evaluating the effects of narghile use on the periodontium present conflicting conclusions. This study aimed to compare the periodontal status of exclusive narghile smokers (ENSs, n = 74) to that of exclusive cigarette smokers (ECSs, n = 74). Males aged 20-40 years were recruited to participate in this comparative study. Information concerning oral health habits (number of yearly visits to the dentist, daily toothbrushing frequency) and tobacco exposure were obtained. Clinical measurements were performed on all the existing teeth, except the third molars. The number of remaining teeth and decayed/missing/filled teeth (DMFT) were noted. The plaque levels were recorded using the plaque index of Löe and Silness. The gingival index modified by Löe was used to evaluate gingival inflammation. Teeth mobility was measured using bidigital mobility. The probing pocket depth was measured using a periodontal probe. Periodontal disease was defined as the presence of at least 10 sites with a probing depth ≥5 mm. Student's t and chi-square tests were used to compare, respectively, the two groups' quantitative and qualitative data. The two groups were matched for quantities of used tobacco, age, daily toothbrushing frequency, teeth mobility, number of remaining teeth, plaque index, and DMFT. Compared to the ECS group, the ENS group had a significantly lower number of yearly visits to the dentist (mean ± SD: 0.2 ± 0.5 vs. 0.1 ± 0.2), lower probing pocket depth (mean ± SD: 2.33 ± 0.63 vs. 2.02 ± 0.80 mm), and gingival index (median [interquartile]: 0.46 [0.10-0.89] vs. 0.00 [0.00-0.50]), and it included significantly lower percentages of smokers with periodontal disease (24.3% vs. 9.5%). In conclusion, chronic exclusive narghile smoking has fewer adverse effects on the periodontium than chronic exclusive cigarette smoking.
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Affiliation(s)
- Mehdi Khemiss
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia,Research Laboratory N8 LR12SP10: Maxilla Functional and Aesthetic Rehabilitation, Farhat Hached University Hospital of Sousse, Tunisia
| | - Dalila Ben Fekih
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia
| | - Mohamed Ben Khelifa
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia,Research Laboratory N8 LR12SP10: Maxilla Functional and Aesthetic Rehabilitation, Farhat Hached University Hospital of Sousse, Tunisia
| | - Helmi Ben Saad
- Université de Sousse, Hôpital Farhat Hached, Service de Physiologie et Explorations Fonctionnelles, Tunisia,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, Tunisia,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology, Faculty of Medicine of Sousse, Rue Mohamed Karoui, Sousse, Tunisia.
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15
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Hasni Y, Bachrouch S, Mahjoub M, Maaroufi A, Rouatbi S, Ben Saad H. Biochemical Data and Metabolic Profiles of Male Exclusive Narghile Smokers (ENSs) Compared With Apparently Healthy Nonsmokers (AHNSs). Am J Mens Health 2019; 13:1557988319825754. [PMID: 30819065 PMCID: PMC6440044 DOI: 10.1177/1557988319825754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023] Open
Abstract
Studies evaluating the metabolic profiles of ENSs are scarce and presented controversial conclusions. This study aimed to compare the metabolic profiles of ENSs' and AHNSs' groups. Males aged 25-45 years and free from a known history of metabolic and/or cardiovascular diseases were included. According to the smoking status, two groups of ENSs and AHNSs were identified. Body mass index (BMI, kg/m2), waist circumference (WC, cm), systolic and diastolic blood pressures (SBP, DBP, mmHg), fasting blood data in mmol/L (blood glycemia [FBG], triglycerides [TG], total cholesterol [TC], high- and low- density lipoprotein cholesterol [HDL-C, LDL-C]) and obesity status were evaluated. The metabolic syndrome (MetS) was defined according to the 2006 International Diabetes Federation (IDF) recommendations. Data were expressed as mean ± standard deviation ( SD) or percentages. Compared to the AHNSs' group ( n = 29), the ENSs' one ( n = 29) had (a) higher values of BMI (26.5 ± 2.3 vs. 28.2 ± 3.6), WC (95 ± 7 vs. 100 ± 10), and TG (1.22 ± 0.40 vs. 1.87 ± 0.85); and (b) included a lower percentage of males having low HDL-C (82.7% vs. 62.0%), and higher percentages of males having obesity (6.9% vs. 37.9%) or hypertriglyceridemia (10.7% vs. 51.7%). Both the ENSs' and AHNSs' groups: (a) had similar values of FBG (5.38 ± 0.58 vs. 5.60 ± 0.37), TC (4.87 ± 1.16 vs. 4.36 ± 0.74), HDL-C (0.92 ± 0.30 vs. 0.82 ± 0.21), LDL-C (3.09 ± 0.98 vs. 2.92 ± 0.77), SBP (117 ± 9 vs. 115 ± 8), and DBP (76 ± 6 vs. 73 ± 7); and (b) included similar percentages of males having normal weight (17.2% vs. 31.0%); overweight (44.8% vs. 62.1%); android obesity (79.3% vs. 59.6%), hypertension (10.3% vs. 10.3%), hyperglycemia (37.9% vs. 48.2%), and MetS (51.7% vs. 34.5%). There is a need to monitor narghile use among male metabolic patients since it alters some components of the MetS.
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Affiliation(s)
- Yosra Hasni
- Department of Endocrinology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Sabrine Bachrouch
- Department of Endocrinology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Mohamed Mahjoub
- Department of Hospital Hygiene, University Hospital Farhat Hached, Sousse, Tunisia
| | - Amel Maaroufi
- Department of Endocrinology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratory of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, University Hospital Farhat Hached, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, University Hospital Farhat Hached, Sousse, Tunisia
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16
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Silveira ML, Hilmi NN, Conway KP. Reasons for Young Adult Waterpipe Use in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study. Am J Prev Med 2018; 55:650-655. [PMID: 30219210 DOI: 10.1016/j.amepre.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Waterpipe use is common among U.S. young adults (aged 18-24 years), with estimates considerably higher than other age groups. Although studies have examined attitudes and beliefs associated with waterpipe use, no study has examined reasons for use in a nationally representative sample. METHODS Using latent class analyses, this study examined subgroups based on self-reported reasons for use of past 30-day young adult (aged 18-24 years) waterpipe users (n=1,198) from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study. Data analyses were conducted in 2017. Covariates included sociodemographic characteristics, substance use, and internalizing and externalizing problems. RESULTS A three-class model was identified: Class 1 (socializing and flavors, 57%), Class 2 (many reasons [flavors, socializing, less harmful than cigarettes, and affordability], 20%), and Class 3 (socializing, 23%). Class 3 was considered the referent group. Compared with non-Hispanic whites, non-Hispanic blacks were less likely to belong to Class 1, whereas Hispanics were more likely to belong to Class 2. Compared with less than high school education, greater than high school education was associated with membership in Class 1; however, high school graduation was associated with membership in Class 2. Past-year alcohol users compared with non-users were less likely to belong to Class 2. Past 30-day poly-tobacco users compared with non-users were more likely to belong to Class 2. CONCLUSIONS This study revealed distinct classes of waterpipe users based on self-reported reasons for use. Findings inform targeted policies for waterpipe tobacco control as part of public health efforts to mitigate harms associated with tobacco use.
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Affiliation(s)
- Marushka L Silveira
- National Institute on Drug Abuse, NIH, Bethesda, Maryland; Kelly Government Solutions, Rockville, Maryland.
| | - Nahla N Hilmi
- National Institute on Drug Abuse, NIH, Bethesda, Maryland; Kelly Government Solutions, Rockville, Maryland
| | - Kevin P Conway
- National Institute on Drug Abuse, NIH, Bethesda, Maryland
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17
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Kothari S, Berg CJ. Reasons for use, potential use, or discontinued use of hookah among US young adult college students. Tob Prev Cessat 2018; 4. [PMID: 30272038 PMCID: PMC6159938 DOI: 10.18332/tpc/81860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given the increase in hookah use among young adults, characteristics of hookah use/users, as well as reasons for its use or discontinuation among young adults, are critical to understand. METHODS Data from a study of 18–25 year olds from seven Georgia colleges/universities (n=2865) were analyzed to examined: 1) differences in socio-demographics and other substance use among current (past 4 months), never, and former hookah users; 2) use characteristics among current users (e.g. device types/flavors used, quit intentions); and 3) reasons for use, potential use, and discontinued use among current, never, and former users. RESULTS Of the students, 56.3% were never users, 12.4% were current, and 31.3% former users. Correlates of being a current (vs never) user included being ‘other race’ (vs White), attending a historically black college/university (HBCU vs technical college), and use of other substances. Correlates of being a former (vs never) hookah user included being older (vs younger), being ‘other race’ (vs White), attending an HBCU (vs technical college), and use of other tobacco products, marijuana, or alcohol. Among current users, 73.7% reported no intention to quit; 26.2% attempted to quit in the past year. Two factors were identified regarding reasons for current use (flavors, social reasons): one factor regarding potential use among never users (related to flavors and social factors), and three factors regarding discontinued use (inconvenience, anti-tobacco attitude, social reasons). CONCLUSIONS Findings indicate the risk factors for hookah use and the importance of particular factors (e.g. flavors, social influences) relevant to regulation/policy.
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Affiliation(s)
- Shreya Kothari
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States
| | - Carla J Berg
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, United States.,Winship Cancer Institute, Emory University, Atlanta, United States
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18
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Mizher IY, Fawaqa SI, Sweileh WM. Prevalence and personal attitudes towards tobacco smoking among Palestinian healthcare professionals: a cross-sectional study. Addict Sci Clin Pract 2018; 13:17. [PMID: 30053911 PMCID: PMC6063017 DOI: 10.1186/s13722-018-0119-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about tobacco smoking behaviors of healthcare professionals in the Middle East where stress conditions are high and tobacco smoking regulations are either absent or loose. The objective of this study was to identify the prevalence of and attitudes toward tobacco smoking among healthcare professionals. METHODS Trained senior medical students conducted a cross-sectional survey study in all governmental and non-governmental hospitals in Nablus city (Palestine) using a self-administered questionnaire containing both open-and closed-ended questions. RESULTS In total, 708 healthcare professionals participated in the study. The mean age of the participants was 31.4 ± 9.6 years. Forty-five (6.4%) participants were ex-smokers, 419 (59.2%) were never smokers, and 244 (34.5%) were current tobacco smokers. One hundred and forty-two (58.2%) tobacco smokers reported that they smoke inside the hospital and 119 (48.8%) reported that they think of quitting smoking. Univariate analysis indicated that age, gender, marital status, family history of tobacco smoking, country of graduation, and night shifts were significantly associated with tobacco smoking status. No significant difference (p = 0.156) in prevalence of tobacco smoking was found between physicians and other healthcare professionals. Binary logistic regression indicated that older age, male gender, and having a positive family history of smoking were significant predictors of being a current tobacco smoker. Non-smokers had significantly higher frequency of patient counseling than current smokers. CONCLUSION Palestinian healthcare professionals have relatively higher prevalence of tobacco smoking compared to the general population. Urgent national intervention and strict implementation of "No Smoking Law" in health institutions and in public places are needed to root out this negative behavior.
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Affiliation(s)
- Isra Y. Mizher
- College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Shahd I. Fawaqa
- College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M. Sweileh
- Department of Physiology, Pharmacology, and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Jawad M, Eissenberg T, Salman R, Soule E, Alzoubi KH, Khabour OF, Karaoghlanian N, Baalbaki R, El Hage R, Saliba NA, Shihadeh A. Toxicant inhalation among singleton waterpipe tobacco users in natural settings. Tob Control 2018; 28:181-188. [PMID: 29807946 DOI: 10.1136/tobaccocontrol-2017-054230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Studies that assess waterpipe tobacco smoking behaviour and toxicant exposure generally use controlled laboratory environments with small samples that may not fully capture real-world variability in human behaviour and waterpipe products. This study aimed to conduct real-time sampling of waterpipe tobacco use in natural environments using an in situ device. METHODS We used the REALTIME sampling instrument: a validated, portable, self-powered device designed to sample automatically a fixed percentage of the aerosol flowing through the waterpipe mouthpiece during every puff. We recruited participants at café and home settings in Jordan and measured puffing behaviour in addition to inhalation exposure of total particulate matter (TPM), carbon monoxide (CO), nicotine, polycyclic aromatic hydrocarbons and volatile aldehydes. We correlated total inhaled volume with five selected toxicants and calculated the regression line of this relationship. RESULTS Averaged across 79 singleton sessions (52% male, mean age 27.0, 95% home sessions), sessions lasted 46.9 min and participants drew 290 puffs and inhaled 214 L per session. Mean quantities of inhaled toxicants per session were 1910 mg TPM, 259 mg CO, 5.0 mg nicotine, 117 ng benzo[a]pyrene and 198 ng formaldehyde. We found positive correlations between total inhaled volume and TPM (r=0.472; p<0.001), CO (r=0.751; p<0.001), nicotine (r=0.301, p=0.035) and formaldehyde (r=0.526; p<0.001), but a non-significant correlation for benzo[a]pyrene (r=0.289; p=0.056). CONCLUSIONS In the natural environment, waterpipe tobacco users inhale large quantities of toxicants that induce tobacco-related disease, including cancer. Toxicant content per waterpipe session is at least equal, but for many toxicants several magnitudes of order higher, than that of a cigarette. Health warnings based on early controlled laboratory studies were well founded; if anything our findings suggest a greater exposure risk.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, UK
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rola Salman
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.,Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Eric Soule
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan.,Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Nareg Karaoghlanian
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.,Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Rima Baalbaki
- Department of Chemistry, American University of Beirut, Beirut, Lebanon
| | - Rachel El Hage
- Department of Chemistry, American University of Beirut, Beirut, Lebanon
| | - Najat A Saliba
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.,Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.,Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
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20
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Brain‐derived neutrophic factor in adolescents smoking waterpipe: The Irbid TRY. Int J Dev Neurosci 2018; 67:14-18. [DOI: 10.1016/j.ijdevneu.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 12/11/2022] Open
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21
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Khayatzadeh-Mahani A, Breton E, Ruckert A, Labonté R. Banning shisha smoking in public places in Iran: an advocacy coalition framework perspective on policy process and change. Health Policy Plan 2017; 32:835-846. [PMID: 28369366 DOI: 10.1093/heapol/czx015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction Shisha smoking is a widespread custom in Iran with a rapidly growing prevalence especially among the youth. In this article, we analyze the policy process of enforcing a federal/state ban on shisha smoking in all public places in Kerman Province, Iran. Guided by the Advocacy Coalition Framework (ACF), we investigate how a shisha smoking ban reached the political agenda in 2011, how it was framed by different policy actors, and why no significant breakthrough took place despite its inclusion on the agenda. Methods We conducted a qualitative study using a case study approach. Two main sources of data were employed: face-to-face in-depth interviews and document analysis of key policy texts. We interviewed 24 policy actors from diverse sectors. A qualitative thematic framework, incorporating both inductive and deductive analyses, was employed to analyze our data. Results We found that the health sector was the main actor pushing the issue of shisha smoking onto the political agenda by framing it as a public health risk. The health sector and its allies advocated enforcement of a federal law to ban shisha smoking in all public places including teahouses and traditional restaurants whereas another group of actors opposed the ban. The pro-ban group was unable to neutralize the strategies of the anti-ban group and to steer the debate towards the health harms of shisha smoking. Our analysis uncovers three main reasons behind the policy stasis: lack of policy learning due to lack of agreement over evidence and related analytical conflicts between the two groups linked to differences in core and policy beliefs; the inability of the pro-ban group to exploit opportunities in the external policy subsystem through generating stronger public support for enforcement of the shisha smoking ban; and the nature of the institutional setting, in particular the autocratic governance of CHFS which contributed to a lack of policy learning within the policy subsystem. Conclusions Our research demonstrated the utility of ACF as a theoretical framework for analyzing the policy process and policy change to promote tobacco control. It shows the importance of accounting for policy actors' belief systems and issue-framing in understanding how some issues get more prominence in the policy-making process than others. Our findings further indicate a need for significant resources employed by the state through public awareness campaigns to change public perceptions of shisha smoking in Iran which is a deeply anchored cultural practice.
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Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Eric Breton
- EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France.,CNRS, UMR 6051, Arènes, team 1: Social and health care policies -population and inequality, Rennes, France
| | - Arne Ruckert
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.,Canada Research Chair, Globalization and Health Equity Research Unit, University of Ottawa, Ottawa, ON, Canada.,Faculty of Health Sciences, Flinders University of South Australia, Adelaide, Australia
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Al-Hemiery N, Dabbagh R, Hashim MT, Al-Hasnawi S, Abutiheen A, Abdulghani EA, Al-Diwan JK, Kak N, Al Mossawi H, Maxwell JC, Brecht ML, Antonini V, Hasson A, Rawson RA. Self-reported substance use in Iraq: findings from the Iraqi National Household Survey of Alcohol and Drug Use, 2014. Addiction 2017; 112:1470-1479. [PMID: 28238214 DOI: 10.1111/add.13800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/15/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the prevalence of tobacco, alcohol and drug use in Iraq using data from the Iraqi National Household Survey of Alcohol and Drug Use (INHSAD). DESIGN A cross-sectional survey was conducted using a multi-stage cluster sampling method. Trained surveyors conducted face-to-face household interviews. SETTING Iraq, from April 2014 to December 2014. PARTICIPANTS A total of 3200 adult, non-institutionalized Iraqi citizens residing across all 18 governorates of Iraq. MEASUREMENTS We estimated weighted prevalence and 95% confidence intervals (CIs) for life-time, past-year and past-month use of a variety of substances (tobacco, alcohol, prescription drugs and illicit drugs). For each substance, we also estimated whether individuals knew people who currently use the substance. FINDINGS Self-reported past-month tobacco use was 23.2% (95% CI = 21.40, 25.19). Past-month alcohol use was 3.2% (95% CI = 2.58, 3.93). Women reported significantly lower prevalence for both tobacco and alcohol use compared with men (P-value < 0.01 for both). Only 1.4% (95% CI = 0.67, 3.02) reported past-month non-medical use of any prescription drugs. None of the women reported using any illicit drugs, and only 0.2% (95% CI = 0.07, 0.49) of men reported using any illicit drugs in the past month. Approximately 90.5% (95% CI = 88.58, 92.11) knew someone who uses tobacco, 42.4% (95% CI = 39.53, 45.24) knew someone who drinks alcohol, 27.9% (95% CI = 25.53, 30.45) knew someone who uses medication outside a doctor's instructions and 9.2% (95% CI = 7.87, 10.75) knew someone who uses an illicit drug. CONCLUSIONS Psychoactive drug use is generally low in Iraq, tobacco being highest at an estimated 23.2%. Iraqi women report significantly less substance use than Iraqi men, which may be related to cultural gender norms. Discrepancy between self-report and 'knowing someone who uses a substance' suggests under-reporting in this population.
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Affiliation(s)
- Nesif Al-Hemiery
- Psychiatry Division, Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | - Rufaidah Dabbagh
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Mushtaq T Hashim
- Psychiatry Division, Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | | | - Ali Abutiheen
- Department of Family and Community, Medicine College of Medicine, Kerbala University, Iraq
| | | | - Jawad K Al-Diwan
- Department of Community Medicine, College of Medicine, University of Baghdad, Iraq
| | - Neeraj Kak
- University Research Co. LLC, Center for Human Services, Bethesda, ND, USA
| | - Hala Al Mossawi
- University Research Co. LLC, Center for Human Services, Bethesda, ND, USA
| | | | - Mary-Lynn Brecht
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Valerie Antonini
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Albert Hasson
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Richard A Rawson
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Tucktuck M, Ghandour R, Abu-Rmeileh NME. Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study. BMC Public Health 2017; 18:1. [PMID: 28693529 PMCID: PMC5504745 DOI: 10.1186/s12889-017-4524-0] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/20/2017] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND During the last two decades, waterpipe tobacco smoking (WTS), also known as hookah, witnessed a global increase in use, especially among youth. Little information is known about the burden of WTS among Palestinian youth. A cross-sectional study was conducted to estimate the prevalence of WTS and cigarette smoking and explore the associated factors among a sample of Palestinian university students. METHODS 1891 students, from five Palestinian universities in the West Bank and Gaza Strip, completed a self-administered, web-based survey in 2014-2015. The questionnaire, which was based on the Global Adults Tobacco Survey (GATS), had questions on WTS and cigarette smoking patterns and socio-demographic and university-related characteristics. Binary logistic regression analyses were computed to investigate associated factors with WTS and cigarette smoking. RESULTS 50.9% of the sample was women. The mean age was 20.1 ± 2.0. Overall, 30.0% of participants were current tobacco smokers and 33.4% reported ever smoking tobacco through a waterpipe. The prevalence of current WTS (24.4%) surpassed the prevalence of current cigarette smoking (18.0%), with a significantly higher prevalence among men compared to women. The gender gap for WTS (36.4% vs. 12.9%) was smaller than that for cigarette smoking (32.8% vs. 3.6%). Binary logistic regression models for the total sample (men and women) revealed that men were more likely to be current waterpipe and cigarette tobacco smokers compared to women (AOR = 4.20, 95% CI = 3.22-5.48, and AOR = 10.91, 95% CI = 7.25-16.42, respectively). Geographic area of residence, faculty of study and self-reported academic achievement were also associated with the likelihood of being current waterpipe and cigarette tobacco smokers. CONCLUSION A high prevalence of WTS was reported among our study sample, and it surpassed the prevalence of cigarette smoking. Interventions to curb the practice of tobacco smoking among Palestinian youth should be tailored differently to WTS and cigarette smoking, be gender-sensitive and specific and target the regional variation in the smoking behavior.
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Affiliation(s)
- Marina Tucktuck
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
| | - Niveen M. E. Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
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24
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Lopez AA, Eissenberg T, Jaafar M, Afifi R. Now is the time to advocate for interventions designed specifically to prevent and control waterpipe tobacco smoking. Addict Behav 2017; 66:41-47. [PMID: 27871044 DOI: 10.1016/j.addbeh.2016.11.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
Waterpipe tobacco usage is spreading rapidly worldwide, with reports of more youth being waterpipe users compared to adults. In many areas of the world, waterpipe usage surpasses cigarette smoking. Waterpipes and cigarettes are both mechanisms for inhalation of tobacco smoke and therefore have serious health consequences. However, because of the many differences between the two products, prevention and control strategies that have proven effective for cigarettes may not transfer readily to waterpipe. This report highlights the differences between waterpipes and cigarettes in toxicant exposure and physiologic effects, patterns of use, social norms, the extent of evidence, and the policy environment. There is little evidence to date around effective interventions for waterpipe prevention and control. The current state of evidence for intervention to curb or control waterpipe is at ground zero and critically needs attention from both scientists and policy makers. National and global efforts aimed at cigarette prevention have succeeded, particularly in developed countries. We suggest the time has come to harness what we know works for cigarette prevention and control and adapt it to tackle the growing epidemic of waterpipe tobacco use.
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Affiliation(s)
- A A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, USA; Department of Psychology, Virginia Commonwealth University, USA
| | - T Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, USA; Department of Psychology, Virginia Commonwealth University, USA
| | - M Jaafar
- Department of Health Promotion and Community Health, American University of Beirut, Lebanon
| | - R Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Lebanon.
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25
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Sidani JE, Shensa A, Naidu MR, Yabes JG, Primack BA. Initiation, Progression, and Sustained Waterpipe Use: A Nationally Representative Longitudinal Study of U.S. Young Adults. Cancer Epidemiol Biomarkers Prev 2017; 26:748-755. [PMID: 28082346 DOI: 10.1158/1055-9965.epi-16-0687-t] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Waterpipe tobacco smoking (WTS) is increasing in popularity despite evidence of harm and potential for dependence. Intervention development has been hampered by a lack of longitudinal, nationally representative data on usage patterns and factors independently associated with WTS initiation. Therefore, we aimed to characterize key transitions between WTS states in a nationally representative group of young adults, with particular attention to factors independently associated with initiation.Methods: Participants were randomly selected from a national probability-based panel representing 97% of the United States. A total of 1,785 adults ages 18 to 30 at baseline completed two Web-based surveys 18 months apart in 2013 and 2014. Assessments included knowledge of waterpipe tobacco smoke composition, positive and negative attitudes toward WTS, normative beliefs, intention to use waterpipe, and WTS behavior. We used multivariable logistic regression to assess the association between predictive factors and subsequent WTS initiation.Results: In fully adjusted models, overall knowledge about toxicants associated with WTS was not associated with subsequent WTS initiation. Similarly, negative attitudes and normative beliefs were not associated with WTS uptake. However, baseline positive attitudes were strongly and significantly associated with WTS initiation [adjusted OR (AOR) = 1.7; 95% confidence interval (CI), 1.2-2.3]. Similarly, baseline intention to use WTS was strongly associated with subsequent initiation (AOR = 7.0; 95% CI, 3.5-13.7).Conclusions: Prevention efforts may be most successful if they target individuals with clear intentions to use WTS and challenge positive attitudes surrounding WTS.Impact: Surveillance of WTS trajectories will help inform health care and policy surrounding this emerging risk behavior among U.S. young adults. Cancer Epidemiol Biomarkers Prev; 26(5); 748-55. ©2017 AACR.
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Affiliation(s)
- Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania. .,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maharsi R Naidu
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan G Yabes
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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26
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Vanyukov MM, Tarter RE, Conway KP, Kirillova GP, Chandler RK, Daley DC. Risk and resistance perspectives in translation-oriented etiology research. Transl Behav Med 2016; 6:44-54. [PMID: 27012252 DOI: 10.1007/s13142-015-0355-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Risk for a disorder and the mechanisms that determine its elevation, risk factors, are the focus of medical research. Targeting risk factors should serve the goal of prevention and treatment intervention. Risk, however, is but one of the aspects of liability to a disorder, a latent trait that encompasses effects of all factors leading to or from the diagnostic threshold. The coequal but opposite aspect of liability is resistance to a disorder. The factors that increase resistance and thus enable prevention or recovery may differ from those that elevate risk. Accordingly, there are nontrivial differences between research perspectives that focus on risk and on resistance. This article shows how this distinction translates into goals and methods of research and practice, from the choice of potential mechanisms tested to the results sought in intervention. The resistance concept also differs from those of "resilience" and "protective factors," subsuming but not limited to them. The implications of the concept are discussed using substance use disorder as an example and substantiate the need for biomedical research and its translation to shift to the resistance perspective.
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Affiliation(s)
- Michael M Vanyukov
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA.
| | - Ralph E Tarter
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Galina P Kirillova
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Dennis C Daley
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
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27
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Evans-Polce R, Lanza S, Maggs J. Heterogeneity of alcohol, tobacco, and other substance use behaviors in U.S. college students: A latent class analysis. Addict Behav 2016; 53:80-5. [PMID: 26476004 DOI: 10.1016/j.addbeh.2015.10.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/14/2015] [Accepted: 10/04/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify subgroups of college students with distinct profiles of traditional and alternative types of tobacco, alcohol, and other substance use and to examine how demographic characteristics and academic and social activities are associated with subgroup membership. METHODS We used latent class analysis to characterize subgroups of individuals in their fourth-year of college based on their patterns of seven substance use behaviors: extreme heavy episodic drinking (HED), cigarette use, cigar/cigarillo/little cigar use, smokeless tobacco use, hookah use, marijuana use, and non-medical prescription drug use. Demographic characteristics and academic and social activities were then incorporated as predictors of these latent classes. RESULTS We identified five classes defined by unique behavior patterns: (1) Non/Low Users, (2) Non-Hookah Tobacco Users, (3) Extreme HED & Marijuana Users, (4) Hookah and Marijuana Users, and (5) Poly-Substance Users. Being male, older, and involved in sports were associated with greater odds of being in the Poly-Substance User class compared to the Low/No User class, and participating in an honors society and reporting more positive peer relationships were associated with being in the Hookah and Marijuana User class compared to the Low/No User class. CONCLUSION Our findings of unique characteristics in the subgroups identified suggest that college substance users are a heterogeneous population requiring different targeted interventions. Of particular concern are subgroups with high rates of alternative tobacco products, as perceived risks of use may be inaccurate and this is not currently a focus of college substance use prevention interventions.
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28
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Sidani JE, Shensa A, Shiffman S, Switzer GE, Primack BA. Behavioral associations with waterpipe tobacco smoking dependence among US young adults. Addiction 2016; 111:351-9. [PMID: 26417942 PMCID: PMC4715762 DOI: 10.1111/add.13163] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/11/2015] [Accepted: 09/04/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Waterpipe tobacco smoking (WTS) is increasingly prevalent in the United States, especially among young adults. We aimed to (1) adapt items from established dependence measures into a WTS dependence scale for US young adults (the US Waterpipe Dependence Scale), (2) determine the factor structure of the items and (3) assess associations between scale values and behavioral use characteristics known to be linked to dependence. DESIGN Cross-sectional survey. SETTING United States. PARTICIPANTS A total of 436 past-year waterpipe tobacco users ages 18-30 years selected at random from a national probability-based panel. MEASUREMENTS Participants responded to six tobacco dependence items adapted for WTS in US populations. Behavioral use characteristics included factors such as frequency of use and age of initiation. FINDINGS Principal components analysis yielded an unambiguous one-factor solution. Approximately half (52.9%) of past-year waterpipe tobacco users received a score of 0, indicating that none of the six WTS dependence items were endorsed. Approximately one-quarter (25.4%) endorsed one dependence item and 22.7% endorsed two or more items. Higher WTS dependence scores were associated significantly with all five behavioral use characteristics. For example, compared with those who endorsed no dependence items, those who endorsed two or more had an adjusted odds ratio (AOR) of 3.90 [95% confidence interval (CI) = 1.56-9.78] for having had earlier age of initiation and an AOR of 32.75 (95% CI = 9.76-109.86) for more frequent WTS sessions. CONCLUSIONS Scores on a six-item waterpipe tobacco smoking dependence scale (the US Waterpipe Dependence Scale) correlate with measures that would be expected to be related to dependence, such as amount used and age of initiation.
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Affiliation(s)
- Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Galen E Switzer
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Departments of Medicine, Psychiatry, Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA.,Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA, USA
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29
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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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Schauer GL, King BA, Bunnell RE, Promoff G, McAfee TA. Toking, Vaping, and Eating for Health or Fun: Marijuana Use Patterns in Adults, U.S., 2014. Am J Prev Med 2016; 50:1-8. [PMID: 26277652 DOI: 10.1016/j.amepre.2015.05.027] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/12/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. METHODS Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. RESULTS Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. CONCLUSION Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning.
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Affiliation(s)
- Gillian L Schauer
- Carter Consulting, Inc., Contractor to Office on Smoking and Health, CDC, Atlanta, Georgia; Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia;.
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Rebecca E Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Gabbi Promoff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Timothy A McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Khabour O, Alzoubi KH, Abu Thiab TM, Al-Husein BA, Eissenberg T, Shihadeh A. Changes in the expression and protein level of matrix metalloproteinases after exposure to waterpipe tobacco smoke. Inhal Toxicol 2015; 27:689-93. [PMID: 26484568 PMCID: PMC4890709 DOI: 10.3109/08958378.2015.1085471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Waterpipe smoking has become a worldwide epidemic with health consequences that only now are beginning to be understood fully. Because waterpipe use involves inhaling a large volume of toxicant-laden smoke that can cause inflammation, some health consequences may include inflammation-mediated lung injury. Excess matrix metalloproteinase expression is a key step in the etiology of toxicant exposure-driven inflammation and injury. In this study, changes in the level and mRNA of major matrix metalloproteinases (MMP-1, -9, and -12) in the lungs of mice following exposure to waterpipe smoke were investigated. Balb/c mice were exposed to waterpipe smoke for one hour daily, over a period of 2 or 8 weeks. Control mice were exposed to fresh air only. ELISA and real-time PCR techniques were used to determine the protein and mRNA levels of MMP-1, -9, and -12 in the lungs. Our findings showed that MMP-1, -9, and -12 levels in the lung significantly increased after both 2 (p < 0.05) and 8 weeks (p < 0.01) exposures. Similarly, RT-PCR findings showed that mRNA of those proteinases significantly increased following 2 (p < 0.01) and 8 weeks (p < 0.001) exposures. In conclusion, waterpipe smoking is associated strongly with lung injury as measured by elevation in the expression of MMPs in the lung tissue.
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Affiliation(s)
- Omar Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H. Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Tuqa M. Abu Thiab
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Belal A. Al-Husein
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
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32
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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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Shepardson RL, Hustad JTP. Hookah Tobacco Smoking During the Transition to College: Prevalence of Other Substance Use and Predictors of Initiation. Nicotine Tob Res 2015; 18:763-9. [PMID: 26259986 DOI: 10.1093/ntr/ntv170] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The prevalence of hookah tobacco smoking is increasing, and the transition to college is a vulnerable time for initiation. Hookah use is associated with other forms of substance use, but most research has been cross-sectional, thus limiting our understanding of temporal patterns of use. The goals of this longitudinal study were to assess the prevalence of hookah use and initiation, as well as other forms of substance use among hookah users, and identify which forms of substance use predicted hookah initiation during the first 30 days of college. METHODS Incoming students (N = 936, 50% female) reported on past 30-day substance use prior to the start of the Fall 2011 semester and again 30 days later (n = 817). Substances included hookah, cigarettes, other forms of tobacco, alcohol, marijuana, and other illegal drugs. RESULTS Current prevalence of hookah use increased from 9.0% before college to 13.1% during the first month of college. At baseline and follow-up, current hookah users were more likely than nonusers to report current use of cigarettes, cigars/little cigars/clove cigarettes, smokeless tobacco, marijuana, and alcohol. Among pre-college hookah never users, 13.8% initiated hookah use in the first month of college. Alcohol (adjusted odds ratio [AOR] 1.11, 95% confidence interval [CI] 1.05, 1.17) and marijuana (AOR 1.30, 95% CI 1.03, 1.65) were the only substances predictive of hookah initiation. CONCLUSIONS Findings indicate that hookah prevention and intervention is needed during the transition to college, and interventions may need to address comorbid alcohol, marijuana, and hookah use. IMPLICATIONS To our knowledge this is the first longitudinal study examining predictors of hookah initiation among male and female incoming first-year college students. While hookah users were more likely than nonusers to use all other substances before and during the first month of college, pre-college marijuana and alcohol use were the only two predictors of hookah initiation during the first 30 days of college. Collectively, these findings provide additional support for the need for efficacious hookah prevention and intervention programs. The transition to college appears to be an ideal time to deliver prevention programs given the increased prevalence of hookah use during the first 30 days of college. In addition to prevention, former users may benefit from targeted relapse prevention as one-fifth of former hookah smokers resumed use during the first 30 days of college.
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Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY;
| | - John T P Hustad
- Department of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
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Grinberg A. Subjective well-being and hookah use among adults in the United States: A nationally-representative sample. Drug Alcohol Depend 2015; 153:242-9. [PMID: 26099176 DOI: 10.1016/j.drugalcdep.2015.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Using a nationally-representative dataset of adults 18-30 years old in the United States, this study examined the relationship between hookah use and subjective well-being. Levels of sadness, happiness, tiredness, pain, and stress were compared between persons who have used hookah and those who have not. METHODS Data were merged from the Tobacco Use Supplement of the Current Population Survey, the American Time Use Survey, and the Subjective Well-being Supplement to the American Time Use Survey for the years 2010-2012 for persons 18-30 years old (n=1147). Wald tests were used to compare mean differences in subjective well-being between hookah users and non-users. Lastly, multivariable regression was used to determine whether there were significant differences in subjective well-being between hookah users and non-users, controlling for demographic factors, self-perceived health, and cigarette smoking. RESULTS The lifetime prevalence rate of hookah use was 5.2% among 18-30 year olds. Hookah users reported higher levels of stress and sadness than non-users. These relationships remained significant after controlling for demographic characteristics, self-perceived health, and cigarette use. The results were robust to the use of different statistical models, different age cut-offs, the inclusion of additional covariates (such as income and population density), and separate analyses by sex. CONCLUSIONS Hookah use is an emerging public health issue associated with increased levels of stress and sadness. Similar to cigarette use, healthcare providers may consider expanding their screening tests to include hookah use. Public policy geared toward greater prevention and control of hookah use is also recommended.
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Affiliation(s)
- Alice Grinberg
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA.
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Haddad L, El-Shahawy O, Ghadban R, Barnett TE, Johnson E. Waterpipe Smoking and Regulation in the United States: A Comprehensive Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6115-35. [PMID: 26110330 PMCID: PMC4483691 DOI: 10.3390/ijerph120606115] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Researchers in tobacco control are concerned about the increasing prevalence of waterpipe smoking in the United States, which may pose similar risks as cigarette smoking. This review explores the prevalence of waterpipe smoking in the United States as well as the shortcomings of current U.S. policy for waterpipe control and regulation. METHODS Researchers conducted a literature review for waterpipe articles dated between 2004 and 2015 using five online databases: MEDLINE, CINHAHL, ScienceDirect, PMC, and Cochrane Library. RESULTS To date, few studies have explored the marketing and regulation of waterpipe smoking in the U.S., which has increased in the last ten years, especially among women, adolescents, and young adults. Data indicate that the majority of waterpipe smokers are unaware of the potential risks of use. In addition, current tobacco control policies do not address waterpipe smoking, enabling tobacco companies to readily market and sell waterpipe products to young adults, who are at risk for becoming lifelong smokers. CONCLUSION Policy makers in the area of public health need to update existing tobacco regulations to include waterpipe smoking. Similarly, public health researchers should develop public health campaigns and interventions to address the increasing rates of waterpipe smoking in the United States.
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Affiliation(s)
- Linda Haddad
- College of Nursing, University of Florida, Gainesville, FL 32610, USA.
| | - Omar El-Shahawy
- Social and Behavioral Health Department, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA.
| | - Roula Ghadban
- School of Nursing, Virginia Commonwealth University, 821 West Franklin Street, Richmond, VA 23284, USA.
| | - Tracey E Barnett
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA.
| | - Emily Johnson
- College of Health and Human Performance, University of Florida, Gainesville, FL 32610, USA.
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Sterling KL, Fryer CS, Majeed B, Duong MM. Promotion of waterpipe tobacco use, its variants and accessories in young adult newspapers: a content analysis of message portrayal. HEALTH EDUCATION RESEARCH 2015; 30:152-61. [PMID: 24957675 PMCID: PMC4296886 DOI: 10.1093/her/cyu035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
The objective of our study was to identify waterpipe tobacco smoking advertisements and those that promoted a range of products and accessories used to smoke waterpipe tobacco. The content of these advertisements was analyzed to understand the messages portrayed about waterpipe tobacco smoking in young adult (aged 18-30) newspapers. The study methods include monitoring of six newspapers targeting young adults from four major cities in the Southeastern United States over a 6-month period. A total of 87 advertisements were found; 73.5% (64) were distinct and content analyzed. The study results showed that of the advertisements analyzed, 25% advertised waterpipe tobacco smoking, 54.7% featured waterpipe tobacco smoking and other tobacco use, 14.1% featured non-tobacco waterpipe variants (i.e. vaporizers), and 6.3% featured waterpipe apparatus accessories (e.g. charcoal, hoses). The sociability (34%) and sensuality (29.7%) of waterpipe smoking were promoted themes. Alternative to cigarette use messages (3.1%), and harm-reduction messages (17.1%) emphasized that smoking waterpipe tobacco using the featured accessory or waterpipe variant was a healthier experience than cigarette smoking. The study concluded that the messages that promoted waterpipe tobacco smoking to young adults are parallel to those used to promote cigarette use. Tobacco control professionals should continue to monitor young adult newspapers as a source of waterpipe-related advertising.
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Affiliation(s)
- Kymberle L Sterling
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30033, USA and Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742-2611, USA
| | - Craig S Fryer
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30033, USA and Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742-2611, USA
| | - Ban Majeed
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30033, USA and Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742-2611, USA
| | - Melissa M Duong
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30033, USA and Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742-2611, USA
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Akl EA, Ward KD, Bteddini D, Khaliel R, Alexander AC, Lotfi T, Alaouie H, Afifi RA. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control 2015; 24 Suppl 1:i13-i21. [PMID: 25618895 PMCID: PMC4345979 DOI: 10.1136/tobaccocontrol-2014-051906] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review. Data sources The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms. Study selection Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years. Data extraction Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results. Data synthesis The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels. Conclusions The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.
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Affiliation(s)
- E A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - K D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - D Bteddini
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R Khaliel
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - A C Alexander
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - T Lotfi
- Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - H Alaouie
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R A Afifi
- 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: 357] [Impact Index Per Article: 35.7] [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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Goodwin RD, Grinberg A, Shapiro J, Keith D, McNeil MP, Taha F, Jiang B, Hart CL. Hookah use among college students: prevalence, drug use, and mental health. Drug Alcohol Depend 2014; 141:16-20. [PMID: 24882367 DOI: 10.1016/j.drugalcdep.2014.04.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/08/2014] [Accepted: 04/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is consistent evidence that hookah use is as, if not more, harmful than cigarette use. Yet, hookah users underestimate the potential deleterious effects of hookah use. This study examined the rates of hookah use and associated demographic characteristics in a sample of undergraduates at a small Northeastern university. This study also examined the relationships between hookah use and other substance use, mental health problems, and perceived levels of stress. METHODS Data were drawn from the Spring 2009 American Health Association-National College Health Assessment (ACHA-NCHA) at one small, Northeastern university (N=1799). The relationships between hookah use and other substance use, mental health problems, and perceived stress levels were examined using logistic regression analyses. RESULTS Hookah use (in the past month) was reported among 14.1% (253/1799) of this sample of undergraduates. Hookah users were more likely to use other substances, including cigarettes, cannabis, alcohol, cocaine, and amphetamines. The strongest associations emerged between hookah use and alcohol and cigarette use. There were no significant associations found between hookah use and any mental health problems or perceived stress levels. CONCLUSIONS Hookah users are significantly more likely to use other substances, including alcohol, cigarettes, cannabis, cocaine, and amphetamines compared with non-hookah users. In contrast to cigarette smoking, hookah use does not appear to be associated with mental health problems or perceived stress levels in this sample of undergraduates. Further investigation into the prevalence and correlates of hookah use is needed in representative population samples.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.
| | - Alice Grinberg
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA
| | - Jack Shapiro
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Diana Keith
- Department of Psychology, Columbia University, New York, NY, USA
| | - Michael P McNeil
- Health Promotion and Student Health Department, Columbia University, New York, NY, USA
| | - Farah Taha
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA
| | - Bianca Jiang
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367, USA
| | - Carl L Hart
- Department of Psychology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Sutfin EL, Song EY, Reboussin BA, Wolfson M. What are young adults smoking in their hookahs? A latent class analysis of substances smoked. Addict Behav 2014; 39:1191-6. [PMID: 24746345 PMCID: PMC4091668 DOI: 10.1016/j.addbeh.2014.03.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 01/14/2023]
Abstract
RATIONALE Hookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked. METHODS In fall 2010, 3447 students from 8 colleges in N.C. completed an online survey. RESULTS 44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first. CONCLUSIONS Rates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
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Alberg AJ, Shopland DR, Cummings KM. The 2014 Surgeon General's report: commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking. Am J Epidemiol 2014; 179:403-12. [PMID: 24436362 DOI: 10.1093/aje/kwt335] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The question of whether cigarette smoking was associated with lung cancer was central to the expansion of epidemiology into the study of chronic diseases in the 1950s. The culmination of this era was the 1964 report of the Advisory Committee to the Surgeon General, a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria. The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that "remedial action" was warranted at the societal level. The 2014 Surgeon General's report commemorates the 50th anniversary of the 1964 report. The evidence on the health consequences of smoking has been updated many times in Surgeon General's reports since 1964. These have summarized our increasingly greater understanding of the broad spectrum of the deleterious health effects of exposure to tobacco smoke across most major organ systems. In turn, this evidence has been translated into tobacco control strategies implemented to protect the public's health. The Surgeon General report process is an enduring example of evidence-based public health in practice. Substantial progress has been made, but cigarette smoking remains one of the most pressing global health issues of our time.
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Eissenberg T. What can waterpipe tobacco smoking teach us about the need for a more rapid response to emerging non-communicable disease risks? Addiction 2013; 108:1885-6. [PMID: 24118755 DOI: 10.1111/add.12296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA, 23298, USA.
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Affiliation(s)
- Olivia M. Maynard
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology
- MRC Integrative Epidemiology Unit
| | - Suzanne H. Gage
- MRC Integrative Epidemiology Unit
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology
- MRC Integrative Epidemiology Unit
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Jawad M, McEwen A, McNeill A, Shahab L. The importance of addressing waterpipe tobacco smoking: research and policy responses. Addiction 2013; 108:1887-8. [PMID: 24118757 DOI: 10.1111/add.12341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK.
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