Water pipe smoking and its association with cigarette and cannabis use in young adults in Switzerland

Addictive profiles of Lebanese university students in terms of smoking, alcohol, and illegal drug use

The Lebanese economic crisis, financial crisis, and USD shortage were conducive to an increased drug addiction especially for students who feel that their future in Lebanon is not safe, as well as the psychological fragility of the Lebanese people, and the more permissive sociocultural context. Our study aimed to assess the addiction levels and profiles of university students in Lebanon, and thus to evaluate the rapid rising in dependence regarding smoking, alcohol, and illegal drug use during this crisis. This cross-sectional study was carried out between February and September 2020. A total of 467 participants (315 females, 152 males; Mage = 23.48 ± 6.03) were recruited through convenience sampling through several universities in Lebanon's governorates. Participants received the online link to the survey. Students were divided into three clusters as follows: cluster 1, which corresponds to students with moderate addictions; cluster 2, which corresponds to students with high addictions; and cluster 3, which corresponds to students with low addictions. When comparing cluster 1 to cluster 3, the results of the multinomial regression showed that older age (aOR=1.08) and having a high monthly income compared to no income (aOR=2.78) were significantly associated with higher odds of being in cluster 1 compared to cluster 3. When comparing cluster 2 to cluster 3, the results of the multinomial regression showed that female gender (aOR=0.19) was significantly associated with lower odds of being in cluster 2 compared to cluster 3, whereas having a dead (aOR=16.38) or divorced parent (aOR=6.54) and having a low (aOR=3.93) or intermediate income compared to zero income (aOR=4.71) were significantly associated with higher odds of being in cluster 2 compared to cluster 3. The results of our study revealed a considerable prevalence of addiction to alcohol, illicit drugs, and specially to smoking, among Lebanese university students. These findings emphasize the need to implement firm policies and rules in an attempt to minimize the tendency of the young population to engage in such addictions.

Association between cumulative cigarette and Waterpipe smoking and symptoms of dependence in Lebanese adults

BACKGROUND

Waterpipe and cigarette smoking dependence are becoming increasingly prevalent forms of addiction globally. This study examined whether cumulative cigarette smoking and cumulative waterpipe smoking are associated with higher dependence on both cigarettes and waterpipe.

METHODS

This cross-sectional study conducted between February and April 2020, enrolled 363 participants drawn from all Lebanese districts. The mean age was 29.51 years, 64.8% were females, and 124 (34.2%) exclusive cigarette smokers, 189 (52.1%) exclusive waterpipe smokers, and 50 (13.8%) dual smokers (waterpipe and cigarette). We used the Hooked on Nicotine Checklist (HONC) as an indicator of decreased autonomy towards nicotine, in addition to the Lebanon Waterpipe Dependence Scale-11 (LWDS11) and the Lebanese Cigarette Dependence scale (LCD). A stepwise linear regression was performed taking the HONC scores due to cigarette and waterpipe smoking, LCD and LWDS-11 scores as dependent variables.

RESULTS

The results showed that in the total sample, higher cumulative cigarette smoking (B = 0.005 with a confidence interval of 0.004, 0.006) was significantly associated with higher HONC cigarette scores, whereas higher cumulative waterpipe smoking (B = -0.006 with a confidence interval of - 0.009, - 0.002) was significantly associated with lower HONC cigarette scores. Moreover, higher cumulative waterpipe smoking (B = 0.012 with a confidence interval of 0.009,0.015) was significantly associated with higher HONC waterpipe scores. The results showed that, in both sexes, higher cumulative cigarette smoking was associated with higher HONC cigarette scores and lower HONC waterpipe scores. Furthermore, higher cumulative waterpipe smoking was significantly associated with higher HONC waterpipe scores in both sexes.

CONCLUSION

Our study supports the fact that heavy nicotine consumption, related to both the increased frequency and smoking duration, can increase the risk of dependence. It raises the need for strategic plans to minimize and discourage the use of nicotine products in Lebanese community settings.

Genetic Vulnerability for Smoking and Cannabis Use: Associations With E-Cigarette and Water Pipe Use

INTRODUCTION

Cigarette smoking and cannabis use are heritable traits and share, at least in part, a common genetic substrate. In recent years, the prevalence of alternative methods of nicotine intakes, such as electronic cigarette (e-cigarette) and water pipe use, has risen substantially. We tested whether the genetic vulnerability underlying cigarettes smoking and cannabis use explained variability in e-cigarette and water pipe use phenotypes, as these vaping methods are alternatives for smoking tobacco cigarettes and joints.

METHODS

On the basis of the summary statistics of the International Cannabis Consortium and the Tobacco and Genetics Consortium, we generated polygenic risk scores (PRSs) for smoking and cannabis use traits, and used these to predict e-cigarette and water pipe use phenotypes in a sample of 5025 individuals from the Netherlands Twin Register.

RESULTS

PRSs for cigarettes per day were positively associated with lifetime e-cigarette use and early initiation of water pipe use, but only in ex-smokers (odds ratio = 1.43, R2 = 1.56%, p = .011) and never cigarette smokers (odds ratio = 1.35, R2 = 1.60%, p = .013) respectively.

CONCLUSIONS

Most associations of PRSs for cigarette smoking and cannabis use with e-cigarette and water pipe use were not significant, potentially due to a lack of power. The significant associations between genetic liability to smoking heaviness with e-cigarette and water pipe phenotypes are in line with studies indicating a common genetic background for substance-use phenotypes. These associations emerged only in nonsmokers, and future studies should investigate the nature of this observation.

IMPLICATIONS

Our study showed that genetic vulnerability to smoking heaviness is associated with lifetime e-cigarette use and age at initiation of water pipe use. This finding has implications for the current debate on whether alternative smoking methods, such as usage of vaping devices, predispose to smoking initiation and related behaviors.

Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults' intention to quit waterpipe tobacco smoking

Background

Theory of planned behavior (TPB) is one of the most widely used theoretical frameworks to explain addictive behaviors, such as tobacco smoking. The aim of this study is to develop and validate an instrument based on TPB variables to measure factors influencing Iranian rural adults’ intention to quit waterpipe tobacco smoking.

Methods

This study was performed on a sample of rural adult waterpipe consumers living in two villages in Shiraz, Southern Iran. In the beginning, the initial items of instrument were extracted from the literature review and interviews with 20 waterpipe consumers. After that, face validity and qualitative content validity of the items were appraised. To measure quantitative content validity index (CVI) and the content validity ratio (CVR), a panel of experts reviewed the items. In addition, the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to characterize the construct validity of the instrument. Finally, Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were computed.

Results

CVI and CVR of items were within the ranges of 0.89–0.95 and 0.85–0.96, respectively. EFA indicated the Kaiser-Meyer-Olkin (=0.71) and Bartlett’s test of sphericity was significant (=912.36, df=105, p<0.0001). Principal component analysis revealed that 15 items could be grouped into four subscales that accounted for 64.97% of the variance. Based on CFA, two items were deleted. CFA results showed that the remained data were fit to the model. The Cronbach’s alpha and ICC of subscales were, respectively, in the ranges of 0.72–0.87 and 0.64–0.82. Finally, a 13-item instrument with four subscales was confirmed.

Conclusions

The findings reveal that the developed TPB instrument is a reliable and valid scale to identify the determinants of the intention to quit waterpipe smoking among Iranian rural adults.

Lifetime prevalence and correlates of smoking behavior in Iranian adults' population; a cross-sectional study

ABSTACT

BACKGROUND: There are few if any reports concerning the joint use of waterpipe, cigarette and exposure to second-hand smoking in Tehran, Iran. Here, we simultaneously investigated the prevalence and predictors of smoking habits in Iranian adults.

METHODS

In this population-based cross-sectional study, we recruited 1057 Iranian adults between August 2013 and February 2015, in Tehran, a multi-ethnic city. Participants were selected using random digit dialing. Three separate logistic regression models were applied to estimate the adjusted odds ratios (95% CI).

RESULTS

Exposure to second-hand smoking was the most prevalent smoking type (37, 95% CI: 35-41%) followed by cigarette (23.9% (95% CI: 21-27%)) and water-pipe smoking (20.25% (95% CI: 18-23%)) in adults in Tehran. Almost 3.3 and 4.5% of adults reported three and two types of lifetime smoking behaviors, respectively. Age, sex, history of depression along with lifetime alcohol intake was the important predictors of all three types of smoking. Lifetime alcohol consumption was associated with increased prevalence of all three types of smoking (p for trend < 0.009). Lifetime drug abuse was also associated with increased prevalence of cigarette smoking (OR = 2.04, 95% CI: 1.61-2.59, p < 0.001).

CONCLUSIONS

Lifetime prevalence of waterpipe, cigarette and exposure to second-hand smoking is moderately high. Dual smoking behaviors are increasing in Iranian adults. An apparent age-related difference in pattern of waterpipe and cigarette smoking was observed. These findings highlight the need for further educational and preventive programs especially for dual smoking in Iranian young adults. This could provide practical information for evaluating and reforming the tobacco control programs and policies in Iran.

Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents

INTRODUCTION

Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents 'attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use.

METHODS

Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis.

RESULTS

Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one's owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents' and siblings' smoking behaviors influenced adolescent waterpipe use.

CONCLUSION

Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.

Airway reactivity to mannitol is similarly increased in chronic cigarette and water pipe smokers

Background

In contrast to cigarette smoking, the association between water pipe smoking and airway hyperresponsiveness remains widely unexplored.

Methods

A bronchoprovocation challenge with mannitol was performed in young adults recruited at the University of Basel, Switzerland. Subjects were categorized as acute water pipe smokers (single episode of water pipe smoking, no or <0.5 pack-years cigarette smoking); chronic water pipe smokers (weekly for ≥4 weeks, no or <0.5 pack-years cigarette smoking); cigarette smokers (no water pipe smokers); and never-smokers (no cigarette or water pipe smokers). Primary outcomes were airway reactivity as measured by the response-to-dose ratio (RDR) and airway responsiveness measured by the provocation dose to cause a 15% fall in forced expiratory volume in 1s (FEV₁; PD₁₅).

Results

Seventy-four subjects with a mean age of 22.5±2.5 years and FEV₁ % predicted 90.1%±8.6% were included. Subgroups were matched in terms of age, gender, and spirometry results. RDR in chronic water pipe smokers and cigarette smokers was similar (0.013%/mg [0.010–0.015] vs 0.023%/mg [0.011–0.051], respectively; p=0.12) but significantly higher than in never-smokers (0.007%/mg [0.005–0.010], p<0.01). Neither a history of asthma (p=0.88) nor a positive skin prick test (p=0.69) was associated with increased airway reactivity to the mannitol challenge test. PD₁₅ differed significantly between cigarette smokers and never-smokers (155 mg [115–395] vs 315 mg [155–475], respectively; p=0.04).

Conclusion

Weekly water pipe smoking may increase airway reactivity to a similar extent as cigarette smoking.

Use of a water pipe is not an alternative to other tobacco or substance use among adolescents: results from a national survey in Sweden

INTRODUCTION

Studies of social characteristics and substance use patterns among young users of water pipe are rare in Western countries, and no such study has been conducted in Sweden.

METHODS

Cross-sectional study based on a national survey conducted in 2011, including 4,710 primary school students (15 years of age) and 3,624 high school students (17 years of age). Prevalence of lifetime and current water pipe use was compared among subgroups defined by other substance use, that is, cigarettes, snus, alcohol, and illicit drugs. Logistic regression was employed to calculate odds ratios (OR) of water pipe use and corresponding 95% confidence intervals (CI), conditionally on sociodemographic characteristics.

RESULTS

Use of water pipe was associated with the use of other substances in both age groups. In particular, current use of water pipe at the age of 15 years was strongly associated with current cigarette smoking (OR = 6.46; CI = 5.13-8.14); use of snus (OR = 5.62; CI = 3.94-7.96); binge drinking (OR = 7.39; CI = 5.88-9.31); drunkenness (OR = 7.05; CI = 5.60-8.88); and recent use of illicit drugs (OR = 14.20; CI = 9.18-22.19). Annual alcohol consumption predicted water pipe use in a dose-response fashion. Cigarette smokers willing to quit used water pipe to a lower extent than smokers who did not intend to quit. Being an exclusive smoker of water pipe was associated with substance use when compared with a nonsmoker of tobacco, but not when compared with an exclusive smoker of cigarettes.

CONCLUSIONS

Water pipe use among adolescents in Sweden is not a recreational tobacco use alternative to cigarettes and should be regarded as a marker of multiple substance use.