Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers

Prognostic value of the ratio of pretreatment carcinoembryonic antigen to tumor volume in rectal cancer

Background

As a commonly used biomarker in rectal cancer (RC), the prognostic value of carcinoembryonic antigen (CEA) remains underexplored. This study aims to evaluate the prognostic value of pretreatment CEA/tumor volume in RC.

Methods

This retrospective study included patients who underwent pretreatment magnetic resonance imaging (MRI) with histologically confirmed primary rectal adenocarcinoma from November 2012 to April 2018. Patients were divided into high-risk and low-risk groups according to the median values of CEA/Diapath (CEA to pathological diameter), CEA/DiaMRI (CEA to MRI tumor diameter), and CEA/VolMRI (CEA to MRI tumor volume). Cox regression analysis was utilized to determine the prognostic value of CEA, CEA/Diapath, CEA/DiaMRI, and CEA/VolMRI. Stepwise regression was used to establish nomograms for predicting disease-free survival (DFS) and overall survival (OS). Predictive performance was estimated by using the concordance index (C-index) and area under curve receiver operating characteristic (AUC).

Results

A total of 343 patients [median age 58.99 years, 206 (60.06%) males] were included. After adjusting for patient-related and tumor-related factors, CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in distinguishing high-risk from low-risk patients in terms of DFS [hazard ratio (HR) =1.83; P=0.010] and OS (HR =1.67; P=0.048). Subanalysis revealed that CEA/VolMRI stratified high death risk in CEA-negative individuals (HR =2.50; P=0.038), and also stratified low recurrence risk in CEA-positive individuals (HR =2.06; P=0.024). In the subanalysis of stage II or III cases, the highest HRs and the smallest P values were observed in distinguishing high-risk from low-risk patients according to CEA/VolMRI in terms of DFS (HR =2.44; P=0.046 or HR =2.41; P=0.001) and OS (HR =1.96; P=0.130 or HR =2.22; P=0.008). The nomograms incorporating CEA/VolMRI showed good performance, with a C-index of 0.72 [95% confidence interval (CI): 0.68-0.79] for DFS and 0.73 (95% CI: 0.68-0.80) for OS.

Conclusions

Higher CEA/VolMRI was associated with worse DFS and OS. CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in predicting DFS and OS. Pretreatment CEA/VolMRI may facilitate risk stratification and treatment decision-making.

Comparison of Urinary Heavy Metals and Pulmonary Function Test in Cafe Workers Based on Exposure to Secondhand Tobacco Smoke, Tehran 2021

Background

Secondhand tobacco smoke exposure is one of the morbidity causes but it is ignored occasionally. Various studies have shown that hookah and cigarette smoke contain significant volume of heavy metals. This study was designed aiming biological monitoring of the level of heavy metals in the urine samples of workers in smoking cafés and its association with their lung function and respiratory symptoms in Tehran City.

Methods

The list of cafés in Tehran was provided, and they were divided into water pipe cafés (WPC), cigarette smoking cafés (CSC), and non-smoking cafés (NSC); and then, 10 cafés were randomly selected from each group. Sampling was performed after explaining the study and obtaining the consent of the manager and staff. A check list of demographic data and smoking history was completed and analyzed.

Results

A total of 96 individuals were studied; there were 32 subjects in each group. All subjects were male. Six days a week, they worked about 10 h a day in café. The concentration of heavy metals in the groups of hookah and cigarettes was significantly higher and respiratory indices in these groups were significantly lower than non-smoking group.

Conclusions

Exposure to secondhand smoke increases the urinary level of heavy metals and reduces the respiratory capacity of people and this can be highly pathogenic in the future. Comprehensive informing on human rights should be provided in this regard and smoking bans in public places must be properly enforced.

Sources of variation and establishment of Russian reference intervals for major hormones and tumor markers

OBJECTIVES

A multicenter study was organized to explore sources of variation (SVs) of reference values (RVs) for 22 major immunochemistry analytes and to determine reference intervals (RIs) for the Russian population.

METHODS

According to IFCC Committee on Reference Intervals and Decision Limits (C-RIDL) protocol, 758 healthy volunteers were recruited in St. Petersburg, Moscow, and Yekaterinburg. Serum samples were tested for five tumor markers, 17 hormones and related tests by Beckman Coulter's UniCel DxI 800 immunochemistry analyzer. SVs were explored using multiple regression analysis and ANOVA. Standard deviation ratio (SDR) of 0.4 was used as primary guide for partitioning RIs by gender and age.

RESULTS

SDR for between-city difference was <0.4 for all analytes. Secondary exclusion of individuals was done under the following conditions: for female sex-hormones, those with contraceptives (8%); for CA19-9, those supposed to have negative Lewis blood-group (10.5% males and 11.3% females); for insulin, those with BMI≥28 kg/m2 (31%); for the thyroid panel, those with anti-thyroid antibodies (10.3% males; 24.5% females), for CEA those with smoking habit (30% males and 16% females). Gender-specific RIs were required for all analytes except CA19-9, CA15-3, thyroid-related tests, parathyroid hormone, and insulin. Age-specific RIs were required for alpha-fetoprotein, CEA, all sex-hormones for females, FSH and progesterone for both sexes. RIs were generally derived by parametric method after Gaussian transformation using modified Box-Cox formula. Exceptions were growth hormone, estradiol for females in postmenopause, and progesterone for females in premenopause, for which nonparametric method was required due to bimodal distribution and/or insufficient detection limit.

CONCLUSION

RIs for major hormones and tumor markers specific for the Russian population were derived based on the up-to-date internationally harmonized protocol by careful consideration of analyte-specific SVs.

Postoperative serum carcinoembryonic antigen levels cannot predict survival in colorectal cancer patients with type II diabetes

BACKGROUND

Most clinical guidelines recommend measuring postoperative carcinoembryonic antigen (CEA) levels to predict the prognosis of colorectal cancer. However, type II diabetes can increase serum CEA levels which may bias the prognosis. Thus, we aimed to evaluate the impact of type II diabetes on CEA prognostic accuracy in colorectal cancer.

METHODS

This retrospective cohort study included 407 patients who underwent curative resection for stage I to III colorectal adenocarcinoma in a single institution between January 2010 and June 2018. The patients were categorized into two groups according to their postoperative serum CEA levels: group A <5.0 ng/mL (n = 341) and group B ≥5.0 ng/mL (n = 66). Patients were also categorized into two subgroups according to their history of type II diabetes: patients with type II diabetes mellitus (n = 112) and patients without type II diabetes (n = 295).

RESULTS

The 3-year disease-free survival (DFS) rates were significantly higher in patients with normal postoperative CEA (group A, 83.8%) than in patients with elevated preoperative and postoperative CEA (group B, 63.6%) (p < 0.001). However, although patients with type II diabetes mellitus had higher postoperative CEA levels than those without type II diabetes mellitus (3.1 vs 2.5 ng/mL, p < 0.001), group B patients with type II diabetes mellitus had a significantly higher 3-year DFS rate than those without type II diabetes mellitus (80.0% vs 55.6%, p = 0.003).

CONCLUSION

Type II diabetes was associated with higher preoperative and postoperative CEA levels in patients with colorectal cancer. Consequently, elevated postoperative CEA level was not associated with shorter 3-year DFS in patients with type II diabetes, as opposed to patients without type II diabetes. Therefore, colorectal cancer patients with type II diabetes may need alternative tumor markers to be used during the surveillance strategy after curative surgery.

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) can increase serum carcinoembryonic antigen (CEA) levels. We thus aimed to evaluate the impact of CKD on CEA prognostic accuracy in colorectal cancer.

METHODS

Altogether, 429 patients who underwent curative resection for stages I-III colorectal adenocarcinoma were grouped according to postoperative CEA levels and history of CKD.

RESULTS

Three-year disease-free survival (DFS) was higher in patients with normal postoperative CEA (group A, 83.4%) than in those with elevated postoperative CEA (group B, 64.3%) (p < 0.001). CKD patients had higher postoperative CEA levels than non-CKD patients (odds ratio 3.27, 95% confidence interval 1.78-5.99, p < 0.001). In multivariable analysis, postoperative CEA level was an independent prognostic factor for DFS in non-CKD, but not CKD, patients.

CONCLUSIONS

CKD can increase postoperative CEA levels in colorectal cancer patients. Elevated postoperative CEA levels were associated with shorter DFS in non-CKD, but not CKD, patients.

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients who smoke

Serum carcinoembryonic antigen (CEA) levels can help predict the prognosis of colorectal cancer patients. Accordingly, high preoperative CEA levels that is not restored after surgery are indicative of a worse outcome. On the other hand, smoking can increase serum CEA levels independently of the disease status. Thus, we aimed to evaluate the impact of smoking on the prognostic value of serum CEA levels. This retrospective cohort study included 273 patients who underwent curative resection for stage I–III colorectal adenocarcinoma at a single institution, between January 2010 and December 2017. Patients were grouped as follows: group A, normal preoperative and postoperative CEA levels (n = 152); group B, elevated preoperative CEA levels that returned to reference values after surgery (n = 69); and group C, elevated postoperative serum CEA levels (n = 52). Patients were also grouped according to their smoking history: group S (current smokers, n = 79) and group NS (never and former smokers, n = 194). Group A showed a higher 3-year disease-free survival (DFS) rate (84.9%) than groups B (75.4%) and C (62.0%) (p < 0.001). Postoperative serum CEA levels were significantly higher in the S group than in the NS group (2.6 vs. 3.1 ng/mL, p = 0.009), whereas preoperative levels were similar (3.8 vs. 4.1, p = 0.182). Further, smokers showed higher 3 year-DFS rates than nonsmokers in group C (83.3% vs. 43.9%, p = 0.029). This suggests that while elevated postoperative CEA levels are associated with lower DFS rates in never and former smokers, they are not associated with lower DFS rates in current smokers. We conclude that persistent smoking alters the prognostic value of postoperative serum CEA levels in colorectal cancer patients and that, consequently, alternative surveillance strategies need to be developed for colon cancer patients with smoking habits.

Air pollutants associated with smoking in indoor/outdoor of waterpipe cafés in Tehran, Iran: Concentrations, affecting factors and health risk assessment

Despite increasingly growth in waterpipe smoking in Tehran, so far no study has been conducted on the air quality of the waterpipe and cigarette cafés. Thirty-six cafés were selected and the concentration of three pollutants including formaldehyde, carbon monoxide and nicotine were measured in both indoor and outdoor air of cafés two times (week-day and weekend's session). Air sampling was performed for 180 min for each pollutant. It was observed that the concentration of pollutants inside the cafés was higher during weekend session (with a higher number of "active waterpipe heads") compared with findings during the week-day sessions. Furthermore, the concentration of pollutants in the indoor air of the cafés was significantly higher than that of the outdoors (p < 0.05). According to path analysis, the number of "active waterpipe heads" had the maximum impact on generation of pollutants inside the cafés, followed by the type of tobacco as the second influential factor. The average of lifetime cancer risk (LTCR) resulted by formaldehyde exposure through inhalation in waterpipe (WS), cigarette (CS), waterpipe and cigarette (WCS) and none-smoking (NS) cafés in week-day and weekend sessions were estimated to be 111 × 10^-5 and 61.2 × 10^-5, 33.7 × 10^-5 and 39.4 × 10^-5, 271 × 10^-5 and 322 × 10^-5, and 4.80 × 10^-5 and 5.90 × 10^-5, respectively, which exceed the limit value by the U.S.EPA and WHO. The concentration of pollutants in the indoor air of smoking cafés in Tehran is significantly high, such that it can pose serious risks for the health of both personnel and customers. Therefore, decision makers are expected to enact applicable and strict policies so as to abate this public health risk.

The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis

Background and aims

A systematic review conducted in 2008 found significant associations between waterpipe tobacco smoking and lung cancer, respiratory disease, periodontal disease and low birthweight. Since then, a number of relevant studies have been published. The objective of this study was to update the systematic review on the effects of waterpipe tobacco smoking on health outcomes.

Methods

In May 2015 we electronically searched the following databases with no date restrictions: MEDLINE, EMBASE and the ISI Web of Science using a detailed search strategy with no language restrictions. We also screened the references' lists of the included studies. We included cohort, case-control and cross-sectional studies, and excluded case reports, conference abstracts, editorials and reviews. We excluded studies not conducted in humans, assessing physiological outcomes, not distinguishing waterpipe tobacco smoking from other forms of smoking or not reporting association measures. We assessed risk of bias for each included study and conducted meta-analyses for each of the outcomes of interest.

Results

We identified 50 eligible studies. We found that waterpipe tobacco smoking was significantly associated with: respiratory diseases [COPD; odds ratio (OR) = 3.18, 95% confidence interval CI = 1.25, 8.08; bronchitis OR = 2.37, 95% CI = 1.49, 3.77; passive waterpipe smoking and wheeze OR) = 1.97, 95% CI = 1.28, 3.04]; oral cancer OR = 4.17, 95% CI = 2.53, 6.89; lung cancer OR = 2.12, 95% CI = 1.32, 3.42; low birthweight (OR = 2.39, 95% CI = 1.32, 4.32); metabolic syndrome (OR 1.63-1.95, 95% CI = 1.25, 2.45); cardiovascular disease (OR = 1.67, 95% CI = 1.25, 2.24); and mental health (OR 1.30-2.4, 95% CI = 1.20, 2.80). Waterpipe tobacco smoking was not significantly associated with: oesophageal cancer (OR = 4.14, 95% CI = 0.93, 18.46); worse quality of life scores [standardized mean difference (SMD) = -0.16, 95% CI = -0.66, 0.34]; gastric carcinoma (OR = 2.16, 95% CI = 0.72, 6.47); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); prostate cancer (OR = 7.00, 95% CI = 0.90, 56.90); hepatitis C infection (OR = 0.98, 95%0.80, 1.21); periodontal disease (OR = 3.00, 5.00); gastro-oesophageal reflux disease (OR = 1.25, 95% CI = 1.01, 1.56); nasopharyngeal carcinoma (OR = 0.49, 95% CI = 0.20, 1.23); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); infertility (OR = 2.50, 95% CI = 1.00, 6.30); and mortality (OR = 1.15, 95% CI = 0.93, 1.43).

Conclusions

There is accumulating evidence about the association of waterpipe tobacco smoking with a growing number of health outcomes.

Investigation of the Relation between Carbon Monoxide Exposure/Intoxication and Tobacco-Free Narghile Products

Objectives

Use of tobacco-based narghiles may have potentially fatal consequences, such as carbon monoxide (CO) intoxication. However, there are only limited studies on the effects on human health and CO levels of tobacco-free narghile products. The primary aim of this study was to investigate the effect of tobacco-free narghile consumption on carboxyhemoglobin (COHb) levels and whether this would cause CO intoxication in active and passive narghile users.

Design

Observational study.

Methods

Four hundred ninety-nine individuals exposed to tobacco-free narghile smoke were divided into four groups; Group I: active narghile smokers, and non-cigarette smokers, Group II: active narghile smokers and active cigarette smokers, Group III: passive narghile smokers and non-cigarette smokers and Group IV: passive narghile smokers and active cigarette smokers. Fifty-nine healthy volunteers were enrolled as control groups (Group V, non-cigarette smoker controls, and Group VI, cigarette smoker controls). COHb levels were compared among the groups.

Results

Mean pre-exposure % COHb levels for groups I-IV were 2.61± 1.46, 3.00±1.37, 2.09±1.45 and 3.00±2.13, and post-exposure % COHb levels for groups were 3.45±1.92, 4.17±2.01, 2.60±1.66 and 4.50±2.32, respectively. Control groups (V-VI) % COHb levels were 0.90±0.82 and 1.60±0.85, respectively. COHb levels rose significantly after exposure to tobacco-free narghile smoke in all groups (p<0.001). COHb levels in all groups were higher than those in healthy individuals. Additionally, 12.8% of those exposed to tobacco-free narghile smoke had toxic COHb levels.

Conclusion

The use of tobacco-free narghile products represents a potential danger, and COHb levels in active and passive smokers can reach intoxication levels. (Hong Kong j.emerg.med. 2016;23:17-27)

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

PURPOSE

The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15-17-year-old high school students in Iran.

METHOD

Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15-17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking).

RESULTS

Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking.

CONCLUSION

Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students' and their parents' awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents' access to WPs and tobacco in society.

Characteristics, reasons, behavior and knowledge towards waterpipe smoking in Saudi Arabia

Background The present scenario shows that waterpipe smoking, one of tobacco smoking methods, the practice off which dates back at least 400 year is appealing to the youth. Waterpipe tobacco smoking is frequently linked with nations of the Eastern Mediterranean Region (EMR) comprising Egypt, Kuwait, Lebanon and Syria. The present study shows the socio-demographic characteristics, behavior and knowledge of youth towards waterpipe smoking. Recognizing these features may help emphasize intervention methods. Methods A self-administered questionnaire was used to collect the data about waterpipe smoking comprising sociodemographic, behavior, reasons and knowledge from 230 university students. Results 230 questionnaires were distributed from which only 199 were included in the study as 31 were excluded because of incompleteness of the survey. The mean age for starting smoking was 19.49 ± 3.75 years with 32.5% of family members and the majority of their friends engaged with waterpipe smoking. Pleasure and happiness (76%), helps me to deal with pressure (78%) and acceptance by society (91%), were the major reasons cited for waterpipe smoking. It being less harmful and less addictive (55%) compared to cigarettes and no objection from the parents (58%) were the other cited reasons. Furthermore, less than 50% of the participants had correct knowledge of its harmful effects. Conclusion It is clearly evident from our findings that there is a meagre amount of knowledge regarding the harmful effects of waterpipe smoking. It is essential that programs to impart knowledge regarding the harmful effects of waterpipe smoking and dependence should be of the utmost importance.

Waterpipe tobacco smoking and its human health impacts

Waterpipe tobacco smoking (WTS, also known as hookah, shisha, narghile, and many other names) involves passing tobacco smoke through water prior to inhalation by the consumer. As the number of waterpipe smokers is rising rapidly, there is growing concern over the use of WTS, particularly as there has been a widely held misconception that WTS is free from health hazards. In reality, it is associated with a variety of adverse health outcomes on both a short- and long-term basis. Hence, it is desirable to develop advanced techniques for surveillance, intervention, and regulatory/policy frameworks specific to the production and use of waterpipe tobacco. This review is written to survey the types and extent of pollutants released from its use and their potential health risks. A review of the present regulation guidelines is also included.

Is Smoking Shisha Safer than Cigarettes: Comparison of Health Effects of Shisha and Cigarette Smoking among Young Adults in Kuwait

OBJECTIVE

The aim of this study was to compare the health effects of shisha smoking with cigarette smoking among male college students in Kuwait.

SUBJECTS AND METHODS

This cross-sectional study was conducted on 525 male students in Kuwait from September to October 2013. A pretested questionnaire was used for information on demographics and health complaints. Peak expiratory flow rate (PEFR) was measured using a portable peak flow meter. The outcome variables of health status were compared between smoking shisha, cigarettes, or both, and nonsmoking.

RESULTS

The prevalence of current smoking was 243 of the 525 students (46%); of them, 52 (10%) were shisha smokers, 69 were (13%) cigarette smokers and 122 (23%) were both shisha and cigarette smokers. There were significantly fewer shisha smokers than cigarette smokers with symptoms of persistent cough (4 vs. 13% or 2/52 vs. 15/69; p = 0.007), chest pain (4 vs. 23% or 2/52 vs. 16/69; p = 0.004) and rapid heart rate (12 vs. 28% or 6/52 vs. 19/69; p = 0.04). Other complaints, including asthma, respiratory infections, shortness of breath, high blood pressure, increased blood sugar levels and sleep disturbances were similar in the 2 groups. Values of PEFR for shisha smokers and cigarette smokers were not significantly different.

CONCLUSION

This study produced evidence suggesting that shisha smoking is not safer than cigarette smoking except with regard to complaints such as cough, chest pain and rapid heart rate, and that people who smoke both experience worse health effects in terms of frequent symptoms of respiratory infections, persistent cough, rapid heartbeat and sleep disturbances.

Risk factors for hookah smoking among arabs and chaldeans

Hookah smoking is more prevalent among individuals of Middle Eastern descent. This study examined general and ethnic-specific risk factors for hookah smoking among Arabs and Chaldeans. A self-administered anonymous questionnaire was conducted among 801 adults residing in Southeast Michigan. Binary logistic regression modeling was used to predict risk factors for hookah smoking. Hookah smoking was significantly more prevalent among Arabs (32%) than Chaldeans (26%, p < 0.01) and being Arab was a risk factor for lifetime hookah use. Younger age (<25 years), being male, higher annual income, and having health insurance were significant risk factors for hookah use. Chaldeans believed to a greater extent than Arabs that smoking hookah is less harmful than cigarette smoking (75 vs. 52%, p < 0.001). Hookah smoking is prevalent in both ethnic groups, but significantly higher among Arabs. Results indicate that prevention efforts should target younger males with higher incomes.

Subjective well-being and hookah use among adults in the United States: A nationally-representative sample

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.

Use & Misuse of Water-filtered Tobacco Smoking Pipes in the World. Consequences for Public Health, Research & Research Ethics

BACKGROUND

The traditional definition of an "epidemic" has been revisited by antismoking researchers. After 400 years, Doctors would have realized that one aspect of an ancient cultural daily practice of Asian and African societies was in fact a "global "epidemic"". This needed further investigation particularly if one keeps in his mind the health aspects surrounding barbecues.

METHOD

Here, up-to-date biomedical results are dialectically confronted with anthropological findings, hence in real life, in order to highlight the extent of the global confusion: from the new definition of an "epidemic" and "prevalence" to the myth of "nicotine "addiction"" and other themes in relation to water filtered tobacco smoking pipes (WFTSPs).

RESULTS

We found that over the last decade, many publications, -particularly reviews, "meta-analyses" and "systematic reviews"- on (WFTSPs), have actually contributed to fuelling the greatest mix-up ever witnessed in biomedical research. One main reason for such a situation has been the absolute lack of critical analysis of the available literature and the uncritical use of citations (one seriously flawed review has been cited up to 200 times). Another main reason has been to take as granted a biased smoking robot designed at the US American of Beirut whose measured yields of toxic chemicals may differ dozens of times from others' based on the same "protocol". We also found that, for more than one decade, two other main methodological problems are: 1) the long-lived unwillingness to distinguish between use and misuse; 2) the consistent unethical rejection of biomedical negative results which, interestingly, are quantitatively and qualitatively much more instructive than the positive ones.

CONCLUSION

the great majority of WFTSP toxicity studies have actually measured, voluntarily or not, their misuse aspects, not the use in itself. This is in contradiction with both the harm reduction and public health doctrines. The publication of negative results should be encouraged instead of being stifled.

Young adult waterpipe smokers: Smoking behaviors and associated subjective and physiological effects

INTRODUCTION

The purpose of this pilot study was to investigate smoking behaviors and subjective and physiological effects of nicotine on young adult occasional waterpipe smokers.

METHODS

This study utilized a repeated-measures design that included one repeated factor for condition (nicotine and non-nicotine). For each participant, the sequencing of the repeated factor was assigned using random allocation. The two nicotine conditions were nicotine (0.75 g) and non-nicotine (0 g placebo) tobacco. Over the course of two weeks, twenty-two participants completed subjective (Acute Subjective Effects of Nicotine) and physiological (blood pressure, heart rate, and CO level) measures. Additional measures (QSU and MNWS-R) were used to assess for withdrawal symptoms.

SAMPLE

The participants (n=22) were young adults (23 ± 3.1years); 71% smoked waterpipe once a month in the past year and 29% smoked waterpipe 1-2 times per week. In addition, 60% reported sharing their waterpipe with friends while smoking. None of the participants reported using any other forms of tobacco products.

RESULTS

Under the nicotine condition, participants tended to smoke longer (i.e. smoking duration, p=0.004), take more puffs (p=0.03), take shorter puffs (p=0.03), and inhale less volume with each puff (p=0.02). The repeated measures analysis of the factor headrush revealed an effect of the nicotine condition (F=9.69, p<0.001, partial η(2)=0.31) and time (F=8.17, p=0.02, partial η(2)=0.30). Heart rate increased significantly across the nicotine condition (F=7.92, p=0.01, partial η(2)=0.31) and over time (F=12.64, p=0.01, partial η(2)=0.41).

CONCLUSIONS

This study demonstrates how differences between nicotine and non-nicotine waterpipe smoking are associated with changes in smoking behaviors, experiencing a headrush and an increase in heart rate.

Harmful effects of shisha: literature review

Tobacco is a preventable cause of morbidity and mortality across the world. A recently infamous way of smoking tobacco is shisha. Shisha smoking is also known as water pipe, hookah and Narghile smoking. The percentage of shisha smokers is on the rise rapidly spanning the globe. A literature review was conducted to identify all evidence on the epidemiological variations and health effects of shisha smoking. “Pub med” is used as a searching tool to identify all relevant empirical studies conducted worldwide. A qualitative overview of evidence is presented.

Exposure to Shisha smoking is significantly associated with low infant weight, heart rate variations, hyperglycemia and hypertriglyceridemia. Increased risk of carcinoma is also leagued with it including carcinomas of the pancreas and lung being at the forefront. In conclusion, this review identifies grounds of several adverse conditions being associated with the habit of shisha smoking. It also evaluates the relevant epidemiological variations around the globe. The review culminates in the importance of enlightening shisha smokers regarding its deleterious effects.

Hookah, is it really harmless?

The hookah is a snuff smoking device whose origin dates back to the fifteenth century, has been used extensively in the Middle East in recent decades has become popular in Western culture countries, particularly in Americas and Europe. It has been reported that like other forms smoking tobacco, their use can lead to addiction also is used for inhaling and other addictive substances. Has also been considered a risk factor for various isolated diseases, including chronic obstructive pulmonary disease (COPD), different types of cancer, hemodynamic alterations, vascular disease, infectious diseases, among others. In pregnant women has been reported that there use condition a diminution on fetal growth and different diseases in the newborn. It was also mentioned that hookah smoke contains several toxic substances that can affect both, the primary and the passive smoker, so we did this review to determine the complications associated with its use.

A novel homogeneous time-resolved fluoroimmunoassay for carcinoembryonic antigen based on water-soluble quantum dots

Quantum dots are not widely used in clinical diagnosis. However, the homogeneous time-resolved fluorescence assay possesses many advantages over current methods for the detection of carcinoembryonic antigen (CEA), a primary marker for many cancers and diseases. Therefore, a novel luminescent terbium chelates- (LTCs) and quantum dots-based homogeneous time-resolved fluorescence assay was developed to detect CEA. Glutathione-capped quantum dots (QDs) were prepared from oil-soluble QDs with a 565 nm emission peak. Conjugates (QDs-6 F11) were prepared with QDs and anti-CEA monoclonal antibody. LTCs were prepared and conjugates (LTCs-S001) were prepared with another anti-CEA monoclonal antibody. The fluorescence lifetime of QDs was optimized for sequential analysis. The Förster distance (R0) was calculated as 61.9 Å based on the overlap of the spectra of QDs-6 F11 and LTCs-S001. Using a double-antibody sandwich approach, the above antibody conjugates were used as energy acceptor and donor, respectively. The signals from QDs were collected in time-resolved mode and analyzed for the detection of CEA. The results show that the QDs were suitable for time-resolved fluoroassays. The spatial distance of the donor-acceptor pair was calculated to be 61.9 Å. The signals from QDs were proportional to CEA concentration. The standard curve was LogY = 2.75566 + 0.94457 LogX (R = 0.998) using the fluorescence counts (Y) of QDs and the concentrations of CEA (X). The calculated sensitivity was 0.4 ng/mL. The results indicate that water-soluble QDs are suitable for the homogenous immunoassay. This work has expanded future applications of QDs in homogeneous clinical bioassays. Furthermore, a QDs-based homogeneous multiplex immunoassay will be investigated as a biomarker for infectious diseases in future research.

Requests for tumor marker tests in Turkey without indications and frequency of elevation in benign conditions

AIMS

To investigate the incidence of ordering tests for tumor markers which are used in cancer diagnosis, follow-up treatment and detection of recurrence, the rate of elevation in benign diseases and which clinics order them frequently.

MATERIALS AND METHOD

Data for the tumor markers carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), cancer antigen 15-3 (CA 15-3) and alpha- fetoprotein (AFP) that were ordered by all the clinics in our Hospital between 2010 and 2011 were screened. When excluding repeated orders the results of 3,416 patients were available. It has been determined that in which benign diseases were the tumor markers frequently ordered and which of these conditions had high levels of them.

RESULTS

CA 19-9 was ordered for 1,858 patients 191 (10.3%) were malignant while 1667 (89.7%) were ordered in benign diseases. For CEA the total was 1,710, 226 (13.2%) malignant and 1484 (86.8%) benign, and for CA 125 1267, 111 (8.8%) malignant and 1156 (91.2%) benign. AFP was ordered for 1687 cases, 80 (4.7%) malignant but 1607 (95.3%) benign. CA 15-3 was ordered 1449 times, 174 (12%) for malignant and 1275 (88%) for benign diseases. In all cases, considerable proportions were positive.

CONCLUSIONS

It was shown that clinicians frequently order tumor markers for benign conditions. The findings of this study has shown that tumor markers are used widely without indications as cancer screening tests.

Waterpipe (hookah) tobacco smoking among youth

Waterpipe tobacco smoking is a centuries old practice, influenced by cultural tradition in Eastern Mediterranean countries, the Middle East, and parts of Asia. It historically has been an activity enjoyed primarily by men. In the past 2 decades, however, this method of tobacco smoking has increased in popularity in other parts of the world, including the USA. Growing interest in this form of smoking can be traced, in part, to the advent of a flavored tobacco, called maassel. The combination of flavoring agents and the paraphernalia itself used in the smoking process, along with its mystic appeal, novelty, affordability, and the social atmosphere in which smoking often occurs, has made waterpipe smoking attractive to women as well as men, cigarette smokers and nonsmokers alike, and particular groups, including persons of college age and younger adolescents. Although waterpipe smoking is perceived by its new generation of users to be less addictive and hazardous to health than cigarette smoking, researchers draw diametrically opposed conclusions. Research demonstrates that numerous toxic agents, including carcinogens, heavy metals, other particulate matter, and high levels of nicotine, are efficiently delivered through waterpipes. Moreover, sidestream smoke exposes others in the vicinity of waterpipe smokers to the risk of respiratory diseases and other conditions. In addition, persons sharing waterpipe mouthpieces may share infectious agents as well. Waterpipe tobacco smoking has been declared a public health problem by the World Health Organization and other authorities. Recognition of the deleterious effects of waterpipe smoking has led to initial attempts to expand regulatory control. Because waterpipe tobacco is not directly burned in the smoking process, many existing control measures do not apply. Public health authorities should monitor waterpipe tobacco use carefully. Finally, pediatricians and other healthcare providers should discourage experimentation and continued use among their adolescent patients.

Waterpipe tobacco smoking: an emerging health crisis in the United States

OBJECTIVE

To examine the prevalence and potential health risks of waterpipe tobacco smoking.

METHODS

A literature review was performed to compile information relating to waterpipe tobacco smoking.

RESULTS

Waterpipe tobacco smoking is increasing in prevalence worldwide; in the United States, 10-20% of some young adult populations are current waterpipe users. Depending on the toxicant measured, a single waterpipe session produces the equivalent of at least 1 and as many as 50 cigarettes. Misconceptions about waterpipe smoke content may lead users to underestimate health risks.

CONCLUSION

Inclusion of waterpipe tobacco smoking in tobacco control activities may help reduce its spread.

Sociodemographic risk indicators of hookah smoking among White Americans: a pilot study

BACKGROUND

Despite the sustained public health efforts to decrease cigarette smoking, there is an increasing trend in the use of alternative tobacco products that are perceived by some as less harmful. One example is hookah smoking. This study aimed to assess hookah trends among White Americans.

METHODS

Two hundred and forty-five White American adults residing in southeast Michigan answered a self-administered standardized questionnaire that included basic demographics, socioeconomic status, and questions related to hookah smoking behavior. Logistic regression was used to determine risk indicators for hookah smoking.

RESULTS

The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco.

DISCUSSION

In addition to reporting the prevalence of use in this important group of potential users, we outline important sociodemographic risk factors for hookah use in a non-Arab American population. More research is needed with a larger population to better understand this new tobacco trend in order to curb a new potential health threat.

Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A critical review of the relevant literature and the public health consequences

Hookah (narghile, shisha, "water-pipe") smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker's respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.

Tobacco use and cessation among Somalis in Minnesota

BACKGROUND

Somalis compose the largest African refugee group living in the U.S., with more than 10,330 primary arrivals in fiscal year 2006 alone. Half of all Somalis in the U.S. live in Minnesota. Although tobacco use is a considerable problem among Somalis, especially among men, little research has examined factors affecting tobacco use and cessation.

METHODS

A sequential exploratory design informed the overall study methodology. Key informant interviews (n=20) and focus group discussions (13 groups; n=91) were conducted with Somali adults and youth in the fall of 2006 and the summer of 2007, respectively. Participants were asked about tobacco-use prevalence, prevention, and cessation, and the marketing of tobacco.

RESULTS

Perceived prevalence of tobacco use by Somalis is high at 50%. The main reason for initiating tobacco use was the influence of friends or peer pressure and included other social factors. Prevention and cessation messages suggested by participants include medical advice, education on the negative health effects of tobacco use, religion, and the support of family and friends. Barriers to cessation include lack of insurance coverage, lack of knowledge on where to find assistance, and lack of cessation support groups. Severe social stigma for Somali female smokers poses specific challenges to prevention and intervention efforts. Water-pipe smoking is perceived to be prevalent, particularly among female youth.

CONCLUSIONS

Somalis view tobacco use as an important issue in their community. Religious and social support and demographically targeted approaches should be key factors in creating effective prevention and cessation programs and must address water-pipe smoking.