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Nakkash R, Tleis M, Khalil J, Romani M, Salloum RG. A qualitative study on tobacco use during the COVID-19 pandemic in Lebanon: Waterpipe and cigarette smokers' views, risk perceptions, and behaviors. Tob Prev Cessat 2024; 10:TPC-10-27. [PMID: 38938265 PMCID: PMC11209738 DOI: 10.18332/tpc/189770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/26/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Since the beginning of the COVID-19 pandemic, a growing number of studies have documented more severe COVID-19 symptoms and worse outcomes among smokers compared to non-smokers. The aim of this research is to understand the views, risk perceptions, and behaviors of Lebanese adult smokers during the pandemic. METHODS We conducted 18 qualitative online structured interviews with adults who smoke cigarettes and waterpipe tobacco residing in Lebanon from November 2020 through April 2021. Participants were recruited predominantly via paid social media ads. Interviews were audio-recorded using Zoom software then transcribed verbatim. Data were analyzed thematically. RESULTS The findings showed three main themes: changes to smoking behaviors, concerns over the susceptibility and severity of COVID-19, and using coping methods to protect smokers from COVID-19. Although there was an increased risk perception of COVID-19 in relation to smoking, most participants reported an increase in smoking. Instead of being encouraged to quit, participants developed coping strategies against COVID-19 while smoking. CONCLUSIONS Smoking behavior did not seem to decrease during the COVID-19 pandemic. To support cessation initiatives and raise awareness, effective health messaging aimed at smokers is pivotal. Smoking cessation programs need to be better equipped at supporting people who smoke in finding healthier coping mechanisms during a pandemic. Moreover, policies to regulate the propagation of misinformation are required to prevent the development of a false sense of safety and protection from COVID-19.
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Affiliation(s)
- Rima Nakkash
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, Virginia, United States
| | - Malak Tleis
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joanna Khalil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maya Romani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
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Bacterial communities of hookah tobacco products are diverse and differ across brands and flavors. Appl Microbiol Biotechnol 2022; 106:5785-5795. [PMID: 35927334 PMCID: PMC9361917 DOI: 10.1007/s00253-022-12079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022]
Abstract
Abstract Young adults are increasingly using non-cigarette products, such as hookahs, since they are perceived as healthier alternatives to cigarette smoking. However, hookah users are exposed to not only carcinogenic compounds but also microorganisms that may play an active role in the development of both infectious and chronic diseases among users. Nevertheless, existing hookah research in this area has focused only on microorganisms that may be transferred to users through the smoking apparatus and not on bacterial communities associated with hookah tobacco. To address this knowledge gap, we conducted time-series experiments on commercially available hookah brands (Al Fakher (flavors: two apple, mint, and watermelon) and Fumari (flavors: white gummy bear, ambrosia, and mint chocolate chill)) stored under three different temperature and relative humidity conditions over 14 days. To characterize bacterial communities, the total DNA was extracted on days 0, 5, 9, and 14, PCR-amplified for the V3V4 region of the bacterial 16S rRNA gene, sequenced on the Illumina HiSeq platform, and analyzed using R. Diversity (alpha and beta) analyses revealed that the microbiotas of Fumari and Al Fakher products differed significantly and that flavor had a significant effect on the hookah microbiota. Overall, Pseudomonas, Bacillus, Sphingomonas, and Methylobacterium were the predominant bacterial taxa across all products. Additionally, we observed compositional differences between hookah brands across the 14-day incubation. These data suggest that the bacterial communities of hookah tobacco are diverse and differ across brands and flavors, which may have critical implications regarding exposures to specific bacteria among hookah users. Key points • Commercial hookah products harbor diverse bacterial communities. • Brands and flavors impact the diversity of these communities. • Research on their viability and transmission to users’ respiratory tracts is needed. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00253-022-12079-7.
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Alaouie H, Krishnamurthy Reddiar S, Tleis M, El Kadi L, A Afifi R, Nakkash R. Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations. Tob Control 2022; 31:187-197. [PMID: 35241587 DOI: 10.1136/tobaccocontrol-2021-056550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/06/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. METHODS We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation's Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. RESULTS Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. CONCLUSIONS Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.
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Affiliation(s)
- Hala Alaouie
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Malak Tleis
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
| | - Lama El Kadi
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
| | - Rima A Afifi
- College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Rima Nakkash
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
- Global and Community Health Department, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
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Sinclair RG, Somsamouth K, Sahar D, Englert R, Singh P. Microbial contamination in the communal-use Lao tobacco waterpipe. Int Health 2021; 13:344-349. [PMID: 33049758 PMCID: PMC7665567 DOI: 10.1093/inthealth/ihaa078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The use of the Asian tobacco waterpipe (TWP) in the Lao People's Democratic Republic represents a potential communal source of infectious disease. This practice of smoking can lead to weakened defences of a smoker's respiratory epithelium, making the smoker vulnerable to respiratory diseases such as coronavirus disease 2019, tuberculosis and others. METHODS This study evaluated the water quality and hygiene factors among 43 smokers of five villages in rural Luang Namtha Province. Water samples were collected from participant's TWPs and assessed for the presence of Escherichia coli, coliforms and aerobic plate count (APC) bacteria using the 3M Petrifilm. RESULTS The microbial indicator testing results were 95% positive for the APC, 38% positive for coliforms and 17% positive for the E. coli indicator. The concentrations were highest for the APC, with an average of 106 colony forming units (cfu)/ml, followed by coliforms with <100 cfu/ml and lowest for E. coli with <10 cfu/ml. Most TWPs were infrequently cleaned, heavily used and contained a warm, brown-coloured water. CONCLUSIONS The warm, dark and moist internal water container may facilitate microbial survival and growth. The use of a TWP adds several unstudied modes of transmission to a complex and common biobehavioural and environmental pathogen exposure. Future TWP cessation activities should be tailored to consider risks of infectious disease transmission.
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Affiliation(s)
- Ryan G Sinclair
- Loma Linda University School of Public Health, 24951 N. Circle Drive, Nichol Hall 2014, Loma Linda, CA 92350, USA
| | - Khamphithoun Somsamouth
- Centre of Information and Education for Health, Ministry of Health, Simuang Road, Vientiane Capital, Lao PDR
| | - Demetria Sahar
- Loma Linda University School of Public Health, 24951 N. Circle Drive, Nichol Hall 2014, Loma Linda, CA 92350, USA
| | - Robyn Englert
- Loma Linda University School of Public Health, 24951 N. Circle Drive, Nichol Hall 2014, Loma Linda, CA 92350, USA
| | - Pramil Singh
- Loma Linda University School of Public Health, 24951 N. Circle Drive, Nichol Hall 2014, Loma Linda, CA 92350, USA
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Maziak W, Osibogun O, Asfar T. Waterpipe smoking: the pressing need for risk communication. Expert Rev Respir Med 2019; 13:1109-1119. [PMID: 31519113 PMCID: PMC7004232 DOI: 10.1080/17476348.2019.1668271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023]
Abstract
Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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Petersen AB, Muffley N, Somsamouth K, Singh PN. Smoked Tobacco, Air Pollution, and Tuberculosis in Lao PDR: Findings from a National Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3059. [PMID: 31443595 PMCID: PMC6747342 DOI: 10.3390/ijerph16173059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023]
Abstract
In 2017, more than half of the global burden of incident tuberculosis (TB) came from the Western Pacific region. In Lao People's Democratic Republic (PDR), the high rates of tobacco use and use of polluting biomass fuels for cooking (e.g., wood, charcoal, crop waste, dung) represent significant risk factors for TB. The purpose of this study was to determine the association between self-reported (1) smoking and TB; and (2) exposure to air pollution (from both cooking fires and environmental tobacco smoke) and TB among adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR-a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Utilizing a nationally representative sample and inferential, multivariable methods, we observed a significant increase in odds of self-reported TB among those who smoked tobacco (OR = 1.73, 95% CI = (1.00 to 2.98)). Larger multivariable models identified independent contributions from exposure to tobacco pipes (OR = 21.51, 95% CI = (6.34 to 72.89)) and communal outdoor fires (OR = 2.27, 95% CI = (1.15 to 4.49)). An index measuring combined exposure to smoked tobacco, environmental tobacco smoke in enclosed workspace, indoor cooking fire, trash fires, and other outdoor communal fires also showed a positive association (OR per added exposure = 1.47, 95% CI = (1.14 to 1.89)). The findings of this study underscore the need for multi-sectoral collaboration between tobacco control, environmental health, TB prevention and treatment programs, national authorities, policy makers, civil groups, and the private sector to address the convergence of potential risk factors impacting respiratory health in Lao PDR.
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Affiliation(s)
- Anne Berit Petersen
- Department of Graduate Nursing, School of Nursing, Loma Linda University, 11262 Campus Street, Loma Linda, CA 92350, USA
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Natassia Muffley
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Khamphithoun Somsamouth
- Center for Information and Education for Health, Ministry of Health, Simuang Road, Vientiane, Lao PDR
| | - Pramil N Singh
- Center for Health Research, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
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Asfar T, Schmidt M, Ebrahimi Kalan M, Wu W, Ward KD, Nakkash RT, Thrasher J, Eissenberg T, Ben Romdhane H, Maziak W. Delphi study among international expert panel to develop waterpipe-specific health warning labels. Tob Control 2019; 29:159-167. [PMID: 30696784 DOI: 10.1136/tobaccocontrol-2018-054718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control. METHODS A panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median. RESULTS Starting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP's harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes. CONCLUSION This study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP's harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.
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Affiliation(s)
- Taghrid Asfar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.,Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, US
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, Tennessee, USA
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria.,School of Public Health, The University of Memphis, Miami, Florida, USA
| | - Rima T Nakkash
- Health Behaviour and Education Department, American University of Beirut, Beirut, Lebanon
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria.,USA Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis-Tunisia, Tunis, Tunisia
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
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Kassem NO, Jackson SR, Kassem NO, Liles S, Posis AIB, Hovell MF. College Student Beliefs and Behavior Regarding Sharing When Smoking Hookahs. Am J Health Behav 2019; 43:133-144. [PMID: 30522572 DOI: 10.5993/ajhb.43.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: We examined college students' beliefs and behavior regarding sharing when smoking a hookah, a practice that may involve substantial risk of disease transmission. Methods: We carried out a cross-sectional Web-based survey of undergraduate ever users of hookah (N = 970) at a US university in 2007. Results: Hookah sharing started at initiation of hookah use. The first-time participants smoked hookah, 96.9% shared it, and 97.5% were with friends either in a hookah lounge (59.5%) or at a friend's home (30%). Participants shared a hookah when they first smoked it because sharing was acceptable with friends, family, or trusted others, normative etiquette, not problematic/harmful, cheaper, or the only smoking option. Participants did not use a mouth tip when they first smoked a hookah because it is not necessary with friends/family, there was no tip available, they were unaware of tips, or did not want to use one. Conclusions: Overwhelmingly, hookah sharing started at smoking initiation. Efforts are needed to create an environment in which sharing hookah practices are less acceptable such as increasing awareness of potential health risks of sharing, particularly among youth, and providing disposable hoses, disposable mouth tips, and proper hookah device cleaning practices in private and public hookah venues settings.
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Affiliation(s)
- Nada O.F. Kassem
- Associate Director, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA;,
| | - Sheila R. Jackson
- Data Manager, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA
| | - Noura O. Kassem
- Study Coordinator, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA
| | - Sandy Liles
- Data Analyst, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA
| | - Alexander Ivan B. Posis
- Research Assistant, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA
| | - Melbourne F. Hovell
- Director, Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA
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A biomarker feasibility study in the South East Asia Community Observatory health and demographic surveillance system. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2018; 3:e14. [PMID: 30263138 PMCID: PMC6152490 DOI: 10.1017/gheg.2018.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/10/2018] [Accepted: 07/15/2018] [Indexed: 11/16/2022]
Abstract
Background Integration of biomarker data with information on health and lifestyle provides a powerful tool to enhance the scientific value of health research. Existing health and demographic surveillance systems (HDSSs) present an opportunity to create novel biodata resources for this purpose, but data and biological sample collection often presents challenges. We outline some of the challenges in developing these resources and present the outcomes of a biomarker feasibility study embedded within the South East Asia Community Observatory (SEACO) HDSS. Methods We assessed study-related records to determine the pace of data collection, response from potential participants, and feedback following data and sample collection. Overall and stratified measures of data and sample availability were summarised. Crude prevalence of key risk factors was examined. Results Approximately half (49.5%) of invited individuals consented to participate in this study, for a final sample size of 203 (161 adults and 42 children). Women were more likely to consent to participate compared with men, whereas children, young adults and individuals of Malay ethnicity were less likely to consent compared with older individuals or those of any other ethnicity. At least one biological sample (blood from all participants – finger-prick and venous [for serum, plasma and whole blood samples], hair or urine for adults only) was successfully collected from all participants, with blood test data available from over 90% of individuals. Among adults, urine samples were most commonly collected (97.5%), followed by any blood samples (91.9%) and hair samples (83.2%). Cardiometabolic risk factor burden was high (prevalence of elevated HbA1c among adults: 23.8%; of elevated triglycerides among adults: 38.1%; of elevated total cholesterol among children: 19.5%). Conclusions In this study, we show that it is feasible to create biodata resources using existing HDSS frameworks, and identify a potentially high burden of cardiometabolic risk factors that requires further evaluation in this population.
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Adolescents' Perceptions of Health Risks, Social Risks, and Benefits Differ Across Tobacco Products. J Adolesc Health 2016; 58:558-66. [PMID: 27107909 PMCID: PMC5072979 DOI: 10.1016/j.jadohealth.2016.01.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco. METHODS A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure. RESULTS Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender. CONCLUSION Given the significant differences in adolescents' perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes.
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Veeranki SP, Alzyoud S, Dierking L, Kheriallah K, Mzayek F, Pbert L, Ward KD. Associations of Adolescents' Cigarette, Waterpipe, and Dual Tobacco Use With Parental Tobacco Use. Nicotine Tob Res 2015; 18:879-84. [PMID: 26438651 DOI: 10.1093/ntr/ntv224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/25/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Previous studies have demonstrated the influence of parental (both mother and father) cigarette smoking on adolescents' cigarette smoking. Little is known, however, about how parental tobacco use is related to waterpipe and dual waterpipe/cigarette use, which is increasing dramatically in the Arab countries. METHODS Study data (n = 34 788, N = 6 109 572) were obtained from nationally representative Global Youth Tobacco Surveys in 17 Arab countries. Study outcome was adolescents' tobacco use categorized into none, cigarette smoking only, waterpipe smoking (WPS) only, and dual use. Primary exposure included parental tobacco use categorized into 10 groups-maternal (mother) cigarette smoking only, maternal WPS only, maternal dual use, paternal (father) cigarette smoking only, paternal WPS only, paternal dual use, parental (both mother and father) cigarette smoking only, parental WPS only, parental dual use, and none. Weighted multinomial regression models were conducted to assess the relationships. RESULTS Adolescents reported smoking WPS only (5.7%), cigarettes only (2.9%), and dual use (3.5%). Compared to adolescent with no exposure to parental tobacco use, adolescent exposure to parental dual use was associated with significant increase in WPS only (OR = 6.08, 95% CI = 2.38-15.51) and dual use (OR = 3.86, 95% CI = 1.43-10.43). Effect modification of the relationship by adolescents' sex was observed. CONCLUSIONS This is the first study to examine adolescent cigarette, waterpipe, and dual use with parental tobacco use. Study findings may help development of cessation interventions targeting parental tobacco use to prevent the rising waterpipe and dual use strain of the global tobacco epidemic. IMPLICATIONS (1) Influence of parents' cigarette smoking on adolescents' smoking has been demonstrated in earlier studies, however, little is known about how tobacco use behaviors of mother and father influences an adolescent's cigarette, waterpipe and dual cigarette/waterpipe use. (2) Associations of parental (both mother and father) tobacco use with adolescents' tobacco use differed significantly if the adolescent is a waterpipe smoker or dual user compared to an adolescent cigarette smoker. (3) Adolescents' exposed to their mothers' WPS or dual use were more likely to be a waterpipe smoker or dual user. High likelihood of adolescents' cigarette, waterpipe and dual use is found in homes where parental tobacco use is rampant with both parents smoking either cigarette, waterpipe or both.
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Affiliation(s)
- Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX;
| | - Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan
| | - Leah Dierking
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Khalid Kheriallah
- Deparment of Public Health, Jordan University of Science and Technology, Irbed, Jordan
| | - Fawaz Mzayek
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN; Syrian Center for Tobacco Studies, Aleppo, Syria
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Abstract
Shisha smoking, with origins in India and the Arab world, is today spreading rapidly into other parts of the world. One such region is Southeast Asia,where shisha bars are commonly seen around educational institutions. The general public remains unaware of the harmful effects of shisha smoking and many assume that shisha smoking does not involve tobacco. Shisha smoking is not adequately addressed in the current anti-tobacco policies by most governments of Southeast Asia. Only a few countries have already taken concrete measures of including shisha smoking in anti-tobacco policies. We highlight the emerging trend of shisha smoking in Southeast Asian nations, associated health effects, and the loopholes in the governmental policies that are being exploited by the vendors of shisha. While most research, taxation policies, and health education on tobacco-related products have focused on cigarettes, additional methods of tobacco delivery become more common.
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Jawad M, Nakkash RT, Mahfoud Z, Bteddini D, Haddad P, Afifi RA. Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon. Public Health 2015; 129:370-6. [PMID: 25749674 DOI: 10.1016/j.puhe.2015.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon. STUDY DESIGN The study design was a cross sectional survey. METHODS 126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS. RESULTS Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS. CONCLUSIONS Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.
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Affiliation(s)
- M Jawad
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon; Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - R T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Z Mahfoud
- Department of Global and Public Health, Weill Cornell Medical College, Doha, Qatar
| | - D Bteddini
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - P Haddad
- Biostatistics, Epidemiology and Biomathematics Research Core, Weill Cornell Medical College, Doha, Qatar
| | - R A Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.
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Aboaziza E, Eissenberg T. Waterpipe tobacco smoking: what is the evidence that it supports nicotine/tobacco dependence? Tob Control 2015; 24 Suppl 1:i44-i53. [PMID: 25492935 PMCID: PMC4345797 DOI: 10.1136/tobaccocontrol-2014-051910] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/20/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Waterpipe tobacco smoking (WTS) involves passing tobacco smoke through water prior to inhalation, and has spread worldwide. This spread becomes a public health concern if it is associated with tobacco-caused disease and if WTS supports tobacco/nicotine dependence. A growing literature demonstrates that WTS is associated with disability, disease and death. This narrative review examines if WTS supports nicotine/tobacco dependence, and is intended to help guide tobacco control efforts worldwide. DATA SOURCES PUBMED search using: (("waterpipe" or "narghile" or "arghile" or "shisha" or "goza" or "narkeela" or "hookah" or "hubble bubble")) AND ("dependence" or "addiction"). STUDY SELECTION Excluded were articles not in English, without original data, and that were not topic-related. Thirty-two articles were included with others identified by inspecting reference lists and other sources. DATA SYNTHESIS WTS and the delivery of the dependence-producing drug nicotine were examined, and then the extent to which the articles addressed WTS-induced nicotine/dependence explicitly, as well as implicitly with reference to criteria for dependence outlined by the WHO. CONCLUSIONS WTS supports nicotine/tobacco dependence because it is associated with nicotine delivery, and because some smokers experience withdrawal when they abstain from waterpipe, alter their behaviour in order to access a waterpipe and have difficulty quitting, even when motivated to do so. There is a strong need to support research investigating measurement of WTS-induced tobacco dependence, to inform the public of the risks of WTS, which include dependence, disability, disease and death, and to include WTS in the same public health policies that address tobacco cigarettes.
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Affiliation(s)
- Eiman Aboaziza
- Center for Clinical and Translational Research and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
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Martins SR, Paceli RB, Bussacos MA, Fernandes FLA, Prado GF, Lombardi EMS, Terra-Filho M, Santos UP. Experimentation with and knowledge regarding water-pipe tobacco smoking among medical students at a major university in Brazil. J Bras Pneumol 2014; 40:102-10. [PMID: 24831393 PMCID: PMC4083634 DOI: 10.1590/s1806-37132014000200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/12/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE: Water-pipe tobacco smoking is becoming increasingly more common among young
people. The objective of this study was to estimate the prevalence of the use of
water pipes and other forms of tobacco use, including cigarette smoking, among
medical students, as well as to examine the attitudes, beliefs, and knowledge of
those students regarding this issue. METHODS: We administered a questionnaire to students enrolled in the University of São
Paulo School of Medicine, in São Paulo, Brazil. The respondents were evaluated in
their third and sixth years of medical school, between 2008 and 2013. Comparisons
were drawn between the two years. RESULTS: We evaluated 586 completed questionnaires. Overall, the prevalence of current
cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an
increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively.
All respondents believed that health professionals should advise patients to quit
smoking. However, few of the medical students who smoked received physician advice
to quit. Experimentation with other forms of tobacco use was more common among
males (p<0.0001). Despite their knowledge of its harmful effects, students
experimented with water-pipe tobacco smoking in high proportions (47.32% and
46.75% of the third- and sixth-year students, respectively). CONCLUSIONS: The prevalence of experimentation with water-pipe tobacco smoking and other forms
of tobacco use is high among aspiring physicians. Our findings highlight the need
for better preventive education programs at medical schools, not only to protect
the health of aspiring physicians but also to help them meet the challenge posed
by this new epidemic.
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Affiliation(s)
- Stella Regina Martins
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Renato Batista Paceli
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antônio Bussacos
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Gustavo Faibischew Prado
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Mário Terra-Filho
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ubiratan Paula Santos
- Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Jawad M, Lee JT, Millett C. The relationship between waterpipe and cigarette smoking in low and middle income countries: cross-sectional analysis of the global adult tobacco survey. PLoS One 2014; 9:e93097. [PMID: 24664109 PMCID: PMC3963998 DOI: 10.1371/journal.pone.0093097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/03/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Waterpipe tobacco smoking is receiving growing attention due to accumulating evidence suggesting increasing prevalence in some populations and deleterious health effects. Nevertheless, the relationship between waterpipe and cigarette smoking remain unknown, particularly in low and middle income countries. MATERIALS AND METHODS We analysed waterpipe and cigarette smoking using data from Global Adult Tobacco Survey, a household survey of adults aged ≥15 years conducted between 2008-2010 in LMICs. Factors associated with waterpipe and cigarette use were assessed using multiple logistic regression. Factors associated with the quantity of waterpipe and cigarette smoking were assessed using log-linear regression models. RESULTS After adjusting for age, gender, residence, education, occupation and smokeless tobacco use, waterpipe smoking was significantly higher among cigarette users than in non-cigarette users in India (5.6% vs. 0.6%, AOR 13.12, 95% CI 7.41-23.23) and Russia (6.7% vs. 0.2%, AOR 27.73, 95% CI 11.41-67.43), but inversely associated in Egypt (2.6% vs. 3.4%, AOR 0.21, 95% CI 0.15-0.30) and not associated in Vietnam (13.3% vs. 4.7%, AOR 0.96, 95% CI 0.74-1.23). Compared to non-cigarette smokers, waterpipe smokers who also used cigarettes had more waterpipe smoking sessions per week in Russia (1.3 vs. 2.9, beta coefficient 0.31, 95% CI 0.06, 0.57), but less in Egypt (18.2 vs. 10.7, beta coefficient -0.45, 95% CI -0.73, -0.17) and Vietnam (102.0 vs. 79.3, beta coefficient -0.31, 95% CI -0.56, -0.06) and similar amounts in India (29.4 vs. 32.6, beta coefficient -0.12, 95% CI -0.46, 0.22). CONCLUSIONS Waterpipe smoking is low in most LMICs but important country-level differences in use, including concurrent cigarette smoking, should be taken into account when designing and evaluating tobacco control interventions.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - John Tayu Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
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