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Jehi T, Sabado P, Beeson L, Matta D, Herring P, Sharma A, Emory K, Serban P. Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study. J Community Health 2024:10.1007/s10900-024-01374-1. [PMID: 39003669 DOI: 10.1007/s10900-024-01374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/15/2024]
Abstract
Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.
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Affiliation(s)
- Tony Jehi
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA.
| | - Parichart Sabado
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Lawrence Beeson
- Department of Nutrition & Dietetics, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Dania Matta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Patti Herring
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Archana Sharma
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Kristen Emory
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Pamela Serban
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
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Hammoudi Halat D, Hallit S, Younes S, AlFikany M, Khaled S, Krayem M, El Khatib S, Rahal M. Exploring the effects of health behaviors and mental health on students' academic achievement: a cross-sectional study on lebanese university students. BMC Public Health 2023; 23:1228. [PMID: 37365573 DOI: 10.1186/s12889-023-16184-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students' nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students' academic achievement. METHODS A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS). RESULTS A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = - 0.06) and a higher number of days of eating out (Beta = - 0.07) were significantly associated with lower SAAS scores. CONCLUSIONS This is the first investigation on a Lebanese university students' academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.
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Affiliation(s)
- Dalal Hammoudi Halat
- Academic Quality Department, QU Health, Qatar University, Doha, Qatar
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Samar Younes
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Mira AlFikany
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Sanaa Khaled
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Maha Krayem
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology (GUST), Hawally, Kuwait
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
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Abstract
Tobacco use still represents a major threat to global public health and this calls for extensive efforts to control tobacco products and advocate harm-reduction policies. Recent global trends of prevalence rates in smoking are promising, as trajectories show a decline in all World Health Organization regions. Yet, this decline varies significantly at the national level. Jordan, as a country in the Eastern Mediterranean Region, has been in a long battle against tobacco. Despite that, the country is found to have one of the highest prevalence rates of tobacco use in the region and the world. Many challenges slow down effective and successful anti-tobacco policy implementation in Jordan, most notably cultural influences on smoking and the interference of the tobacco industry in tobacco policy making. Decision makers in Jordan should consider strengthening of anti-tobacco measures to avoid a public health catastrophe if tobacco use keeps rising at the current pace.
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Affiliation(s)
- Ala'a B Al-Tammemi
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
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Sanayeh EB, Iskandar K, Fadous Khalife MC, Obeid S, Hallit S. Parental divorce and nicotine addiction in Lebanese adolescents: the mediating role of child abuse and bullying victimization. Arch Public Health 2022; 80:79. [PMID: 35287735 PMCID: PMC8919634 DOI: 10.1186/s13690-022-00848-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lebanon ranks first amongst Middle-Eastern countries in terms of cigarette and waterpipe smoking. Understanding the mediating factors for nicotine addiction in adolescents who have experienced parental divorce is vital to take effective measures that will help in lowering its prevalence in our community. The objective of this study was to investigate the association between the increasingly concerning parental divorce and nicotine addiction in Lebanese adolescents while taking into consideration the plausible mediating effect of abuse and bullying victimization. METHODS This was a cross-sectional survey-based study that was conducted between January and May 2019. A total of 1810 adolescents aged between 14 and 17 years was enrolled from 16 Lebanese schools. Linear regressions taking the cigarette and waterpipe dependence scores as dependent variables were conducted respectively, using the SPSS software. PROCESS v3.4 model 4 was used for mediation analysis. RESULTS A total of 11.9% of the enrolled participants had divorced parents. Higher cigarette and waterpipe dependence were found in adolescents whose parents were divorced compared to those living together. More child psychological abuse, having divorced parents vs living together, and more child physical abuse were significantly associated with higher cigarette dependence. More child psychological and physical, and having divorced parents vs living together were significantly associated with more waterpipe dependence. In addition, all forms of abuse (except neglect) and bullying victimization had a partially mediating effect in the associations between parental divorce and nicotine dependence (cigarette and waterpipe) in adolescents. CONCLUSION This study results may serve as a first step towards enrolling separated parents and their children in special prevention programs to help them create a protective and supportive environment.
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Affiliation(s)
- Elie Bou Sanayeh
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1027, F-31000, Toulouse, France
| | - Marie-Claude Fadous Khalife
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.,Department of Pediatrics, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Bashirian S, Barati M, Karami M, Hamzeh B, Ezati E. Prevalence of water pipe smoking and associated risk factors among female adolescents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:359. [PMID: 34761045 PMCID: PMC8552255 DOI: 10.4103/jehp.jehp_68_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/10/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND The prevalence of water pipe smoking is increasing among young people, but there are limited data on its use among adolescents in Iran. The aim of this study is to investigate the prevalence of WP smoking and associated risk factors among female adolescents in Western Iran. MATERIALS AND METHODS This cross-sectional study was conducted in schools. It included 1302 middle school (48.1%) and high school (51.9%) female students (grades 7-12) recruited through stage random sampling and conducted in 2019 in the western city of Kermanshah, Iran. The data collection tool was a researcher-made questionnaire. Logistic regression analyses and descriptive statistics were executed using SPSS version 22. RESULTS The mean (standard deviation) ages of the students and the ages when the participants started WP smoking were 15.22 ± 1.85 and 13.64 (1.64), respectively. Nearly 32.2% had a single experience of WP smoking during their lifetime and 20.4% were current consumers of WP. Most of the subjects smoked WPs at their friends' home (45.8%) and with their friends (47.4%). The significantly important factors that affect WP smoking in these age groups are the father's and mother's occupation, family size, living with others, father's education, having a friend who smokes WPs, friends' encouragement to smoke WP, and being in a family that smoke WPs. CONCLUSIONS Considering the increasing popularity of WP among adolescent females and its increasing prevalence, the results showed that Water pipe smoking with friends played a key role in WP smoking among female adolescents. There is a need to design interventional studies to increase people's skills and to design and implement programs to prevent water pipe.
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Affiliation(s)
- Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Manoochehr Karami
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinacies of Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elahe Ezati
- Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Kakaje A, Alhalabi MM, Alyousbashi A, Ghareeb A, Hamid L, Al-Tammemi AB. Smoking habits and the influence of war on cigarette and shisha smoking in Syria. PLoS One 2021; 16:e0256829. [PMID: 34473786 PMCID: PMC8412248 DOI: 10.1371/journal.pone.0256829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/16/2021] [Indexed: 12/04/2022] Open
Abstract
Tobacco smoking might be impacted by various influences, including psychological, socio-cultural, and economic factors. A community-based cross-sectional survey was conducted in Syrian Arab Republic from March to April 2019 using a web-based questionnaire. The survey aimed at assessing tobacco use (shisha and cigarettes) as well as examining the association between current tobacco use and various sociodemographic and war-related factors. The sample comprised 978 participants (251 males: 727 females) and had a mean age of 24.7 years (SD: 7.60). Most participants were single (n = 825, 84.4%), reside in Damascus and Rif-Dimashq (n = 579, 59.2%), and had a college/university education (n = 911, 93.1%). Concerning smoking, a total of 371 participants (37.9%) were identified to be current tobacco smokers, of whom 211, 84, 76 were exclusive shisha smokers, exclusive cigarette smokers, and dual smokers, respectively. The prevalence of cigarette smoking (exclusive and dual) among males and females was found to be 34.7%, and 10.0%, respectively. On the other hand, the prevalence of shisha smoking (exclusive and dual) among males and females was around 34.3% and 27.6%, respectively. Additionally, various factors have predicted a higher likelihood of cigarette smoking including male gender (AOR = 4.152; 95% CI: 2.842-6.064; p<0.001), and losing someone due to the war (AOR = 1.487; 95% CI: 1.028-2.151; p = 0.035), while unemployed individuals were found to have lower odds of being cigarette smokers (AOR = 0.634; 95% CI: 0.429-0.937; p = 0.022). Concerning shisha smoking, married (AOR = 0.622; 95% CI: 0.402-0.963; p = 0.033), and unemployed individuals (AOR = 0.679; 95% CI: 0.503-0.916; p = 0.011) were found to have lower odds of shisha smoking. Amid the tobacco epidemic in the region, rates of tobacco use in Syria are still worrying. The Syrian armed conflicts may possess a double-edged effect on smoking, and tobacco users who adopt smoking to cope with various stressors should be targeted with well-structured health education, along with appropriate psychological services.
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Affiliation(s)
- Ameer Kakaje
- Faculty of Medicine, Damascus University, Damascus, Syria
- University Hospital Geelong, Barwon Health, Victoria, Australia
| | | | | | - Ayham Ghareeb
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Loura Hamid
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ala’a B. Al-Tammemi
- Faculty of Medicine, Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
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Al-Delaimy AK, Al-Ani WAT. Prevalence of hookah smoking and associated factors among male high school students in Iraq. BMC Public Health 2021; 21:1317. [PMID: 34225683 PMCID: PMC8256481 DOI: 10.1186/s12889-021-11386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of the hookah-smoking device is increasing at a large scale in the Eastern Mediterranean region. Hookah users are exposed to an array of chemical compounds and may suffer several chronic diseases as a result. The purpose of this study was to determine the prevalence of hookah use among male high school students in the region and to study different associated factors in order to provide local tobacco control officials with an understanding of this public health problem. METHODS A convenient non-probability sampling study was conducted among students in three high schools in Al-Karkh district, Baghdad. The study period was from October 2017 till January 2019 and included 847 male students aged 15-18 years old. Using a simple random technique to select the high schools from a list of schools we chose one school from each directorate. Descriptive, chi-square test of significance, bivariate, and multivariate logistic regression analyses of data were carried out for identifying the risk factors associated with hookah smoking among these high school adolescent males. RESULTS The overall prevalence of hookah smoking in the last 30 days among male high school students was 46.1% while in the past 6 months it was as high as 85.7%. More than two-thirds (70.6%) of the students thought that hookah smoking was more socially acceptable than cigarette smoking. Factors such as having first heard about it from friends, the media, or the presence of a hookah café near their residence were significantly associated (p > 0.05) with hookah smoking among the students. Similarly, being surrounded by friends who used hookah was also found to be significantly associated with hookah smoking, with an odds ratio of 0.18, 95% CI (0.087-0.394). Hookah smokers were less likely than non-hookah smokers to report its use as forbidden in Islam and more likely to say it is allowed in Islam. CONCLUSIONS We found an alarmingly high use of hookah smoking among male high school students in this study. Family members and peers had an important role in the prevention of hookah smoking among these students. There is a need for students to be educated about the toxicity of hookah tobacco smoking and its direct effect on their health.
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Affiliation(s)
- Ahmed K Al-Delaimy
- Family & Community Medicine Department / Anbar Medical College, University of Anbar, Ramadi, Iraq.
| | - Waleed A T Al-Ani
- Family & Community Medicine Department Al-Mustansiriya Medical College, University of Al-Mustansiriya, Baghdad, Iraq
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Krela-Kazmierczak I, Szymczak-Tomczak A, Tomczak M, Lykowska-Szuber L, Eder P, Kucharski MA, Stawczyk-Eder K, Waszak K, Karczewski J, Dobrowolska A. Is there a relation between vitamin D, interleukin-17, and bone mineral density in patients with inflammatory bowel disease? Arch Med Sci 2021; 17:662-674. [PMID: 34025836 PMCID: PMC8130475 DOI: 10.5114/aoms.2018.78009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/01/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION In inflammatory bowel diseases (IBD), osteopenia and osteoporosis constitute a significant medical problem. Cytokines, especially IL-17, play an important role in the pathogenesis of IBD and osteoporosis. Vitamin D is a regulator of bone metabolism, and helps maintain immune system homeostasis. MATERIAL AND METHODS The research sample consisted of 208 persons: 83 patients (age 35 ±11.99 years) with Crohn's disease (CD); 86 patients (age 39.58 ±14.74 years) with ulcerative colitis (UC); and 39 persons (age 30.74 ±8.63 years) in the control group (CG). Clinical data on bone mineral density of the lumbar spine (L2-L4), bone mineral density of the femoral neck (FN), and body mass index (BMI) were collected. 25OHD and IL-17 serum concentrations were also measured. RESULTS Body mass index (kg/m2) results: in CD, 21.51 ±3.68; in UC, 23.31 ±4.38; and in CG, 24.57 ±3.45 (p < 0.01). Densitometry results for L2-L4 T-score SD: in CD -0.83 ±1.45; in UC -0.47 ±1.15; in CG 0.09 ±0.70. Densitometry results for FN T-score SD: in CD -0.62 ±1.26; in UC -0.29±1.17; in CG 0.41 ±1.03 25OHD (ng/ml) serum concentrations: in CD, 21.33±12.50; in UC, 22.04±9.56; in CG, 21.56±9.11 (ns). IL-17 (pg/ml) serum concentrations: in CD, 8.55±10.99; in UC, 11.67±12.97; in CG, 5.16±9.11 (ns). CONCLUSIONS Inflammatory bowel diseases patients and persons from the CG did not differ in vitamin D or IL-17 levels. Patients with a mild course of the disease had a higher vitamin D concentration and bone mineral density. In UC, higher vitamin D concentrations were associated with lower IL-17 concentrations. The IBD patients with a severe course of the disease had a lower body mass than those in the CG and the patients with a mild course of the disease.
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Affiliation(s)
- Iwona Krela-Kazmierczak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Szymczak-Tomczak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Tomczak
- Department of Psychology, Poznan University of Physical Education, Poznan, Poland
| | - Liliana Lykowska-Szuber
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin A. Kucharski
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Kamila Stawczyk-Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Waszak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Karczewski
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Ebrahimi Kalan M, Bahelah R, Bursac Z, Ben Taleb Z, DiFranza JR, Tleis M, Nakkash R, Jebai R, Alam MM, Cano MÁ, Sutherland MT, Fenni K, Asfar T, Eissenberg T, Ward KD, Maziak W. Predictors of nicotine dependence among adolescent waterpipe and cigarette smokers: A 6-year longitudinal analysis. Drug Alcohol Depend 2020; 217:108346. [PMID: 33075692 PMCID: PMC7861130 DOI: 10.1016/j.drugalcdep.2020.108346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Identifying the factors associated with nicotine dependence (ND) is essential to prevent initiation and continued use, and to promote cessation among youth. This study aims to document the predictors of the appearance of initial ND symptoms and full ND syndrome among adolescent waterpipe (WP) and cigarette smokers. METHODS A 6-year longitudinal study was conducted among 8th and 9th graders from 38 schools in Lebanon. The analysis sample included exclusive-WP (n = 228) and exclusive-cigarette smokers (n = 139). Weighted Cox proportional hazards models were used to characterizing predictors of initial ND symptoms and full ND syndrome. RESULTS Predictors of experiencing initial ND symptoms among WP smokers included low maternal educational level, having a sibling who smoked WP, low physical activity, high body mass index (BMI), smoking initiation at a younger age. For cigarette smokers these were being male, younger, having lower BMI, having a sibling who smoked cigarettes, living in a crowded household, and smoking daily. Among WP smokers, predictors of developing full ND syndrome include being younger, believing that WP smokers have more friends, depression, high levels of impulsivity, and initiating smoking at a younger age. For cigarette smokers, predictors of full ND syndrome were being younger and initiating smoking at a younger age. CONCLUSION Smoking cessation and prevention interventions targeting youth should address modifiable, and tobacco use-specific factors that influence the development of ND among young WP and cigarette smokers. They also need to start at a younger age to target those most vulnerable to developing life-long addiction to tobacco products.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA.
| | - Raed Bahelah
- School of Health Sciences, Baldwin Wallace University, Kamm Hall, 191 E Center St, Berea, OH 44017, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, 11200 SW 8th St AHC5, 4th Floor, Miami, FL, 33199, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 411 S. Nedderman Drive Box 19407, Arlington, Texas 76019-0407, USA
| | - Joseph R DiFranza
- Reliant Medical Group, 225 New Lancaster Rd, Leominster, MA 01453, USA
| | - Malak Tleis
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Bliss Street. P.O. Box 11-0236. Beirut, Lebanon
| | - Rima Nakkash
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Bliss Street. P.O. Box 11-0236. Beirut, Lebanon
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Mohammad Masudul Alam
- Center for the Study of Tobacco, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11101 S.W. 13 ST., Miami, FL 33199, USA
| | - Kristopher Fenni
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road Sarasota, FL 34243, FL, USA
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 120 NW 14th Street, CRB 919, Miami, FL 3313, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136, USA; Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria; Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, 100 W. Franklin St. Suite 200, Richmond, VA 23220, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria; School of Public Health, University of Memphis, 3720 Alumni Ave, Memphis, TN 38152, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA; Syrian Center for Tobacco Studies, Tishreen Street, SheehanAleppo, P.O.Box: 16542, Syria
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10
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Waterpipe Nicotine Dependence and Depressive Symptoms among Adolescent Waterpipe and Dual Users. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:2364571. [PMID: 33204280 PMCID: PMC7665911 DOI: 10.1155/2020/2364571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
Background Waterpipe nicotine dependence and its association with depressive symptoms and dual usage among adolescents are currently not examined in the literature. Adolescents are a vulnerable population that is susceptible to depression and initiation of tobacco use. We aim, in this novel study, to assess the association between depressive symptoms and waterpipe nicotine dependence among adolescents in Jordan, evaluate the association between waterpipe smoking status (waterpipe smoker vs. dual user) and waterpipe nicotine dependence, and assess the internal validity of the Waterpipe Nicotine Dependence Scale (WNDS). Method A cross-sectional study among adolescents of grade 9th to 12th in Jordan was conducted through multistage cluster random sampling. The self-reported Arabic Youth Tobacco Use Composite Measure Questionnaire (YTUCM) was used to collect the surveys that include demographic information, smoking status, and the WNDS to assess waterpipe nicotine dependence and depressive symptoms. Multiple linear regression and the t-test were used to analyze the data. Findings. One thousand three hundred and three surveys were collected, of which 1082 were included in the study (443 males and 639 females). 64.9% of the sample were nontobacco users, while 20.1% were waterpipe- (WTP-) only smokers, 11.4% were dual users, and 3.7% were cigarettes-only users. After adjusting for weights, 66.6% were nonsmokers, 19.2% were WTP-only smokers, 10.2% were dual users, and 3.9% were cigarettes-only smokers. Using multiple linear regression, depressive symptoms were significantly associated with WTP nicotine dependence (β 0.618), upon adjusting for confounders. Furthermore, dual users were associated with higher WTP nicotine dependence (β 12.034) compared to WTP-only smokers after adjusting for confounders. Cronbach's alpha for the WNDS was 0.955. Conclusions Our study shows that there is a statistically significant association between depressive symptoms and WTP nicotine dependence and higher dependence among dual users compared to WTP-only smokers. The WNDS can be a useful tool to assess WTP nicotine dependence with high internal consistency. However, a longitudinal study is needed to further understand the association and temporality between the depressive symptoms and WTP nicotine dependence. Additionally, research is needed to shorten the WNDS while maintaining high internal consistency and assess the external validity of the WNDS and the short- and long-term consequences of dual usage.
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Alzyoud S, Veeranki SP, Pbert L. Waterpipe tobacco smoking: nicotine dependence and smoking control strategies among youth. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1738572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan
- World Health Organization, Amman, Jordan
| | - Sreenivas P. Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Kheirallah KA, Cobb CO, Alsulaiman JW, Alzoubi A, Hoetger C, Kliewer W, Mzayek F. Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan. J Public Health (Oxf) 2020; 42:e343-e351. [PMID: 31742341 DOI: 10.1093/pubmed/fdz128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls. METHODS Syrian refugee students (mean [standard deviation] age = 14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status. RESULTS One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support. CONCLUSIONS Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies.
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Affiliation(s)
- Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 21110, Jordan
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Jomana W Alsulaiman
- Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid 21110, Jordan
| | - Abdallah Alzoubi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 21110, Jordan
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Fawaz Mzayek
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, TN 38152, USA
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Alzyoud S, Massoud F. Waterpipe and cigarette tobacco smoking and depressive symptoms among public school students in central Jordan. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-09-2019-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeTobacco is the most widely used substance in the world that has been linked to several psychological problems. Few studies have assessed the relationship between dual (waterpipe and cigarette) tobacco smoking. This study aims to examine the relationship between dual tobacco use and symptoms of depression amongst its users.Design/methodology/approachA cross-sectional study using a random sample of school students was conducted to assess youth tobacco smoking in the central region of Jordan. A self-reported questionnaire including biographical information, smoking status and experience of depression symptoms was used with a sample of 9th to 12th-grade students. χ2 and regression test were used to analyze the data.FindingsThe final sample comprised 576 school students, of whom 60% were males. The age range was between 16 and 18 years (mean = 15.84 years, SD ± 0.97). 30% of the participants were dual tobacco smokers. A significant difference was found between males and females, with males being more likely to be dual tobacco smokers compared to females. Two depressive symptoms (“feeling sad” and “having crying spells”) had a significant likelihood amongst the youth who were dual smokers.Originality/valueTo the best of the authors' knowledge, this is the first study that aims to report the relationship between dual tobacco smoking and depressive symptoms. Prevention programs are crucial for raising awareness of the harmful effects of dual tobacco smoking and smoking cessation amongst the youth
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Logo DD, Kyei-Faried S, Oppong FB, Ae-Ngibise KA, Ansong J, Amenyaglo S, Ankrah ST, Singh A, Owusu-Dabo E. Waterpipe use among the youth in Ghana: Lessons from the Global Youth Tobacco Survey (GYTS) 2017. Tob Induc Dis 2020; 18:47. [PMID: 32547350 PMCID: PMC7291957 DOI: 10.18332/tid/120937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The Global Youth Tobacco Survey’s findings have been used to support Ghana’s tobacco control legislation, monitor tobacco use among the youth and also used in meeting various Articles of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). These Articles include: Article 8 (Protection for exposure to tobacco smoke); Article 12 (Education, communication, training and public awareness); Article 13 (Tobacco advertising, promotion, and sponsorship); Article 14 (Demand reduction measures concerning tobacco dependence and cessation); and Article 16 (Sales to and by minors). Among the four waves of GYTS in Ghana, the 2017 GYTS was the first to assess waterpipe smoking, through optional questions included in the GYTS questionnaire. We assessed sex, age and regional differentials in waterpipe smoking among the youth in Ghana, and also explored the association between the use of other tobacco products and waterpipe use. METHODS The GYTS employs a standardized methodology with self-administered questionnaires, consisting of core, optional, and country specific questions. Fourteen questions, out of the seventy-four (74) questions administered for the entire GYTS, assessed waterpipe tobacco smoking (WTS). Chi-squared test was used to assess sex, age, grade/form and regional differentials in waterpipe use. Furthermore, the association between smoking cigarettes, smokeless tobacco, electronic cigarettes and waterpipe smoking, was explored by employing a chi-squared test with a 5% significance level. RESULTS Of a total of 5664 students who participated in the study, 90.9% were aged 13–15 years. The respondents were almost equally distributed among males and females. Overall, 3.1% of the respondents had ever smoked waterpipe. The overall prevalence of current waterpipe use was 1.7%; with 2.1% in girls (95% CI: 0.9–4.7%) and 0.9% in boys (95% CI: 0.5–1.6%), p=0.033. Additionally, more than half (55.0%) of the current waterpipe users smoked three or more sessions per day. Surprisingly, close to half (46.9%) of the current waterpipe users smoked at home. CONCLUSIONS Waterpipe use, particularly among the female student population, represents an emerging tobacco epidemic and hence deserves immediate attention from authorities. This study revealed that waterpipe is being used among Junior High students in Ghana. Education on the health implications of waterpipe use should be intensified among the youth, to help minimize its use and to prevent its associated health harms.
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Affiliation(s)
- Divine D Logo
- Research and Development Division, Ghana Health Service, Accra, Ghana.,Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Felix B Oppong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Joana Ansong
- World Health Organization Ghana Country Office, Accra, Ghana
| | - Seidu Amenyaglo
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sampson T Ankrah
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Arti Singh
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Darawad MW, Rezk-Hanna M, Alhussami M, Lee J, Mostafa A, Abu-Rmeileh N, Kheirallah K, Salama M, Nakkash R, Saleh Z, Salloum R. Poly-Tobacco Use among Young Adult Waterpipe Smokers: Insights from University Students in Three Eastern Mediterranean Countries. Subst Use Misuse 2020; 55:2099-2108. [PMID: 32666880 DOI: 10.1080/10826084.2020.1790010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is a tendency of waterpipe smokers to advance their practice toward concurrent use (poly-tobacco use) of other tobacco products and nicotine delivery systems. This study investigated poly-tobacco use among waterpipe smokers, and its effect on their quit intention. METHODS Descriptive cross-sectional design was utilized to recruit a convenience sample of university students who used waterpipe in three East Mediterranean countries. Using an internet-based survey, data were collected regarding participants' demographics, use of alternative tobacco products and nicotine delivery systems, and waterpipe quitting profile. Results: A total of 2290 students agreed to participate, among which 1116 (45.3%) reported using at least one tobacco product beside waterpipe. Poly-tobacco use was highest (61.1%) in Egypt, followed by Jordan (45.1%) and Palestine (33.1%). Across countries, cigarettes were the most common product (45.2%, n = 924) followed by cigar (18.6%, n = 374) and e-shisha (17.5%, n = 353). Conversely, the least reported product was smokeless tobacco (7.5%, n = 151) preceded by regular pipe (9.5%, n = 193). Participants who were males (OR = 2.83, 95% CI: 2.18-3.65), older (22-29 years) (OR = 1.15, 95% CI: 1.09-1.22), unemployed (OR = 1.58, 95% CI: 1.22-2.04), and those who initiated waterpipe at a younger age (OR = 0.87, 95% CI: 0.87-0.91) had higher odds of being poly-smokers. Poly-tobacco users were significantly more resistant to quit waterpipe. Conclusion: This study demonstrates poly-tobacco use as a rising phenomenon among waterpipe smokers and highlights the necessity for initiating advanced interventions to help waterpipe poly-tobacco users quit this dangerous type of addiction. Various country-specific programs are needed considering the various products used by the users.
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Affiliation(s)
| | - Mary Rezk-Hanna
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | | | - Juhan Lee
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aya Mostafa
- Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Khalid Kheirallah
- Department of Public Health-Medical School, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammed Salama
- Clinical Nursing Department, Mansoura University, Mansoura, Egypt
| | - Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeyad Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Ramzi Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
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Miri-Moghaddam M, Shahrakipour M, Nasseri S, Miri-Moghaddam E. Higher prevalence of water pipe compared to cigarette smoking among medical students in Southeast Iran. Cent Eur J Public Health 2019; 27:188-194. [PMID: 31580552 DOI: 10.21101/cejph.a5615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking of water pipe (WP) and cigarettes has recently turned into a major global health burden. The present study aimed at assessing WP and cigarette smoking among Zahedan University of Medical Sciences (ZUMS) students in Iran. METHODS A cross-sectional survey was conducted on 500 students in ZUMS (182 males, 318 females). The subjects were selected through randomized cluster sampling. Morgan's chart was applied to calculate the sample size; 96.6% of the attendees completed a questionnaire designed to address the aims of the study. RESULTS The mean age of the subjects was 21.2 ± 2.4 years. WP and cigarette smoker rates were at 31.2% and 15.2%, respectively. The age of smoking initiation ranged between 15 and 20 years. Friends played crucial roles in triggering the smoking in both groups of WP and cigarette smokers (78% and 54%, respectively). The main reasons for WP and cigarette smoking were entertainment followed by curiosity. Furthermore, males used more cigarette (26.5 vs. 8.7%) and WP (50.6 vs. 20.4%) than females. Among father and mother smokers, respectively, 54.2% and 60% of children were also WP smokers (p = 0.001). Also, 21.9% and 60% of children smoking cigarettes had father and mother smokers, respectively (p = 0.05). CONCLUSION Tobacco use, especially for WP seems to be at alarming rates among medical students in Iran. It is highly recommended to control the progressive prevalence of WP smoking by governmental/academic preventive measures as educational and smoking cessation activities.
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Affiliation(s)
- Masoud Miri-Moghaddam
- Student Research Centre, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahnaz Shahrakipour
- Department of Biostatistics and Epidemiology, Oral and Dental Disease Research Centre, Health Faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeed Nasseri
- Cellular and Molecular Research Centre, Birjand University of Medical Sciences, Birjand, Iran
| | - Ebrahim Miri-Moghaddam
- Department. of Molecular Medicine, Cardiovascular Research Centre, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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The Effect of Waterpipe Smoking on DNA Integrity Among Youth in Jordan. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2019. [DOI: 10.1007/s13369-019-03794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluating health warning messages specific to waterpipe smoking among university students in Jordan. J Am Assoc Nurse Pract 2019; 31:133-138. [PMID: 30507761 DOI: 10.1097/jxx.0000000000000107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Health warning messages specific to waterpipe smoking (WPS) have not been tested enough in literature. This study evaluated university students' response to such messages. Specifically, this study (1) assessed the extent to which certain warning messages and pictorial signs motivate participants to quit WPS smoking; (2) identified the best location to place the warning signs of waterpipe as perceived by participants; and (3) assessed participants' intention to quit WPS. METHODS A descriptive, cross-sectional design was used to collect data from 397 university students in Jordan using an Internet-based survey. The following data were collected: intentions regarding WPS, response to nine warning messages, and responses to four pictorial signs. RESULTS The message that had the highest motivation to quit smoking was " WPS during pregnancy can harm your baby" (79.3%), whereas the highest pictorial sign was regarding "Protect your children" (64.2%). Most (69.5%) participants believed that WPS products and accessories should contain warnings, and the best suggested location was the pipe handle (52.4%). Participants who reported quitting WPS and those who had an intention to quit had significantly higher responses to both types of health warning labels (HWLs). CONCLUSION Both text-only and pictorial HWLs were found to encourage quitting WPS among university students. Knowing that participants are having an intention to quit mandates extra efforts to make WPS experience less appealing through reminding them regarding its harms. IMPLICATIONS FOR PRACTICE Support is needed by health care providers to put those effective health warning messages in action. Furthermore, providers can use such health warnings in motivating their patients to quit WPS.
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Al-Qerem W, Gassar ES, Hammad AM, Al-Qirim RA, Jarrar YB, Ling J, Basheti IA. Assessing the Application of the Reference Lung Age Equations on the Jordanian Population. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190112151713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Ezeddin S. Gassar
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Alaa M. Hammad
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Rania A. Al-Qirim
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Yazun B. Jarrar
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing University of Sunderland, England, United Kingdom
| | - Iman A. Basheti
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Jawad M, Charide R, Waziry R, Darzi A, Ballout RA, Akl EA. The prevalence and trends of waterpipe tobacco smoking: A systematic review. PLoS One 2018; 13:e0192191. [PMID: 29425207 PMCID: PMC5806869 DOI: 10.1371/journal.pone.0192191] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Waterpipe tobacco smoking is harmful to health however its prevalence estimates remain uncertain. We aimed to systematically review the medical literature on waterpipe tobacco prevalence and trends. METHODS We searched Medline, Embase and ISI Web of Science for 'waterpipe' and its synonyms, without using language or date restrictions. We included any measure of waterpipe tobacco smoking prevalence in jurisdictionally representative populations. We stratified findings by prevalence measure (past 30 day, ever, regular or occasional, daily, other or unspecified) and age (adults or youth). RESULTS We included 129 studies reporting 355 estimates for 68 countries. In general, prevalence estimates among adults were highest in the Eastern Mediterranean, and among youth were about equal between Eastern Mediterranean and European regions. Past 30 day use was highest among Lebanese youth (37.2% in 2008), ever use was highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%), regular or occasional use was highest in among Iranian university students (16.3% in 2005), and daily use was highest among Egyptian youth (10.4% in 2005). Trend data were limited but most studies reported increased use over time, ranging from 0.3-1.0% per year among youth in the US to 2.9% per year among youth in Jordan (both for past 30 day use). Results were similar for ever use trends. Turkey (2.3% in 2008 to 0.8% in 2010) and Iraq (6.3% in 2008 and 4.8% in 2012) both witnessed decreased waterpipe use. CONCLUSION Waterpipe tobacco smoking is most prevalent in Eastern Mediterranean and European countries, and appears higher among youth than adults. Continued surveillance will be important to assess and inform policy measures to control waterpipe tobacco use.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom
- * E-mail:
| | - Rana Charide
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Reem Waziry
- Department of Epidemiology Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Andrea Darzi
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Rami A. Ballout
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Al-Sheyab NA, Alomari MA. Prevalence, associated factors, and control level of asthma symptoms among adolescents in Northern Jordan. Int J Adolesc Med Health 2018; 32:ijamh-2017-0159. [PMID: 29331100 DOI: 10.1515/ijamh-2017-0159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
Objective To investigate the prevalence, associated factors, and control level of asthma in Jordanian high school students. Methods A descriptive, comparative, cross sectional design was used and a cluster sample of 2691 students (mean age = 14.5 years, 51.0% girls), drawn from eight randomly selected public high schools in Northern Jordan, participated in the study. Each student had the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire completed in the classroom between February and May, 2015. Results The prevalence of recent wheezing in the last 12 months was 11.7% whereas the prevalence of diagnosed asthma was 6.2%. About 49% of students experienced cough all the time, and 33.5% experienced waking up at night due to wheezing some of the time. About 30.9% of students reported moderate to big exercise-induced asthma. The mean total Asthma Control Test (ACT) score was 5.85 (SD = 3.56) with all of students reporting uncontrolled asthma during the last month. Higher rates of asthma symptoms were reported by females, 10th graders, and students with negative family history. Importantly, students with diagnosed asthma or recent wheezing reported higher rates of ever smoking tobacco vs. non-asthmatics (p < 0.000); dual (18.6% vs. 9.8%), cigarettes only (11.2% vs. 7.3%), and waterpipe only (18.0% vs. 14.7%). Conclusion Overall, students with asthma or wheezing had increased rates of tobacco smoking. Policies need to be set and enforced to provide a better environment for these youth, especially making all schools smoke-free zones. A multifaceted, comprehensive awareness and management program is required in schools to control and manage asthma symptoms.
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Affiliation(s)
- Nihaya A Al-Sheyab
- Jordan University of Science and Technology, Faculty of Nursing, Midwifery and Health, PO BOX 3030, Irbid, 22110, Jordan, Phone: +962 2 7201000 (Extension 23609), Fax: +962 2 7095012
| | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Alomari MA, Al-Sheyab NA. Impact of waterpipe smoking on blood pressure and heart rate among adolescents: The Irbid-TRY. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1394379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mahmoud A. Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A. Al-Sheyab
- Faculty of Nursing, Maternal and Child Health Department, Jordan University of Science and Technology, Irbid, Jordan
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Alomari MA, Al-sheyab NA. Dual tobacco smoking is the new trend among adolescents: Update from the Irbid-TRY. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1348559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mahmoud A. Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A. Al-sheyab
- Faculty of Nursing, Maternal and Child Health Department, Jordan University of Science and Technology, Irbid, Jordan
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Tucktuck M, Ghandour R, Abu-Rmeileh NME. Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study. BMC Public Health 2017; 18:1. [PMID: 28693529 PMCID: PMC5504745 DOI: 10.1186/s12889-017-4524-0] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/20/2017] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND During the last two decades, waterpipe tobacco smoking (WTS), also known as hookah, witnessed a global increase in use, especially among youth. Little information is known about the burden of WTS among Palestinian youth. A cross-sectional study was conducted to estimate the prevalence of WTS and cigarette smoking and explore the associated factors among a sample of Palestinian university students. METHODS 1891 students, from five Palestinian universities in the West Bank and Gaza Strip, completed a self-administered, web-based survey in 2014-2015. The questionnaire, which was based on the Global Adults Tobacco Survey (GATS), had questions on WTS and cigarette smoking patterns and socio-demographic and university-related characteristics. Binary logistic regression analyses were computed to investigate associated factors with WTS and cigarette smoking. RESULTS 50.9% of the sample was women. The mean age was 20.1 ± 2.0. Overall, 30.0% of participants were current tobacco smokers and 33.4% reported ever smoking tobacco through a waterpipe. The prevalence of current WTS (24.4%) surpassed the prevalence of current cigarette smoking (18.0%), with a significantly higher prevalence among men compared to women. The gender gap for WTS (36.4% vs. 12.9%) was smaller than that for cigarette smoking (32.8% vs. 3.6%). Binary logistic regression models for the total sample (men and women) revealed that men were more likely to be current waterpipe and cigarette tobacco smokers compared to women (AOR = 4.20, 95% CI = 3.22-5.48, and AOR = 10.91, 95% CI = 7.25-16.42, respectively). Geographic area of residence, faculty of study and self-reported academic achievement were also associated with the likelihood of being current waterpipe and cigarette tobacco smokers. CONCLUSION A high prevalence of WTS was reported among our study sample, and it surpassed the prevalence of cigarette smoking. Interventions to curb the practice of tobacco smoking among Palestinian youth should be tailored differently to WTS and cigarette smoking, be gender-sensitive and specific and target the regional variation in the smoking behavior.
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Affiliation(s)
- Marina Tucktuck
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
| | - Niveen M. E. Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
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Ozouni Davaji RB, Dadban Shahamat Y, Hajili Davaji F, Mirkarimi K, Charkazi A, Pahlavanzadeh B, Seydghasemi NS, Sharifirad G, Moodi M, Elahi A. Patterns, Beliefs, Norms and Perceived Harms of Hookah Smoking in North Iran. Asian Pac J Cancer Prev 2017; 18:823-830. [PMID: 28441793 PMCID: PMC5464506 DOI: 10.22034/apjcp.2017.18.3.823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Hookah smoking is considered as a public health threat around the globe. The aim of this study was to investigatethe hookah smoking patterns, beliefs, norms and perceived harms in Golestan province of Iran. Methods: A cross-sectional study was conducted on 395 hookah smokers using convenience sampling method in 2015. To collect data, Heinz’s hookah patternwas utilized. Ordinal regression models were used to exploring of covariates related to the odds of life time, last-30-day, and current hookah use. Results: In general, 357 (90.4%) subjects were male smokers. Most of subjects smoked hookah in café (62.2%) and with friends (75.6%). The majority of them (71.1%) did not consider themselves as a hooked person. Cigarette smoking (OR =.65, 95 % CI. 42-.98), low perceived addictiveness of hookah than cigarettes (OR =2.33, 95 % CI 1.45-3.73), Social context of hookah smoking with friends in café (OR =1.14, 95 % CI 1.08-1.2), and number of close friends who smoked hookah (OR =1.38, 95 % CI 1.18-1.61) were effective variables affected the past month use of hookah. Conclusion Development, implementation and assessment of interventions particularly adapted to hookah smoking regarding increase of perceived harm of hookah than cigarette and its probable addiction focusing on close friends appeared to be beneficial.
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Affiliation(s)
- Rahman Berdi Ozouni Davaji
- Health Management and Social Development Research Center, Golbarg Aval St, South Motahhari Av, Karimi Sq, Gorgan, Iran.
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Jiang N, Ho SY, Wang MP, Leung LT, Lam TH. The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents. Addict Behav 2017; 64:123-128. [PMID: 27608324 DOI: 10.1016/j.addbeh.2016.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/14/2016] [Accepted: 08/29/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. METHODS We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. RESULTS Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19). CONCLUSIONS Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.
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Affiliation(s)
- Nan Jiang
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong.
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Correlates of nicotine dependence among adolescent waterpipe smokers. Drug Alcohol Depend 2016; 168:230-238. [PMID: 27716576 PMCID: PMC5086296 DOI: 10.1016/j.drugalcdep.2016.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Waterpipe smoking is addictive and its use is increasing globally among youth, yet little is known about the factors associated with nicotine dependence (ND) among waterpipe smokers. We investigated the factors associated with ND symptoms among a sample of Lebanese adolescents who smoke a waterpipe. METHODS We collected data on factors potentially associated with ND (individual, socio-demographic, environmental, smoking patterns) among 160 current (past 30days) waterpipe smokers recruited from 8th and 9th school grades in Lebanon. We assessed the loss of autonomy over tobacco using the Hooked on Nicotine Checklist (HONC), ND using the International Classification of Diseases, 10th revision (ICD-10), and the number of ND symptoms endorsed. RESULTS Depressive symptoms, lower self-esteem, and having at least one sibling who smokes a waterpipe were associated with the presence of ND symptoms, while enrollment in public schools, smoking a waterpipe ≥30min per session, and believing that cigarette smoking is harmful to health were associated with endorsement of a higher number of ND symptoms. Smoking a whole waterpipe head without sharing and being in 9th grade in this study were associated with the presence and endorsement of a higher number of ND symptoms. CONCLUSIONS We identified specific social and psychological characteristics, waterpipe smoking patterns, and beliefs about harmful effects of smoking associated with the presence of ND among adolescent waterpipe smokers. Considering these factors when planning policies to prevent ND among waterpipe smokers is warranted.
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Al-sheyab NA, Al-Fuqha RA, Kheirallah KA, Khabour OF, Alzoubi KH. Anthropometric measurements of newborns of women who smoke waterpipe during pregnancy: a comparative retrospective design. Inhal Toxicol 2016; 28:629-635. [DOI: 10.1080/08958378.2016.1244227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mauseth KB, Skalisky J, Clark NE, Kaffer R. Substance Use in Muslim Culture: Social and Generational Changes in Acceptance and Practice in Jordan. JOURNAL OF RELIGION AND HEALTH 2016; 55:1312-1325. [PMID: 25972289 DOI: 10.1007/s10943-015-0064-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Through narrative analysis, this paper explores the changes in acceptance of and response to substance use in Muslim culture by evaluating data collected in qualitative interviews in Jordan in 2013. What is known and unknown about substance use in Muslim culture throughout the Arab world from previous research findings provides a foundation from which to explore new perspectives and compare themes between younger and older generations in Jordan. Trends of social change and behavioral expression influenced by dramatic political and social upheaval in the Arab world in the last 5 years will also be evaluated for the way in which they may be influencing both substance use and its acceptance among young adults in this population. Recommendations for future research and work in this area are also provided based on these findings.
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Affiliation(s)
- Kira B Mauseth
- Department of Psychology, Seattle University, 901-12th Ave, Seattle, WA, 98211, USA.
| | - Jordan Skalisky
- Department of Psychology, Seattle University, 901-12th Ave, Seattle, WA, 98211, USA
| | - Noël E Clark
- Department of Psychology, Seattle Pacific University, 3307-3rd Ave W, Seattle, WA, 98119, USA
| | - Ray Kaffer
- Department of Psychology, Seattle University, 901-12th Ave, Seattle, WA, 98211, USA
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Jiang N, Ho SY, Wang MP, Leung LT, Lam TH. Waterpipe smoking among secondary school students in Hong Kong. Int J Public Health 2016; 61:427-34. [PMID: 26873908 DOI: 10.1007/s00038-016-0796-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/28/2015] [Accepted: 01/27/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To examine the prevalence of waterpipe smoking and its associated factors among adolescents in Hong Kong. METHODS We analyzed data of the School-based Survey on Smoking among Students 2012/2013 from a representative sample of 45,857 secondary school students in Hong Kong (mean age 14.8, SD 1.9). We conducted Chi-square tests and t test to compare current (past 30 days) waterpipe users and nonusers by sociodemographic variables and other covariates. Univariate and multivariable logistic regression models were used to examine the factors associated with current waterpipe smoking. RESULTS Overall, 1.2 % of students reported current waterpipe smoking, of whom 43 % reported concurrent use of cigarettes. Waterpipe was the most popular alternative tobacco product (non-cigarette) used by students. Current waterpipe smoking was associated with older age, male sex, higher self-perceived family financial status, poor knowledge about the harm of cigarette smoking, positive attitudes toward smoking, current cigarette smoking, other tobacco use, and alcohol consumption. CONCLUSIONS Waterpipe smoking was the most popular alternative tobacco product among Hong Kong adolescents. Despite the low prevalence, it should be routinely monitored. Education programs and cessation interventions need to address waterpipe smoking in addition to cigarette smoking.
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Affiliation(s)
- Nan Jiang
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Kheirallah KA, Veeranki SP, Alzyoud S, Alzoubi A, Walker L, Khader Y, Mzayek F, Pbert L, Ward KD. Collision of waterpipe and cigarette smoking epidemics among youth in Arab countries. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1082159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kheirallah KA, Alsulaiman JW, Mohammad H AS, Alzyoud S, Veeranki SP, Ward KD. Waterpipe Tobacco Smoking among Arab Youth; a Cross-Country Study. Ethn Dis 2016; 26:107-12. [PMID: 26843803 DOI: 10.18865/ed.26.1.107] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Waterpipe tobacco smoking (WTS) is considered a global epidemic that is spreading among youth. Our analysis was conducted to compare the national baseline prevalence rate estimates of WTS among Arab boys and girls. DESIGN SETTING AND PARTICIPANTS The Global Youth Tobacco Survey (GYTS) is a school-based survey using standardized self-administered questionnaires; it employs a two-stage cluster sampling technique to obtain a representative sample of youth (13-15 years of age). We conducted a secondary data analysis of nationally representative GYTSs available from 16 Arab countries. MAIN MEASURES Youth who self-reported smoking waterpipe at least once in the past 30 days were considered to be current waterpipe tobacco smokers. National weighted WTS prevalence rate estimates along with respective 95% confidence intervals were reported for boys and girls. RESULTS Pooled GYTS data from 16 Arab countries yielded a total of 31,359 youth. Overall, 10.6% of the respondents were current waterpipe tobacco smokers, with boys (13.7%) having significantly higher estimates than girls (7.2%). Overall, current WTS prevalence rate estimates ranged from .9% in Oman to 34.2%, in Lebanon. The WTS epidemic was more predominant among boys and girls, respectively, in the West Bank (42.8% and 24.2%), Lebanon (38.6% and 30.5%) and Jordan (25.7% and 14.5%). CONCLUSION Among Arab boys and girls, WTS represents a growing strain of the tobacco epidemic that requires immediate attention.
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Affiliation(s)
- Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology
| | | | | | - Sukaina Alzyoud
- Department of Community and Mental Health Nursing, Hashemite University
| | - Sreenivas P Veeranki
- Division of Epidemiology, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis
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Alzyoud S, Kheirallah KA, Ward KD, Al-Shdayfat NM, Alzyoud AA. Association of Religious Commitment and Tobacco Use Among Muslim Adolescents. JOURNAL OF RELIGION AND HEALTH 2015; 54:2111-2121. [PMID: 25080891 DOI: 10.1007/s10943-014-9921-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to examine the relationship between religious observance and tobacco use among a sample of Jordanian youth. Using multistage, random sampling, a cross-sectional survey of middle and high school students was conducted. Of the 950 Muslim students in the study, 32% were daily tobacco users and 72% prayed regularly. Frequency of praying was negatively associated with tobacco smoking. Religious observance was found to be strongly associated with tobacco smoking among Jordanian youth. Our results indicate that religion can be a culturally important tool in health professionals' efforts for tobacco control.
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Affiliation(s)
- Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, P.O. Box 150459, Zarqa, 13115, Jordan.
| | - Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | | | - Abd Albaset Alzyoud
- Faculty of Arts, Hashemite University, P.O. Box 150459, Zarqa, 13115, Jordan
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Waterpipe Use and Susceptibility to Cigarette Smoking Among Never-Smoking Youth. Am J Prev Med 2015; 49:502-11. [PMID: 26143951 DOI: 10.1016/j.amepre.2015.03.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Susceptibility to cigarette smoking, defined as the lack of a firm decision against smoking, is a strong predictor of regular smoking and addiction. Several modifiable risk factors have been identified among never cigarette smokers, and one potential factor of interest is waterpipe use. The purpose of this study is to determine the association of waterpipe use with susceptibility to cigarette smoking among never-smoking youth. METHODS In a pooled analysis of 17 Arab nations with nationally representative Global Youth Tobacco Surveys conducted during 2002-2011, tobacco-related information was obtained from 30,711 never-smoking adolescents representing 4,962,872 youth. Study outcome was susceptibility to cigarette smoking, and primary exposure was waterpipe use. Data were analyzed in 2014 using weighted logistic regression models, including stratified models by gender, to determine the odds of susceptibility to cigarette smoking with waterpipe use, adjusting for confounders. RESULTS Overall, 20% of never-smoking youth were susceptible to cigarette smoking, ranging from 13.1% in Oman to 32.6% in Somalia; 5.2% currently used waterpipe, ranging from 0.3% in Morocco to 23.5% in Kuwait. The estimated odds of susceptibility to cigarette smoking were 2.5 (95% CI=1.9, 3.4) times higher for adolescents who used waterpipe in the past month compared with those who did not, controlling for confounders. Estimates were similar when stratified by gender. CONCLUSIONS Waterpipe use is associated with susceptibility to cigarette smoking. Study findings identify a novel risk factor for never smokers to initiate smoking and will help the public health community develop and implement policies around waterpipe use prevention.
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Jaber R, Madhivanan P, Khader Y, Mzayek F, Ward K, Maziak W. Predictors of waterpipe smoking progression among youth in Irbid, Jordan: A longitudinal study (2008-2011). Drug Alcohol Depend 2015; 153:265-70. [PMID: 26024787 PMCID: PMC4510020 DOI: 10.1016/j.drugalcdep.2015.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/23/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The predictors of waterpipe smoking progression are yet to be examined using a longitudinal study that is guided by a theoretical model of behavioral change. This study identifies the gender-specific predictors of waterpipe smoking progression among adolescents in Irbid, Jordan. METHODS This study uses data from a school longitudinal study of smoking behavior in Irbid, Jordan. A random sample of 19 schools was selected by probability proportionate to size. A total of 1781 seventh graders were enrolled at baseline, and completed a questionnaire annually from 2008 through 2011. Students who reported ever smoking waterpipe (N=864) at any time point were assessed for progression (escalation in the frequency of waterpipe smoking) in the subsequent follow-up. Grouped-time survival analysis was used to identify the risk of progression. RESULTS During the three years of follow-up, 29.6% of students progressed in waterpipe smoking. Predictors of waterpipe smoking progression were higher mother's education, enrollment in public school, frequent physical activity, and low refusal self-efficacy among boys, having ever smoked cigarettes, and having friends and siblings who smoke waterpipe among girls. Awareness of harms of waterpipe was protective among boys and seeing warning labels on the tobacco packs was protective among girls. CONCLUSIONS Even at this early stage, about a third of waterpipe smokers progressed in their habit during the 3 year follow up. Factors predicting progression of use differed by gender, which calls for gender-specific approaches to waterpipe interventions among Jordanian youth.
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Affiliation(s)
- Rana Jaber
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States.
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States.
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Fawaz Mzayek
- Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States.
| | - Kenneth Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria., Department of Epidemiology and Biostatistics, University of
Memphis, Memphis, TN
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States; Syrian Center for Tobacco Studies, Aleppo, Syria.
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Ward KD, Siddiqi K, Ahluwalia JS, Alexander AC, Asfar T. Waterpipe tobacco smoking: The critical need for cessation treatment. Drug Alcohol Depend 2015; 153:14-21. [PMID: 26054945 DOI: 10.1016/j.drugalcdep.2015.05.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/27/2015] [Accepted: 05/18/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Waterpipe use has spread globally, and has substantial negative health effects and nicotine dependence potential. A growing literature addresses cessation-related experiences of waterpipe users, but this literature has not been summarized nor is guidance available on developing and testing cessation interventions. METHOD Authors gathered key empirical papers on waterpipe cessation-related topics, including observational studies about users' perceived ability to quit, interest in quitting, quit rates, and cessation trials. Based on this review, recommendations are made to guide the development and rigorous evaluation of waterpipe cessation interventions. RESULTS Many users want to quit and make quit attempts, but are unsuccessful at doing so on their own; therefore, developing and testing waterpipe cessation interventions should be a priority for global tobacco control efforts. Early efforts have tested waterpipe cessation interventions designed for, or adapted from, cigarette smoking programs. CONCLUSIONS Waterpipe-specific cessation programs that address unique features of waterpipe smoking (e.g., its cultural significance, social uses, and intermittent use pattern) and characteristics and motivations of users who want to quit are needed. Recommendations are provided to move waterpipe cessation intervention development forward.
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Affiliation(s)
- Kenneth D Ward
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, TN 38152-3450, United States; Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, PO Box: 16542, Aleppo, Syria.
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington York YO10 5DD, England, United Kingdom
| | - Jasjit S Ahluwalia
- Rutgers School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Room 235, Piscataway, NJ 08854, United States
| | - Adam C Alexander
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, TN 38152-3450, United States
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, PO Box: 16542, Aleppo, Syria; Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Suite 912, Miami, FL 33136, United States
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Alzyoud S, Veeranki SP, Kheirallah KA, Shotar AM, Pbert L. Validation of the Waterpipe Tolerance Questionnaire Among Jordanian School-Going Adolescent Waterpipe Users. Glob J Health Sci 2015; 8:198-208. [PMID: 26383198 PMCID: PMC4804001 DOI: 10.5539/gjhs.v8n2p198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction: Waterpipe use among adolescents has been increasing progressively. Yet no studies were reported to assess the validity and reliability of nicotine dependence scale. The current study aims to assess the validity and reliability of an Arabic version of the modified Waterpipe Tolerance Questionnaire WTQ among school-going adolescent waterpipe users. Methods: In a cross-sectional study conducted in Jordan, information on waterpipe use among 333 school-going adolescents aged 11-18 years was obtained using the Arabic version of the WTQ. An exploratory factor analysis and correlation matrices were conducted to assess validity and reliability of the WTQ. Results: The WTQ had a 0.73 alpha of internal consistency indicating moderate level of reliability. The scale showed multidimensionality with items loading on two factors, namely waterpipe consumption and morning smoking. Conclusion: This study report nicotine dependence level among school-going adolescents who identify themselves as waterpipe users using the WTQ.
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Kheirallah KA, Alzyoud S, Ward KD. Waterpipe use and cognitive susceptibility to cigarette smoking among never-cigarette smoking Jordanian youth: analysis of the 2009 Global Youth Tobacco Survey. Nicotine Tob Res 2015; 17:280-4. [PMID: 25159679 PMCID: PMC5479504 DOI: 10.1093/ntr/ntu140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/10/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Susceptibility to cigarette smoking, defined as lack of a firm decision to not initiate smoking, predicts youth smoking initiation and experimentation and is a first step in the transition to regular smoking. This study investigated whether waterpipe (WP) smoking, an increasingly prevalent form of tobacco use among Arab adolescents, was associated with increased susceptibility to cigarette smoking. METHODS A secondary analysis of the 2009 Jordan Global Youth Tobacco Survey was conducted to assess the association between WP use and cigarette susceptibility, after adjusting for important confounders. RESULTS A total of 1,476 youth aged 13-15 years old who had never smoked cigarettes were identified and represented 166,593 never-cigarette smoking Jordanian youth. We found 40% of boys and 29% of girls were susceptible to cigarette smoking, and both boys (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI] = 1.41-1.54) and girls (AOR = 1.95, 95% CI = 1.83-2.04) who had ever smoked WP were more susceptible to cigarette smoking than those who never smoked WP. CONCLUSION This is the first study to report that WP use may increase youth's susceptibility to initiate cigarette smoking.
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Affiliation(s)
- Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan;
| | - Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
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Akl EA, Ward KD, Bteddini D, Khaliel R, Alexander AC, Lotfi T, Alaouie H, Afifi RA. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control 2015; 24 Suppl 1:i13-i21. [PMID: 25618895 PMCID: PMC4345979 DOI: 10.1136/tobaccocontrol-2014-051906] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review. Data sources The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms. Study selection Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years. Data extraction Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results. Data synthesis The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels. Conclusions The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.
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Affiliation(s)
- E A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - K D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - D Bteddini
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R Khaliel
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - A C Alexander
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - T Lotfi
- Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - H Alaouie
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R A Afifi
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Al-Sheyab N, Kheirallah KA, Mangnall LJT, Gallagher R. Agreement between exhaled breath carbon monoxide threshold levels and self-reported cigarette smoking in a sample of male adolescents in Jordan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:841-54. [PMID: 25599375 PMCID: PMC4306896 DOI: 10.3390/ijerph120100841] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/13/2015] [Indexed: 12/13/2022]
Abstract
This study aimed to measure the percent agreement between Exhaled Breath Carbon Monoxide (eBCO) measure using a piCO+ smokerlyzer® and self-reported cigarette smoking status and to determine the optimal thresholds for definite identification of cigarette smokers of male school students in Jordan. A descriptive, cross sectional, study of a random sample of male adolescents in grades 7 and 8 from four public high schools in Irbid, completed an adaptation of a standardized Arabic-language tobacco smoking questionnaire and an eBCO measure. Sensitivity and specificity of the eBCO were calculated against self-reported cigarette smoking. Participants (n = 439) had a mean age of 12.5 years (SD = 0.50) and 174 (39.9%) reported being an ever smoker of whom 59 (33.9%) reported being a recent (30-day) smoker. The optimal eBCO cut-off point for recent smoking was 4.5 ppm with a sensitivity of 84.7% and specificity of 65.5%. Overall, eBCO can accurately identify recent smokers and distinguish them from non-smokers. The eBCO use enables healthcare professionals and researchers to assess efficacy of smoking cessation and prevention programs without necessarily relying on self-report. Further research is indicated to validate our findings and should be expanded to include females, detailed characteristics of cigarette and waterpipe smoking.
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Affiliation(s)
- Nihaya Al-Sheyab
- Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Linda J Thomson Mangnall
- Charles Perkins Centre, Faculty of Nursing and Midwifery, the University of Sydney, Sydney 2007, Australia.
| | - Robyn Gallagher
- Faculty of Health, University of Technology, Sydney 2007, Australia.
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Zahlan L, Ghandour L, Yassin N, Afifi R, Martins SS. Double trouble: Exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents. Drug Alcohol Depend 2014; 145:217-23. [PMID: 25456333 DOI: 10.1016/j.drugalcdep.2014.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/19/2014] [Accepted: 10/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND In youth, both waterpipe tobacco smoking (WTS) and nonmedical use of prescription drugs (NMUPD) are globally growing concerns. This study assesses for the first time the lifetime and past-year associations between WTS and four classes of psychoactive prescription drugs. METHODS Cross-sectional data (2011) on 986 high school students attending public and private high schools in Beirut (Lebanon) was analyzed. Schools were selected using proportionate random cluster sampling from a comprehensive list of schools provided by the Ministry of Education. RESULTS Almost half (46%) had tried WTS compared to 25% who had ever tried cigarettes. Lifetime prevalence estimates of NMUPD were: pain relievers (8.2%), sedatives/tranquilizers (5.6%), stimulants (3.5%), antidepressants (2.5%), and sleeping pills (2.3%). WTS was associated with increased odds of sedatives/tranquilizer use (OR = 3.22, 95% CI: 1.25, 8.25), pain reliever use (OR = 4.31, 95% CI: 2.02, 9.17), and sleeping medication use (OR = 8.31, 95% CI: 2.37, 29.20), controlling for sex, age, school type, and other substance use. For cigarettes, the associations were consistently either weaker or non-existent, except with stimulant use (OR = 5.29, 95% CI: 1.55, 18.05). CONCLUSIONS While public health professionals have watched with caution the global prevalence of youth cigarette use-worldwide, an insidious alternative form of tobacco use has grown. Further research is needed to understand the unique risk factors and motives associated with WTS and how these relate to NMUPD in order to inform the development of effective intervention programs and policies that support youth positive health decisions.
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Affiliation(s)
- Leona Zahlan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA.
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Bliss street, Riad el Solh, 11072020 Beirut, Lebanon.
| | - Nasser Yassin
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Rima Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236 Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA.
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Alzyoud S, Kheirallah KA, Weglicki LS, Ward KD, Al-Khawaldeh A, Shotar A. Tobacco smoking status and perception of health among a sample of Jordanian students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7022-35. [PMID: 25019264 PMCID: PMC4113858 DOI: 10.3390/ijerph110707022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/05/2014] [Accepted: 06/27/2014] [Indexed: 11/23/2022]
Abstract
Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.
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Affiliation(s)
- Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan.
| | - Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Linda S Weglicki
- College of Nursing, Wayne State University, Detroit, MI 48202, USA.
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN 38152, USA.
| | - Abdallah Al-Khawaldeh
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
| | - Ali Shotar
- Department of Legal Medicine, Toxicology and Forensic science, School of Medicine, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan.
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