Shisha Smoking Practices, Use Reasons, Attitudes, Health Effects and Intentions to Quit among Shisha Smokers in Malaysia

Shisha Consumption and Presence of Cotinine in Saliva Samples among Students in Public Universities in Coastal Kenya

Background

Despite the well-known adverse health effects of tobacco, shisha use among students in tertiary institutions remains a public health concern. In Kenya, the literature on status of shisha after the 2017 ban is scanty. This study sought to ascertain actual shisha use among university students along the coastal strip.

Methods

We investigated confirmed and self-reported shisha use. Using proportionate-to-size and snowball sampling methods, 380 respondents were enrolled from three universities. Sociodemographic characteristics and self-reported history of shisha use were documented using a participant-assisted questionnaire. Actual shisha use was determined qualitatively using 6 panel plus alcohol saliva test kit that detected cotinine use among other selected drugs.

Results

Of the 380 participants, 278 (73%) were males and their median (IQR) age was 22 (20-23) years. This study reports 29% current use based on testing positive for cotinine. Among those who reported current ever use of shisha, 19% tested positive for cotinine, respectively. In the multivariable analysis, being separated (adjusted risk ratio (aRR): 2.06 (95% CI: 1.45-2.94)) compared to being single and studying for a degree compared to a diploma (aRR: 1.32 (95% CI: 1.10-1.58)) were associated with cotinine positive. The 4th year of study (aRR: 1.68 (95% CI: 1.22-2.33)) compared to the 1st year and reported knowledge of shisha (aRR: 1.84 (95% CI: 1.18-2.87)) were associated with cotinine positive.

Conclusion

Nearly one-third of university students along the Kenyan coast are active shisha users. Saliva testing for cotinine is a more reliable method of reporting tobacco use. We recommend upscaling of health education, re-enforcement of the current ban on shisha consumption by concerned authorities, and saliva testing for cotinine while assessing current tobacco use.

First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries

OBJECTIVE

The majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco or nicotine product tried and the transition to regular product use in 28 European countries.

METHODS

A secondary analysis of participants aged 15-40 years (n=8884) from 28 countries was conducted (Eurobarometer wave 93.2; August-September 2020). Participants who reported having ever tried tobacco or nicotine products were asked which product they tried first. Self-reported history of tobacco use determined whether they were established users (≥1 time weekly) of a range of products at any point in their life. Multilevel logistic regression was used to measure the association between first product tried and becoming a regular user of tobacco or nicotine products.

RESULTS

There was large variation between countries in the proportion of participants aged ≤40 years that ever tried tobacco or nicotine; Estonia had the highest proportion of ever users (85.8%) and Poland had the lowest (38.9%). Among those who had ever tried tobacco or nicotine, boxed cigarettes were the most common first product (72.3%) and pipe was the least common (0.4%). Compared with those who first tried e-cigarettes, the odds of ever becoming a regular user of any tobacco or nicotine product were higher among those who first had hand-rolled cigarettes (adjusted OR, aOR 2.23; 95% CI 1.43 to 3.48) or boxed cigarettes (aOR 2.08; 95% CI1.43 to 3.02) and lower among those who first tried waterpipe (aOR 0.22; 95% CI 0.14 to 0.34).

CONCLUSIONS

Although this study cannot infer causality, the findings show that odds of becoming a regular tobacco user differs widely depending on the first product used. Better understanding of the associations between first product use and regular tobacco use could be informative to tobacco control policy-makers and help tailor prevention programmes.

Prevalence and Associated Factors Related to Tobacco Consumption Among University Students in Malaysia

Tobacco consumption is one of the major public health concerns worldwide. Moreover, alternative tobacco and nicotine products (ATNPs) are growing in popularity, especially among young adults in the past decade. The study aimed to determine the prevalence and associated sociodemographic factors of tobacco consumption among university students. A cross-sectional study was carried out among 338 university students of a private Malaysian university from March to April 2021. Data was collected using a self-administered online questionnaire with items including sociodemographic information, user status of tobacco consumption and types of tobacco product used. Descriptive statistics, Pearson's chi-square test, Fisher's exact test and simple and multiple logistic regression analyses were performed using the IBM SPSS version 26.0 to analyse the data. The prevalence of tobacco consumption in this study was 8.6% and the main tobacco product used was manufactured cigarettes. In Pearson's chi square test and Fisher's exact test, current use of tobacco was significantly associated with nationality, ethnicity, religion, school, current level of education and parents, siblings and friends use of tobacco (p<0.05). In simple and multiple logistic regression analysis, being non-Malaysian, Indian, Muslim, year 4 student and having parents or siblings who used tobacco, all had statistically significant associations with the current use of tobacco (p<0.05). Findings of this study showed that the use of tobacco among university students is concerning and warrants the need to develop and implement a strategic anti-tobacco program to limit this behaviour among university students.

The effectiveness of a theory -based health education program on waterpipe smoking cessation in Iran: one year follow-up of a quasi-experimental research

BACKGROUND

The present research aimed to determine the effect of an educational intervention based on the extended theory of planned behavior (ETPB) on waterpipe (WT) smoking cessation in women.

METHODS

The present quasi-experimental had a pre-test, post-test design with 3, 6 and 12 months follow-ups was conducted in Bandar Abbas city, south of Iran in December 2021-March 2023. A total of 448 women over the age of 15 (224 in the intervention group (IG), 224 in the control group (CG)), using a two-stage cluster sampling method participated. The educational intervention focused on WT smoking cessation implemented in 14 sessions. The educational methods in the training sessions were lectures, collaborative discussions, Q&As, brainstorming, role plays, and peer education. The main outcome was WT cessation behavior. Repeated measures ANOVA tests and post hoc were run to compare the IG and CG at baseline in terms of demographic variables, t-test and chi square test, and in the four points of time of data collection. The data were analyzed in Stata14. A p-value < 0.05 was considered as statistically significant.

RESULTS

The mean and standard deviation of WT cessation behavior and all ETPB constructs in the IG was significantly higher than the CG. After the educational intervention, in the IG, the perceived behavioral control, attitude, subjective norm, intention and knowledge increased, and the weekly smoking and WT smoking habit decreased (P < 0.001). The CG did not have any significant change in other variables except for the increased knowledge score. During the 12-month follow-up, the cessation rate was 43.81% (P = 0.645) in the IG and 7.45% in the CG (P = 0.081).

CONCLUSIONS

The educational intervention positively affected WT smoking reduction and cessation in women through influencing the ETPB constructs. It is strongly recommended to design theory-based interventions beyond the individual level with an emphasis on interpersonal relationships to facilitate WT cessation as far as possible.

The effect of happiness-based education on women's success of water pipe smoking cessation and happiness: a quasi-experimental study

BACKGROUND

Water pipe smoking by women threatens their health. Therefore, it is necessary to take measures to reduce this unhealthy behavior. This study aimed to determine the effect of happiness-based education on women's success of water pipe smoking cessation and happiness.

METHODS

This quasi-experimental study was conducted on female water pipe smokers in Iran, from September to January 2021. The participants (n = 68) were selected using convenience sampling and assigned to the intervention and control groups (34 subjects per group) by blocked randomization. The intervention group received a happiness-based education for one month (eight sessions) based on the Fordyce happiness program. The control group did not receive any special education. Data were collected using the Water Pipe Dependence Scale and the Oxford Happiness Questionnaire before and two months after the intervention. Data were analyzed using descriptive statistics, Chi-square, Fisher's exact test, Independent t-test, Mann-Whitney, and Wilcoxon tests by SPSS software version 22.

RESULTS

Two months after the intervention, the mean change in the happiness score was significantly higher in the intervention group (2.32 ± 2.31) than that in the control group (-0.29 ± 1.81) (P < 0.001). Furthermore, the mean change in the score of water pipe dependence was significantly different between the intervention (-1.44 ± 1.4) and control (0.38 ± 0.85) groups (P < 0.001).

CONCLUSION

The results showed that education based on Fordyce happiness program can increase the success of water pipe smoking cessation and happiness in women. Therefore, it is recommended to use similar interventions in women's health promotion programs.

Impact of waterpipe and tobacco cigarette smoking on global DNA methylation and nuclear proteins genes transcription in spermatozoa: a comparative investigation

BACKGROUND

Waterpipe smoking is harmful and dangerous, and it is a growing threat to public health.

OBJECTIVES

This study was performed to evaluate the influence of waterpipe smoking on global DNA methylation, DNA fragmentation, and protamine deficiency in spermatozoa compared to cigarette heavy smokers and nonsmokers, and to determine whether the transcription levels of spermatozoa nuclear proteins genes 'PRM1, PRM2, and H2BFWT' in waterpipe smokers are different compared to cigarette heavy smokers and nonsmokers.

METHODS

A total of 900 semen samples were collected from males with a mean age of 32.5 ± 6.3 years (300 waterpipe smokers, 300 cigarette heavy smokers, and 300 nonsmokers). The nucleic acids were isolated from purified spermatozoa, and then the global DNA methylation and transcription levels of the PRM1, PRM2, and H2BFWT genes were assessed using ELISA and qPCR, respectively.

RESULTS

A significant increase was found in the level of global DNA methylation (8.6 ± 0.6 ng/μl vs. 7.1 ± 0.6 ng/μl and 4.7 ± 0.6 ng/μl, p < 0.001), protamine deficiency (72.8 ± 15.3 vs. 51.7 ± 19.2 and 15.3 ± 5.9%, p < 0.001), and DNA fragmentation (73.4 ± 13.4 vs. 50.5 ± 18.9 and 9.3 ± 4.3%, p < 0.001) in waterpipe smokers compared to cigarette heavy smokers and nonsmokers. A significant increase was shown in the transcription levels of PRM1, PRM2, and H2BFWT genes in waterpipe smokers compared to cigarette heavy smokers and nonsmokers (p < 0.001). A down-regulation was found in the transcription level of these genes in different smoker groups compared to nonsmokers (<0.001).

CONCLUSION

This study suggests that waterpipe smoking is more harmful than cigarette smoking on semen parameters, global DNA methylation, and transcription of nuclear protein genes.

Effect of hubble-bubble smoking on global DNA methylation and transcription levels of protamine and histone genes in human spermatozoa

This study was conducted to assess the impact of hubble-bubble smoking on global DNA methylation, DNA fragmentation; protamine deficiency of spermatozoa, and to determine whether the transcription levels of the protamine and histone genes are different in hubble-bubble smokers compared to nonsmokers. Five hundred semen samples were collected from males with an average age of 32.2 ± 6.1 years (300 hubble-bubble smokers "60%" and 200 nonsmokers "40%"). The nucleic acid was isolated from purified sperm, then ELISA and qPCR were used to evaluate the global DNA methylation and transcription level of protamine and histone, respectively. A significant elevation in global DNA methylation, protamine deficiency, and DNA fragmentation was found in hubble-bubble smokers compared to nonsmokers (P < 0.0001). A significant decline was shown in transcription levels of protamine and histone genes in hubble-bubble compared to nonsmokers (P < 0.0001). Additionally, a down-regulation in the transcription levels of protamine and histone was revealed in hubble-bubble compared to nonsmokers with fold change (0.0001 and 0.007, respectively). In conclusion, this study provided proof that hubble-bubble smoking has a negative impact on global DNA methylation, DNA fragmentation, protamine deficiency, and the transcription of protamine and histone genes in spermatozoa, and these findings influence negatively males' fecundity.

Attitudes towards the 'Shisha No Thanks' campaign video: Content analysis of Facebook comments

INTRODUCTION

While social media are commonly used in public health campaigns, there is a gap in our understanding of what happens after the campaign is seen by the target audience. This study aims to understand how the Shisha No Thanks campaign video was received by the Facebook audience by analyzing Facebook comments posted to it. Specifically, this study aims to determine whether the Facebook audience accepted or rejected the campaign’s message.

METHODS

A sample of the Facebook comments was extracted, and the study team, which included cultural support workers, developed content categories consistent with the research question. Each comment was then coded by three team members, and only assigned a category if there was agreement by at least two members.

RESULTS

Of the 4990 comments that were sampled, 9.1% (456) accepted the campaign message, 22.9% (1144) rejected the message, 21.8% (1089) were unclear, and 46.1% (2301) contained only tagged names. Of the sample, 2.8% (138) indicated the commenter took on board the campaign message by expressing an intention to stop smoking shisha, or asking a friend to stop smoking shisha. Of the comments that showed rejection of the campaign, the majority were people dismissing the campaign by laughing at it or expressing pro-shisha sentiments.

CONCLUSIONS

This study demonstrates that conducting content analyses of social media comments can provide important insight into how a campaign message is received by a social media audience.

Peer pressure and social acceptability between hookah pipe users and non-users among a sample of South African adolescents

Background. Hookah pipe smoking is a high-risk phenomenon which is widely seen as an acceptable social practice, but the extent of its acceptability is not very clear among South African youth, nor is the influence of peers very clear.Objective. To establish a link between social acceptability and peer pressure and to compare this relationship among hookah pipe users and non-users in a sample of South African adolescents.Methods. A cross-sectional comparative correlation study was conducted among Grade 9 adolescents attending secondary schools in the Metro East Education District in Cape Town. The final sample comprised 270 participants. A questionnaire was used to collect data which were analysed using SPSS.Results. No relationship was found between peer pressure and social acceptability, but a relationship was found between parental rules and monitoring around tobacco use for hookah pipe users. A significant difference was also found in attitudes towards hookah use among users and non-users.Conclusion. This descriptive study of hookah pipe users and non-users among Grade 9 adolescents is a further study in the quantitative research approach and may be helpful in gaining more insight into understanding how parental rules and monitoring are put in place and why users’ and non-users’ attitudes towards tobacco use differ significantly. The implications and significance of this study are further explained.

The prevalence and associated factors of shisha use among smokers attending three primary healthcare centers in Qatar, 2020

INTRODUCTION

Smoking is one of the most serious health issues. One form of tobacco use, shisha, is prevalent in the Eastern Mediterranean Region. There is a misconception among smokers that waterpipe use poses no harm to human health. In Qatar, the Global Adult Tobacco Survey in 2013 has shown that 3.4% of adults in the country were current waterpipe users. Nevertheless, there remains a scarcity of data on the knowledge and practice of shisha smokers in Qatar.

METHODS

This was a cross-sectional study across three primary healthcare (PHC) centers in Qatar between September and December 2020. A convenient sampling technique was employed to enroll participants. Upon consent, an interview was conducted to collect data from adult smokers (aged ≥18 years). Descriptive and analytic statistics were used when appropriate.

RESULTS

A total of 281 individuals participated in this study. Nearly half (48.8%) were current shisha users and almost three-quarters (72.9%) had inadequate knowledge in this regard. In addition, only one-fifth (19.5%) of participants attended smoking cessation clinics at the primary healthcare centers and a quarter (25%) of the respondents managed to quit smoking before relapsing. A significant association was found between the shisha knowledge of participants and their nationality (Qatari), employment status (unemployed), smoking status (current smoker), and duration of smoking.

CONCLUSIONS

The study results convey a high prevalence of shisha use (47.8%), inadequate shisha knowledge (72.9%), and lack of awareness about available smoking cessation services (46.6%) among the participants. Further research is recommended to generate evidence on the determinants of shisha use and knowledge among the attendees of primary healthcare centers in Qatar.

Motivators of impulsivity to smoke waterpipe tobacco among Nigerian youth who smoke waterpipe tobacco: the moderating role of social media normalisation of waterpipe tobacco

BACKGROUND

Impulsivity is a formidable cause of waterpipe tobacco smoking among youth, however, it is understudied among African youth. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco, specifically among youth in Nigeria who smoke waterpipe tobacco.

METHODS

Data were drawn from 695 respondents who smoke waterpipe tobacco across six Nigerian universities in the South-West zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3.

RESULTS

Among Nigerian youth who smoke waterpipe tobacco, intention (β = 0.442, P < 0.001) was the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β = 0.302, P < 0.001). In addition, social media normalisation of waterpipe tobacco acted as a moderator that strengthened the relationship between intention and impulsivity (β = 0.287, P < 0.01), as well as, between positive evaluations and impulsivity (β = 0.186, P < 0.01) among youth.

CONCLUSION

Intention greatly instigates Nigerian youth's impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educational waterpipe tobacco cessation-oriented programmes that utilise diverse constructive-based learning approaches like illustrative learning and counselling, can help to enlighten and encourage Nigerian youth on the importance of shunning the desirability to smoke waterpipe tobacco.

Sociocultural factors contributing to waterpipe tobacco smoking among adolescents and young adult women: a qualitative study in Iran

Purpose: Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods: This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13-30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants' preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results: The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion: A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS.Abbreviation WTS: Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco.

Waterpipe use among the youth in Ghana: Lessons from the Global Youth Tobacco Survey (GYTS) 2017

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.

Intention to quit water pipe smoking among Iranian women: a qualitative directed content analysis

Background

Water-pipe smoking is the most common type of tobacco used among Iranian women. The aim of this study was to explain women’s perceptions of their intention for quitting water-pipe smoking based on the theory of planned behavior.

Methods

The study was a qualitative content analysis which was carried out over 4 months in 2016 in Tehran-Iran. The participants were 26 women ages 18 to 45-years-old who smoked water-pipe and were selected through snowball sampling. The study was performed in hookah cafes, parks, and homes. The data were collected through individual interviews. The interviews were open-ended questions based on the theory of planned behavior. Directed content analysis was used to analyze the data.

Results

Findings showed that women did not intend to quit water-pipe in that time. Main contributing factors influencing not having intention of cessation were positive attitude and false beliefs toward hookah smoking, as well as having peers and family members who smoked water-pipe or approved its use. Although most females realized the obstacles associated with hookah cessation, they believed that quitting water-pipe smoking was up to them and could control more barriers.

Conclusion

Social pressure, positive attitude and false beliefs towards hookah smoking, as well as external and internal obstacles diminished women ‘s intention for cessation. Therefore, it is recommended to apply the theory of planned behavior into behavior change interventions in order to increase the intention to quit water-pipe smoking.

News media coverage of shisha in Nigeria from 2014 to 2018

INTRODUCTION

Shisha which was formally popular mostly in the Eastern Mediterranean region is now gaining popularity globally and has become a trending tobacco product in Nigeria. The increasing popularity of shisha is possibly driven by the attractive flavours and the misperception that it is safer than traditional cigarettes. Since the media plays a significant influence on public awareness, perception and understanding of various issues, this study sought to explore the coverage of shisha use by five national newspapers in Nigeria.

METHODS

Five newspapers were selected based on their website traffic (online readership). The software NVIVO 12 was used to organise the content of the articles into themes.

RESULTS

Between 2014 and 2018, we found 30 relevant publications about shisha. Some newspaper articles reported that shisha smoking was gaining popularity among youths, especially in tertiary institutions across the country. Similarly, some misconceptions about the safety of smoking shisha among shisha users was reported. Addiction to shisha was also reported as being so common that many shisha users were no longer satisfied with just visiting nightclubs and shisha cafes but now own the shisha paraphernalia. There were also reports that the tobacco in shisha was in some instances being replaced or mixed with other hard drugs like marijuana. Subtle advertisement of shisha lounges, which is a violation of the Nigeria National Tobacco Control Act, was also observed.

CONCLUSIONS

There is a need for increased sensitization of the public through the media on the dangers of shisha smoking and other tobacco product use. There is also a need for a national survey to determine the prevalence of shisha use in Nigeria.

The effects of hookah/waterpipe smoking on general health and the cardiovascular system

Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but "appealing" flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.

Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study

BACKGROUND

This study focused on the associations between socioeconomic status (SES) and adolescent smoking among secondary school students (13 to 17 years) in the Federal Territory of Kuala Lumpur, Malaysia. Our objective was to evaluate the relationships between adolescent demographics, socioeconomic status and smoking status.

METHODS

The survey data were based on baseline findings from a cross-sectional study (N = 422 adolescents). Chi-square test was used to assess the relationship between demographic characteristics, socioeconomic status (household monthly income and daily allowance) and adolescent smoking status. Exhaled carbon monoxide (CO) reading and the Hooked on Nicotine Checklist (HONC) were used to evaluate adolescent smoking status. A Multivariate Multinomial Logistic Regression (MMLR) was employed to test selected demographic and socioeconomic predictors of smoking status.

RESULTS

Of the 422 adolescents (M age = 15.58, SD = 1.24), more than half of the participants initiated smoking between 13 to 17 years old (59.0%). A total of 308 (73.0%) were electronic cigarette users, with more than 50% comprising of single users. The mean CO reading was 2.14 ppm with 78.0% of adolescents scoring more than 0 on the Hooked on Nicotine Checklist (HONC). Males and participants aged 15 and 16 years were at increased risks of sole CC smoking. Meanwhile, males, those who are not hooked on smoking and with a non-smoker CO reading were at increased risks of sole EC smoking. Finally, Bumiputeras were at less risk of EC smoking.

CONCLUSIONS

Demographic variables such as age, gender and ethnicity predicted smoking status predicted smoking risk, but not socioeconomic factors. The findings allow policy makers to target specific high-risk demographic groups when designing smoking cessation programs for adolescents.

Prevalence and Perception of Shisha Smoking among University Students: A Cross-sectional Study

Aims and Objectives:

Understanding perceptions and factors behind the rise in the prevalence of shisha smoking is important for the development of prevention strategies and policies. The aim of this descriptive study was to assess the prevalence and perception of shisha smoking among university students.

Materials and Methods:

The anonymous, self-structured 12-item questionnaire was administered to 450 male university students, with an overall response rate of 82.44% (n = 371). Prevalence, knowledge, and other associated factors regarding shisha smoking were compared between dental and other specialty students using SPSS software for descriptive statistical analysis.

Results:

Among 371 university students, 40.43% (n = 150) were nonsmokers, 32.88% (n = 122) were shisha smokers, 12.94% (n = 48) were cigarette smokers, and 13.75% (n = 51) smoked both shisha and cigarette. The overall prevalence of shisha smoking (46.63%, n = 173) was higher than that of cigarette smoking (26.68%, n = 99). The percentage of those knowledgeable about the ill effects of shisha smoking was 44.2% with lesser knowledge among shisha smokers than cigarette smokers. There was no statistically significant difference in the mean total knowledge score between dental (5.65 ± 2.08) and other specialty (5.21 ± 2.3) students.

Conclusions:

A high prevalence of shisha use among university students is reported in this study as well as a general lack of understanding of the dangers involved with this behavior. Study authors recommend the development of policies targeted at preventing further rise in the prevalence of shisha smoking through the implementation of preventive strategies such as incorporating this topic into the school syllabus and encouraging research on shisha smoking.

Alternative Tobacco Products Use among Late Adolescents in Kelantan, Malaysia

BACKGROUND

The rising prevalence of alternative tobacco and nicotine products (ATNPs) use among adolescents is a global concern that has been attributed to the reemergence of preexisting alternative tobacco products and emergence of new ones in the market. This study examined ATNP use among late adolescents. The association between ATNP use and reasons for using them was explored.

METHODS

This cross-sectional study conducted in 2016 involving 388 late adolescents from six government colleges in Kelantan, Malaysia, aged 18 to 19 years. They were requested to answer self-directed questionnaires with items on sociodemographic information and types of ATNP used. Other variables obtained include the environmental influence and reasons for using the products. Regression analyses between the dependent and independent variables were conducted using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The prevalence of ATNP use among late adolescents was 14.4%. The male sex, cigarette smoking status, and peer use were significantly associated with ATNP use. Several reasons for use were not significantly associated with ATNP use: perception of ATNP being less harmful and less addictive compared with cigarettes, curiosity, less expensive than cigarettes, to aid smoking cessation, and pleasurable flavors and taste.

CONCLUSION

The prevalence of ATNP use among late adolescents studying in government colleges in Kelantan is significant. There is higher perception on ATNP being less harmful and addictive than the conventional cigarette among the users compared with non-users. Significant associations are seen for the male sex, peer use, and concurrent cigarette smoking.

A Cross Sectional Study on Knowledge, Beliefs and Psychosocial Predictors of Shisha Smoking among University Students in Sharjah, United Arab Emirates

Background:

Smoking is now prohibited in all educational institutions and other public places in the United Arab Emirates (UAE), but shisha smoking is considered as one of the major problems among the students population. This study aimed to identify the (a) prevalence of ever shisha, current shisha and shisha dependency smokers among university students in the University of Sharjah (UOS), (b) knowledge and belief differences among ever shisha, current shisha as well as shisha dependency smoking students, (c) relationship between precipitating factors and shisha dependency and (d) precipitating factors (stimulation, handling, pleasure, tension reduction, addiction (dependency), automatism (habit) and social interaction, parents smoking behavior, knowledge and beliefs about smoking predict shisha dependency among students in UOS.

Materials and Methods:

In this cross sectional study, 633 students participated from UOS, UAE. Knowledge and Belief scale, Modified Reason for Smoking Scale and Fagerstrom Test for Nicotine Dependence (FTND) were used to measure knowledge, beliefs, shisha dependency and predictive factors of smoking behavior among undergraduate students in UOS.

Results:

Nearly103 (16.3%) of students were addictive to shisha smoking based on FTND. Students had adequate knowledge that smoking led to cardiac problems; however, their knowledge about the other consequences of smoking was inadequate and believed that smoking was not harmful. There was a significant positive relationship between addiction, pleasure, social interaction, habit, parental smoking behavior and shisha dependency behavior among current shisha dependency students. Habit, addiction, pleasure, social interaction and parental smoking were the predictors of shisha smoking dependency among this population. Step wise multiple regressions showed that social interaction was the highest significant predictor for shisha dependency behavior.

Conclusions:

Hence, there is a need to enhance the knowledge and modify irrational beliefs about shisha smoking as these students possess inadequate knowledge about consequences of shisha smoking.

Knowledge, attitude, and practice of medical students regarding smoking and substance abuse, Cairo University, Egypt

Background

Involving medical personnel in all aspects of smoking control in the community is indispensable. In a trial to enhance the participation of healthcare professionals in smoking cessation activities, this study was conducted to evaluate knowledge, behavior, and attitude of medical school students regarding smoking and substance abuse. Perception of their future role “as physicians” in combating smoking and substance abuse was also explored.

Subjects and methods

A cross-sectional descriptive study was conducted. A self-administered questionnaire based on standardized questionnaires prepared by the World Health Organization covering sections about knowledge, beliefs, and practices of the students regarding smoking and substance abuse was submitted to 296 students enrolled in the Faculty of Medicine of Cairo University, during the academic year 2014–2015.

Results

Most of the participants had correct knowledge about health hazards of smoking, where 83.4–93.6% correctly selected the answers, but still stated that they are in need for courses about this issue. Positive attitudes were also expressed towards smoking legislations and tobacco control policies. Cigarette and shisha smoking, bango, and addictive medications abuse were low among the studied group (13.5, 15.2, 2, 3–6.4%, respectively).

Conclusion and recommendations

The prevalence of smoking and substance abuse was relatively low among Cairo University medical students who had generally correct knowledge about the hazards of these practices and positive attitude towards their future role in helping their patients to quit. It may be appropriate to train students about stress management skills through organizing regular “stress coping strategies” sessions to assist them to cope with various stressors and consider implementing counseling programs to support students, especially medical students and the future doctors, who have a leading role in combating smoking and substance abuse in the community.

Reasons for use, potential use, or discontinued use of hookah among US young adult college students

INTRODUCTION

Given the increase in hookah use among young adults, characteristics of hookah use/users, as well as reasons for its use or discontinuation among young adults, are critical to understand.

METHODS

Data from a study of 18–25 year olds from seven Georgia colleges/universities (n=2865) were analyzed to examined: 1) differences in socio-demographics and other substance use among current (past 4 months), never, and former hookah users; 2) use characteristics among current users (e.g. device types/flavors used, quit intentions); and 3) reasons for use, potential use, and discontinued use among current, never, and former users.

RESULTS

Of the students, 56.3% were never users, 12.4% were current, and 31.3% former users. Correlates of being a current (vs never) user included being ‘other race’ (vs White), attending a historically black college/university (HBCU vs technical college), and use of other substances. Correlates of being a former (vs never) hookah user included being older (vs younger), being ‘other race’ (vs White), attending an HBCU (vs technical college), and use of other tobacco products, marijuana, or alcohol. Among current users, 73.7% reported no intention to quit; 26.2% attempted to quit in the past year. Two factors were identified regarding reasons for current use (flavors, social reasons): one factor regarding potential use among never users (related to flavors and social factors), and three factors regarding discontinued use (inconvenience, anti-tobacco attitude, social reasons).

CONCLUSIONS

Findings indicate the risk factors for hookah use and the importance of particular factors (e.g. flavors, social influences) relevant to regulation/policy.

Shisha microbiota: the good, the bad and the not so ugly

OBJECTIVE

Over the last decade, there has been a rapid expansion of the trendy water pipe smoking around the world especially among younger adults. The initial objective of this study was to identify the microbiota of the shisha, which may either be of no harm for the smoker or enhance the threat on his well-being. The total DNA for the metagenomics study was conducted on three different shishas from three different delivery shops in Jounieh, Lebanon. The microbiota in two solid parts of the shisha, shaft and hose, were analysed including the fresh tobacco and the water in the bowl. All samples were analysed using high-throughput sequencing of 16S rRNA gene amplicons.

RESULTS

Overall, more than 40 bacterial genera were found in the three investigated shishas, some are commensal others are pathogenic. All three shishas showed similar microbial content regarding the bacteria inhabiting in water, shaft, or hose. From the results of this study it appears that a very large quantity of bacteria was found in the water pipes, some are harmful and others beneficial. We assume that the presence of gut dependent microbiota is related to the loose hygienic conditions in which the shisha is prepared.