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Sharma R, Kanaan M, Siddiqi K. The Diversity in Tobacco Use Among Women of Reproductive Age (15-49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016-2018. Nicotine Tob Res 2024; 26:931-939. [PMID: 38300742 PMCID: PMC11190045 DOI: 10.1093/ntr/ntae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 12/04/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Tobacco use in women of reproductive age group (15-9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). AIMS AND METHODS We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. RESULTS The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI -1.6 to -0.1) lower whereas it was 0.33 kg (95% CI -0.9 to 0.3) higher for ST users. CONCLUSIONS Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. IMPLICATIONS The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.
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Affiliation(s)
- Radha Sharma
- Department of Health Sciences, University of York, York, UK
- ConnectHEOR Canada Limited, Edmonton, Alberta, Canada
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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Bertani AL, Tanni SE, Godoy I. Dual and Poly Use of Tobacco Products in a Sample of Pregnant Smokers: A Cross-sectional Study. Matern Child Health J 2023:10.1007/s10995-023-03698-1. [PMID: 37395976 PMCID: PMC10359197 DOI: 10.1007/s10995-023-03698-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Our aim was to assess the use of dual/poly tobacco in a sample of pregnant women. DESIGN cross-sectional survey. METHODS Twenty prenatal care units in Botucatu, Sao Paulo, Brazil. We evaluated 127 high-risk pregnant smokers during prenatal care. Those who were 12-38 weeks pregnant and were currently smoking conventional cigarettes. The study enrollment took place between January 2015 and December 2015. The dual/poly prevalence of tobacco products during pregnancy and the characteristics related to smoking in pregnant smokers through a specific questionnaire containing questions related to sociodemographic characteristics, comorbidities, gestational history, smoking history, secondhand smoke exposure, nicotine dependence, motivation stage and use of alternative forms of tobacco. RESULTS Mean age was 26.9 ± 6.6 years, most had only elementary education and belonged to lower income economic groups. Twenty-five (19.7%) smoked conventional cigarettes only while 102 used conventional and alternative forms of tobacco products. Smoking pack-years was significantly lower in those only smoking conventional cigarettes than in dual/poly users. Proportion of patients with elevated degree of nicotine dependence was higher in conventional cigarettes users. On the other side, alcohol intake was higher in dual/poly smokers when compared to conventional cigarettes group. The alternative forms of smoking were associated with significantly higher occurrences of comorbidities as pulmonary, cardiovascular and cancer. CONCLUSIONS FOR PRACTICE The prevalence of alternative forms users of smoking products is high during pregnancy. These data reinforce the importance of a family approach towards smoking in pregnant women and education about the risks of alternative forms of tobacco.
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Affiliation(s)
- André Luís Bertani
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu Campus, Pneumology Area - UNESP, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-970, Brazil.
| | - Suzana Erico Tanni
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu Campus, Pneumology Area - UNESP, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-970, Brazil
| | - Irma Godoy
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu Campus, Pneumology Area - UNESP, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-970, Brazil
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Whelan AR, Gimovsky AC, Jao NC, Werner EF, Vergara-Lopez C, Stroud LR. Waterpipe Tobacco (Hookah) Use in Pregnancy: Associations with Nausea and Vomiting of Pregnancy. Am J Perinatol 2023; 40:1033-1039. [PMID: 36724874 PMCID: PMC10483021 DOI: 10.1055/a-2024-0987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Waterpipe tobacco (WPT) use is common among reproductive age patients and is often perceived as safer than cigarette use. Prior studies have shown a decrease in nausea and vomiting symptoms among pregnant women who use cigarettes, but no studies to date have examined these symptoms in pregnant women who use WPT. This study was aimed to investigate the extent of symptoms of nausea/vomiting of pregnancy among participants who self-reported WPT use during pregnancy. STUDY DESIGN Secondary analysis of a prospective cohort study examining WPT use during pregnancy. Participants completed the Pregnancy-Unique Quantification of Emesis (PUQE) during first and third trimesters. Medical conditions were determined by medical record review. Participants were evaluated by sole WPT use versus dual/polysubstance WPT use and frequency of WPT use. RESULTS Ninety-nine (100%) participants completed the PUQE questionnaire during first trimester and 82 (82.8%) completed the PUQE during third trimester. Almost all (91.9%) participants reported moderate nausea/vomiting symptoms at both assessments. There was no difference in frequency of WPT use in pregnancy or rates of dual/polysubstance WPT use in participants with all levels of the PUQE questionnaire. There was also no difference in rates of WPT use or PUQE scores between sole WPT users and dual/polysubstance users. When comparing low and high WPT use, those who were in the higher frequency use group had higher waterpipe dependence scale scores (7.2 vs. 5.3, p < 0.02). With regard to maternal medical comorbidities, the only difference between groups was that sole WPT users were more likely to have a diagnosis of asthma than dual/polysubstance users (36.8 vs. 14.9%, p < 0.02). CONCLUSION There were no differences in symptoms of nausea and vomiting of pregnancy or medical conditions in pregnant women who use WPT with any frequency during pregnancy. However, sole WPT users had higher rates of asthma than dual/polysubstance WPT users. KEY POINTS · Waterpipe tobacco use is one of the most common forms of tobacco use among reproductive age patients.. · Waterpipe tobacco use was not associated with any changes in nausea/vomiting of pregnancy symptoms.. · Future research on the use of waterpipe tobacco in pregnancy can aid in public health responses..
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Affiliation(s)
- Anna R Whelan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alexis C Gimovsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nancy C Jao
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Erika F Werner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
| | - Chrystal Vergara-Lopez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Laura R Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Asfar T, Livingstone-Banks J, Ward KD, Eissenberg T, Oluwole O, Bursac Z, Ghaddar T, Maziak W. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev 2023; 6:CD005549. [PMID: 37286509 PMCID: PMC10245833 DOI: 10.1002/14651858.cd005549.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND While cigarette smoking has declined globally, waterpipe smoking is rising, especially among youth. The impact of this rise is amplified by mounting evidence of its addictive and harmful nature. Waterpipe smoking is influenced by multiple factors, including appealing flavors, marketing, use in social settings, and misperceptions that waterpipe is less harmful or addictive than cigarettes. People who use waterpipes are interested in quitting, but are often unsuccessful at doing so on their own. Therefore, developing and testing waterpipe cessation interventions to help people quit was identified as a priority for global tobacco control efforts. OBJECTIVES: To evaluate the effectiveness of tobacco cessation interventions for people who smoke waterpipes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Review Group Specialized Register from database inception to 29 July 2022, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language. SELECTION CRITERIA We sought randomized controlled trials (RCTs), quasi-RCTs, or cluster-RCTs of any smoking cessation interventions for people who use waterpipes, of any age or gender. In order to be included, studies had to measure waterpipe abstinence at a three-month follow-up or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from waterpipe use at least three months after baseline. We also collected data on adverse events. Individual study effects and pooled effects were summarized as risk ratios (RR) and 95% confidence intervals (95% CI), using Mantel-Haenszel random-effects models to combine studies, where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarized secondary outcomes narratively. We used the five GRADE considerations (risk of bias, inconsistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence for our primary outcome in four categories high, moderate, low, or very low. MAIN RESULTS This review included nine studies, involving 2841 participants. All studies were conducted in adults, and were carried out in Iran, Vietnam, Syria, Lebanon, Egypt, Pakistan, and the USA. Studies were conducted in several settings, including colleges/universities, community healthcare centers, tuberculosis hospitals, and cancer treatment centers, while two studies tested e-health interventions (online web-based educational intervention, text message intervention). Overall, we judged three studies to be at low risk of bias, and six studies at high risk of bias. We pooled data from five studies (1030 participants) that tested intensive face-to-face behavioral interventions compared with brief behavioral intervention (e.g. one behavioral counseling session), usual care (e.g. self-help materials), or no intervention. In our meta-analysis, we included people who used waterpipe exclusively, or with another form of tobacco. Overall, we found low-certainty evidence of a benefit of behavioral support for waterpipe abstinence (RR 3.19 95% CI 2.17 to 4.69; I2 = 41%; 5 studies, N = 1030). We downgraded the evidence because of imprecision and risk of bias. We pooled data from two studies (N = 662 participants) that tested varenicline combined with behavioral intervention compared with placebo combined with behavioral intervention. Although the point estimate favored varenicline, 95% CIs were imprecise, and incorporated the potential for no difference and lower quit rates in the varenicline groups, as well as a benefit as large as that found in cigarette smoking cessation (RR 1.24, 95% CI 0.69 to 2.24; I2 = 0%; 2 studies, N = 662; low-certainty evidence). We downgraded the evidence because of imprecision. We found no clear evidence of a difference in the number of participants experiencing adverse events (RR 0.98, 95% CI 0.67 to 1.44; I2 = 31%; 2 studies, N = 662). The studies did not report serious adverse events. One study tested the efficacy of seven weeks of bupropion therapy combined with behavioral intervention. There was no clear evidence of benefit for waterpipe cessation when compared with behavioral support alone (RR 0.77, 95% CI 0.42 to 1.41; 1 study, N = 121; very low-certainty evidence), or with self-help (RR 1.94, 95% CI 0.94 to 4.00; 1 study, N = 86; very low-certainty evidence). Two studies tested e-health interventions. One study reported higher waterpipe quit rates among participants randomized to either a tailored mobile phone or untailored mobile phone intervention compared with those randomized to no intervention (RR 1.48, 95% CI 1.07 to 2.05; 2 studies, N = 319; very low-certainty evidence). Another study reported higher waterpipe abstinence rates following an intensive online educational intervention compared with a brief online educational intervention (RR 1.86, 95% CI 1.08 to 3.21; 1 study, N = 70; very low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that behavioral waterpipe cessation interventions can increase waterpipe quit rates among waterpipe smokers. We found insufficient evidence to assess whether varenicline or bupropion increased waterpipe abstinence; available evidence is compatible with effect sizes similar to those seen for cigarette smoking cessation. Given e-health interventions' potential reach and effectiveness for waterpipe cessation, trials with large samples and long follow-up periods are needed. Future studies should use biochemical validation of abstinence to prevent the risk of detection bias. Finally, there has been limited attention given to high-risk groups for waterpipe smoking, such as youth, young adults, pregnant women, and dual or poly tobacco users. These groups would benefit from targeted studies.
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Affiliation(s)
- Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Olusanya Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Miami, FL, USA
| | - Tarek Ghaddar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Khayat S, Navaee M, Fanaei H, Khojasteh F. Waterpipe Smoking in Pregnant Women of Zahedan City in 2020: Prevalence and Associated Factors. Int J Prev Med 2022; 13:128. [PMID: 36452469 PMCID: PMC9704486 DOI: 10.4103/ijpvm.ijpvm_703_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Waterpipe smoking is associated with maternal and fetal complications, and valid data contribute to evidence-based planning. This study was conducted to determine the prevalence and factors related with waterpipe smoking among pregnant women of Zahedan city in 2020. METHODS This cross-sectional study was conducted in 2020, and 400 pregnant women in the third trimester of pregnancy who lived in Zahedan participated in it by single stage randomized cluster sampling. A questionnaire was used to measure awareness of waterpipe complications, and another one investigated the status of waterpipe smoking to collect data. For data analysis, descriptive statistics and multiple logistic regression were used through SPSS 21. RESULTS The findings indicated that the prevalence of waterpipe smoking was 18.8%. In the waterpipe smoking group, 46.6% smoked every day, 89.3% had tried to reduce the smoking, and 64.8% reported fetal death as their main motivation to reduce smoking. Only 5.6% of subjects stated receiving training as the reason for reduction of their waterpipe smoking. The women's level of education, economic status, ethnicity, and awareness of the risks of waterpipe smoking were the predictors for waterpipe smoking (P < 0.05, P = 0.03, P = 0.006, and P < 0.001, respectively). CONCLUSIONS The results of this study show the high prevalence of waterpipe smoking in pregnant women of Zahedan. Further investigation and training in this regard are essential for pregnancy as well as pre-pregnancy care. Special attention should be paid to groups with better economic status and level of education, Baluch women, and those with low level of awareness.
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Affiliation(s)
- Samira Khayat
- Department of Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran,Address for correspondence: Dr. Samira Khayat, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. E-mail:
| | - Maryam Navaee
- Department of Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Fanaei
- Department of Physiology, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farnoosh Khojasteh
- Department of Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Haile ZT, Chertok IRA, Haider MR. Association Between a History of Hookah Use and Breastfeeding Duration. Breastfeed Med 2022; 17:678-686. [PMID: 35675681 DOI: 10.1089/bfm.2021.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: There is limited evidence on the relationship between hookah use and breastfeeding. This study examines the association between a history of hookah use and breastfeeding duration among women in the United States. Materials and Methods: This cross-sectional study examined 96,392 women from the Pregnancy Risk Assessment and Monitoring System (PRAMS) 2016-2019 data. The main outcome of interest was any breastfeeding for at least 3 months. Descriptive statistics, chi-square test, and multivariable regression analyses were performed. Results: Overall, 68.3% of women breastfed for at least 3 months and 4.6% reported using hookah in the last 2 years. Women who reported using hookah in the last 2 years were significantly less likely to breastfeed for at least 3 months compared with women who did not report using hookah in the last 2 years (56.0% versus 68.9%; p < 0.001). In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used hookah in the last 2 years compared with those who did not use hookah; odds ratio (95% confidence interval) 0.82 (0.74-0.92; p < 0.001). Additionally, the odds of breastfeeding for at least 3 months were significantly lower for dual users of hookah and cigarettes 0.48 (0.33-0.68; p < 0.001). Conclusion: A history of hookah use is associated with early weaning, independent of potential confounders. This finding suggests the need for educating women about the negative consequences of hookah use on breastfeeding during preconception, prenatal, and postpartum care encounters.
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Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, USA
| | - Ilana R Azulay Chertok
- School of Nursing, Ohio University College of Health Sciences and Professions, Athens, Ohio, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, Georgia, USA
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Dadipoor S, Heyrani A, Mirzaei-Alavijeh M, Aghamolaei T, Ghaffari M, Ghanbarnejad A. Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation. Addict Sci Clin Pract 2022; 17:18. [PMID: 35287728 PMCID: PMC8919552 DOI: 10.1186/s13722-022-00287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran. Methods In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants’ characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations. Results The results showed no significant difference between women enrolled in control and intervention groups regarding participants’ characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively. Conclusions HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings. Trial registration: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129 Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00287-5.
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Affiliation(s)
- Sakineh Dadipoor
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amin Ghanbarnejad
- Department of Epidemiology And Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Di HK, Gan Y, Lu K, Wang C, Zhu Y, Meng X, Xia WQ, Xu MZ, Feng J, Tian QF, He Y, Nie ZQ, Liu JA, Song FJ, Lu ZX. Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020. World J Pediatr 2022; 18:176-185. [PMID: 35089538 DOI: 10.1007/s12519-021-00501-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Maternal smoking during pregnancy may be associated with low birth weight (LBW) in offspring and global risk estimates have not been summarized previously. We aimed to systematically explore evidence regarding maternal smoking and the LBW risk in offspring globally and examine possible causes of heterogeneity across relevant studies. METHODS Comprehensive search of PubMed, Ovid Embase, Ovid Medline (R), and Web of science from inception until October 2021 was carried out. A random-effects meta-analysis was used to estimate the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). Restricted cubic spline analysis with three knots was used to further examine the dose-response relationship. RESULTS Literature searches yielded 4940 articles, of which 53 met inclusion criteria (comprising 55 independent studies). Maternal smoking during pregnancy was significantly associated with the risk of LBW in offspring (OR = 1.89, 95% CI = 1.80-1.98). Furthermore, an obvious dose-response relationship between the amount of cigarettes daily smoked in pregnancy and the risk of LBW in offspring was observed. The results of subgroup analyses indicated that the risk of maternal smoking on LBW was larger in more recently conducted studies (P = 0.020) and longer period of active smoking during pregnancy (P = 0.002). No evidence of publication bias was found. CONCLUSIONS In summary, maternal smoking in pregnancy was significantly associated with a higher risk of LBW in offspring on a global scale. The risk of maternal smoking on infant LBW seems to be increasing over time, and was higher with longer smoking duration throughout pregnancy and more cigarettes smoked daily.
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Affiliation(s)
- Hong-Kun Di
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Kai Lu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xin Meng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Wen-Qi Xia
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Min-Zhi Xu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qing-Feng Tian
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yan He
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Qiang Nie
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jun-An Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Fu-Jian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, NR47TJ, UK.
| | - Zu-Xun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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9
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Effect of Water-Pipe Smoking on the Normal Development of Zebrafish. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111659. [PMID: 34770174 PMCID: PMC8582815 DOI: 10.3390/ijerph182111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Background: Among all types of tobacco consumption, Water-Pipe Smoking (WPS) is the most widely used in the Middle East and second-most in several other countries. The effect of WPS on normal development is not yet fully understood, thus the aim of this study is to explore the acute toxicity effects of WPS extract on zebrafish larvae. Methods: In this study, we compared the effects of WPS smoke condensates at concentrations varying from 50 to 200 µg/mL on developmental, cardiac, and behavioural (neurotoxicity) functions. Gene expression patterns of cardiac biomarkers were also evaluated by RT-qPCR. Results: Exposing zebrafish embryos to 50, 100, 150 and 200 µg/mL WPS for three days did not affect the normal morphology of Zebrafish embryos, as the tail flicking, behavioural and locomotion assays did not show any change. However, WPS deregulated cardiac markers including atrial natriuretic peptide (ANP/NPPA) and brain natriuretic peptide (BNP/NPPB). Furthermore, it induced apoptosis in a dose-dependent manner. Conclusion: Our data demonstrate that WPS can significantly affect specific cardiac parameters during the normal development of zebrafish. Further investigations are necessary to elucidate the pathogenic outcome of WPS on different aspects of human life, including pregnancy.
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10
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Kheirallah KA, Shugaa Addin N, Alolimat MM. Trends of maternal waterpipe, cigarettes, and dual tobacco smoking in Jordan. A decade of lost opportunities. PLoS One 2021; 16:e0253655. [PMID: 34242237 PMCID: PMC8270187 DOI: 10.1371/journal.pone.0253655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Maternal tobacco use is a global public health problem. In the literature, the focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored dual use among pregnant women. We estimated the prevalence of current maternal tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of ten years (2007 to 2017), and examined the socio-demographic patterning of maternal tobacco use. Methods A secondary analysis of Jordan DHS four data waves was conducted for women who reported to be pregnant at the time of the survey. Current cigarette and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only, waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and waterpipe, regardless of cigarette, were reported. The effect of independent variables on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression models assessed the adjusted effects of socio-demographic variables on cigarette smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted and a time-unadjusted logistic models were conducted. Results Over the last decade, the prevalence estimates of current cigarette-only smoking slightly decreased. The prevalence estimates of current waterpipe-only use exceeded those for cigarette-only after 2007 and showed a steady overall increase. Current dual use showed a continuous rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and 5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed an inverse relationship with cigarette and waterpipe smoking. Household wealth demonstrated a positive association with cigarette and waterpipe smoking. Conclusions Tobacco use epidemic is expanding its roots among pregnant women in Jordan through not only waterpipe use but also dual cigarette–waterpipe smoking. Maternal and child services should consider tobacco counseling and cessation.
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Affiliation(s)
- Khalid A. Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Nuha Shugaa Addin
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maan M. Alolimat
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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11
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Dadipoor S, Aghamolaei T, Mirzaei-Alavijeh M, Ghaffari M, Heyrani A, Hosseini Teshnizi S. What are the intervention goals of women's hookah cessation? A systematic, evidence-based and participatory study. J Ethn Subst Abuse 2021; 21:1-17. [PMID: 33413046 DOI: 10.1080/15332640.2020.1864538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This Study was designed to answer the question: what are the intervention goals of women for ceasing to smoke. The present research was part of a larger study and was a pioneering systematic research conducted between September 23, 2018 and September 26, 2019 through an intervention mapping in southern Iran among professional hookah Smoking (HS) women. In order to know more about the HS among women, the behavioral and environmental correlates of HS/cessation and the determiners or fundamental causes of these factors were extracted via a systematic review and a local qualitative study. As the results revealed, the expected outcomes of the educational program concerning hookah cessation were achieved. As the realization of these outcomes requires certain changes to the behavioral and environmental dimensions, in the next step, the intervention goals of hookah cessation were identified. As the results showed, four behavioral factors involved in the unhealthy HS behavior were individual HS, Being in the Company of hookah smokers, Visiting tempting and contaminated places and Physical and mental dependence on HS (habit), In addition, four effective environmental factors were found at different interpersonal, organizational, community and policy levels. These include, respectively: recommendation and motivation for cessation by influential figures, care providers' poor inadequate knowledge and skill, Easy acceptance of hookah in society, and the lack of effective rules. Knowledge, awareness, social norms, Motivation to comply, skill and self-efficacy, habit, were among the determining factors of hookah cessation. Employment of a systematic is based on evidence and cooperation and is guided by a assessing the needs of the target population. Such a method can suggest more purposive and relevant intervention goals so as to cease HS. The aim would be to intervene in the purposes of the above-mentioned change, as compared in predetermined interventions, and increase the chances of HS cessation among women.
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Affiliation(s)
- Sakineh Dadipoor
- Student Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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12
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Al-Sawalha NA, Pokkunuri ID, Alzoubi KH, Khabour OF, Almomani BN. Waterpipe Tobacco Smoke Exposure during Lactation-Susceptibility of Reproductive Hormones and Oxidative Stress Parameters in Male Progeny Rats. Reprod Sci 2021; 28:37-42. [PMID: 32748221 DOI: 10.1007/s43032-020-00282-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022]
Abstract
There is a growing evidence for the public health hazards associated with waterpipe tobacco smoking (WTS). While the adverse effects of WTS exposure during pregnancy on the offspring are widely reported, its impact during breastfeeding remains less understood. The effects of WTS exposure during lactation on the reproductive hormones and oxidative stress biomarkers of adult male progeny were examined. Lactating rats received either fresh air (controls) or mainstream WTS for 1 h twice/day from day 4 to day 21 of lactation. The offspring was then followed up until week 20. The data indicated that WTS exposure in the lactating animals reduced the levels of follicle-stimulating hormone (FSH), prolactin (P < 0.05), luteinizing hormone (LH) (P = 0.1146), and estradiol (P = 0.0773) in the blood in male progeny. While the activities of testicular superoxide dismutase (SOD), glutathione peroxidase (GPx) and the levels of thiobarbituric acid reactive substances (TBARS) and blood levels of testosterone (P >0.05) remained unaltered, the activity of catalase increased significantly indicating an increased oxidant load in the WTS exposed rats compared to the controls. WTS exposure during lactation impairs male reproductive hormonal profile, augments oxidative damage, and potentially affects male fertility in male offspring rats.
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Affiliation(s)
- Nour A Al-Sawalha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | | | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Omar F Khabour
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Bashar N Almomani
- Ministry of Health, National Institute of Forensic Medicine, Amman, Jordan
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13
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Zauner G, Girardi G. Potential causes of male and female infertility in Qatar. J Reprod Immunol 2020; 141:103173. [PMID: 32652349 DOI: 10.1016/j.jri.2020.103173] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022]
Abstract
A steady decline in the fertility rate has been observed in Qatar during the past fifty years. Therefore, infertility is considered a national priority in Qatar, a pronatalist society. This review article summarises the potential causes of infertility that are particularly prevalent in the Qatari population. The high rate of consanguinity leading to genetic abnormalities, the high incidence of metabolic disease, environmental contamination due to the rapid urbanization and oil and natural gas extraction procedures are discussed. In addition, the particular lifestyle of the Qatari population and the influence of religion and culture on sexual and reproductive behavior in an Arab/Islamic society are considered. The active response of the state of Qatar in implementing ways to mitigate the effects of these factors to protect fertility are also presented.
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Affiliation(s)
- Gerhild Zauner
- Department of Basic Medical Sciences, College of Medicine, Member of QU Health, Qatar University, Doha, Qatar
| | - Guillermina Girardi
- Department of Basic Medical Sciences, College of Medicine, Member of QU Health, Qatar University, Doha, Qatar.
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14
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Garabedian C, Berveiller P, Guerby P. [Other Methods of Consumption: Electronic Cigarette, Heated Tobacco, Shisha and Snus - CNGOF-SFT Expert Report and Guidelines on the management for Smoking Management During Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:583-586. [PMID: 32247094 DOI: 10.1016/j.gofs.2020.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Other methods of cigarette consumption include a variety of electronic products, as well as heated tobacco, snus and shisha. The questions in this chapter are: what other methods of consumption are used during pregnancy (either electronic or containing tobacco) and what is their prevalence? What is their benefit/risk balance? Can their use during pregnancy be proposed? Although the fetus is not exposed to the combustible toxins of tobacco, e-cigarette products may contain nicotine, which maintains the exposure of the fetus. Further research is needed on the other components of the electronic cigarette, such as flavorings and propylene glycol and/or glycerol, in order to assess the benefit/risk balance. In addition, some solvents contain ethanol. In the current state of knowledge, the precautionary principle should be respected and not recommend the initiation or continuation of the electronic cigarette during pregnancy (professional agreement). For smoking cessation or electronic cigarette cessation, it is recommended to provide the same advice and to use methods that have already been evaluated (professional agreement). For the JUUL, there are currently no data on obstetrical outcome when used. The use of shisha during pregnancy is associated with decreased fetal growth. It is recommended not to use shisha during pregnancy (GradeC). There are currently no data on the use of heated tobacco and obstetrical outcome.
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Affiliation(s)
- C Garabedian
- CHU Lille, clinique d'obstétrique, 1, avenue Eugène-Avinée, 59000 Lille, France; Univ. Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France.
| | - P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France
| | - P Guerby
- Service de gynécologie-obstétrique, CHU de Toulouse, 31300, Toulouse, France
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15
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Nematollahi S, Holakouie-Naieni K, Madani A, Shabkhiz H, Torabi E, Lotfi S. The effect of quitting water pipe during pregnancy on anthropometric measurements at birth: a population-based prospective cohort study in the south of Iran. BMC Pregnancy Childbirth 2020; 20:241. [PMID: 32321454 PMCID: PMC7179000 DOI: 10.1186/s12884-020-02948-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence regarding health effects of tobacco cessation during pregnancy is mainly restricted to cigarette while water pipe is the preferred method of tobacco smoking among women in the Middle-East. The present study aimed to assess the effects of cessation of water pipe during pregnancy on birth anthropometric measures in the south of Iran. METHODS Data on 1120 singleton pregnancies (response rate = 93.4%) from a population-based prospective cohort study in suburban communities in Bandar Abbas city was used. Based on water pipe smoking status, the study subjects were categorized into: 1) those who never smoke water pipe (never smoker); 2) those who stopped water pipe during pregnancy and resumed it postpartum (quitters); 3) those who continued smoking water pipe during their pregnancy (always smokers). The Generalized Linear Models (GLMs) were utilized for the analyses. RESULTS Compared to never smokers, quitting water pipe in pregnancy decreased mean birthweight of infants by 99.30 g (β:-99.30, 95%CI:-204.35,-5.75) and an additional decrease of 37.83 g occurred in infants of always smokers (β:-137.13;95%CI:- 262.21,-12.05). Means of birth length did not significantly differ among the three water pipe groups. Means of head circumference, however, significantly increased by 0.79 cm in infants of always smokers (β:079,95%CI:0.13,1.45). CONCLUSION Quitting water pipe during pregnancy had positive effects on infant growth, especially birth weight. Awareness campaigns about health benefits of quitting water pipe during routine prenatal checkups and integration of active follow-up visits into prenatal care protocols for smoking mothers are provided.
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Affiliation(s)
- Shahrzad Nematollahi
- Men's Health and Reproductive Health Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Koroush Holakouie-Naieni
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Abdolhossain Madani
- School of Public Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Shabkhiz
- Bandar Abbas Heath Education & Research Station, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Elham Torabi
- Bandar Abbas Heath Education & Research Station, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Samane Lotfi
- Department of Epidemiology and Public Health, Iran University of Medical Sciences, Tehran, Iran
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16
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Dadipoor S, Kok G, Heyrani A, Aghamolaei T, Ghaffari M, Ghanbarnezhad A. An intervention development for cessation of hookah smoking among Iranian women: study protocol for a systematic and theory-based approach to intervention design. Addict Sci Clin Pract 2020; 15:6. [PMID: 32014048 PMCID: PMC6998820 DOI: 10.1186/s13722-020-0184-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hookah smoking is an emerging global health issue, especially in Eastern Mediterranean region; and accordingly, women are at the center of this issue as they have a more positive attitude towards hookah smoking. Also, the rate of hookah smoking is increasing at a faster rate among women compared to men. The aim of the present study will be systematically designing and implementing an educational intervention program for hookah smoking cessation among 15 years old women and older in the Iranian southern city of Bandar Abbas. METHODS We will use intervention mapping methodology for designing the study. Due to the breadth of factors affecting hookah smoking and the complexity of hookah cessation, we will initially conceptualize hookah smoking cessation program as a set of purposeful activities designed to stop the hookah smoking. In the first step (need assessment), the environmental and behavioral factors related to hookah smoking/cessation and the determinants of these factors will be determined by systematic review and local qualitative study. Then, based on the results of the first step, the behavioral and environmental goals of hookah smoking cessation will be identified. In the second step, the practical goals will be determined for each of the behavioral and environmental outcomes; and then, the logic and matrix of change objectives will be designed using the determinants extracted from the previous step. The products of the second step will be the intervention goals. In the third step, theoretical and practical methods affecting each of the intervention goals will be identified. In the fourth step, contents of educational program for hookah cessation will be produced. The fifth step will be about planning to implement the program. In the sixth step, the effectiveness of designed program will be evaluated in a quasi-experimental intervention. DISCUSSION Appropriate development and successful implementation of a hookah cessation intervention requires a systematic and theory-based approach. We believe that using Intervention Mapping (IM) as the guiding methodology will make it possible to address complexities of developing an intervention program. Also, reflections on the quasi-experimental research and describing the context and executed methods of implementation would contribute to the development of IM and the knowledge needed for the implementation of program. Trial registration IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129.
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Affiliation(s)
- Sakineh Dadipoor
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Gerjo Kok
- Department of Work and Social Psychology, School of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Ghanbarnezhad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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17
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Dadipoor S, Heyrani A, Aghamolaei T, Ghanbarnezhad A, Ghaffari M. Predictors of Hookah Smoking among Women in Bandar Abbas, Southern Iran: A Cross-Sectional Study Based on the Intervention Mapping Protocol. Subst Use Misuse 2020; 55:1800-1807. [PMID: 32441183 DOI: 10.1080/10826084.2020.1765807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: The purpose of this study was to determine the predictors of hookah smoking (HS) among professional HS women in Bandar Abbas, southern Iran using intervention mapping protocol. Methods: The present cross-sectional study is part of a larger study, which was conducted on 332 HS women using a multistage (clustered and randomized) process. Data were collected from October 2018 to August 2019 using a researcher-made questionnaire. Results: Mean age of the participants was 36.1 ± 13.3 years. Ordinal regression model, after the control of confounding variables, showed that attitudes, self-efficacy, habits, and intention were the most important predictors of HS behavior in women (OR = 1.14). The prevalence of HS was 1.76 times higher in women who did not want to quit hookah. Knowledge and Social norms were not associated with the HS behavior. Conclusions: According to the present findings, changing or eliminating women's positive attitude toward HS is deemed possible through reducing the social acceptance of HS in enculturating the negative attitude in society, enhancing women's self-efficacy via purposeful and specific education on resisting hookah temptation, unraveling all factors involved in habit formation and adjusting these factors through long-term interventions and timely interventions to affect intention to consumption before the actual occurrence of behavior (HS).
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Affiliation(s)
- Sakineh Dadipoor
- Student Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Student Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnezhad
- Department of Epidemiology And Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghaffari
- Environmental & Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran
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18
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Maziak W, Osibogun O, Asfar T. Waterpipe smoking: the pressing need for risk communication. Expert Rev Respir Med 2019; 13:1109-1119. [PMID: 31519113 PMCID: PMC7004232 DOI: 10.1080/17476348.2019.1668271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023]
Abstract
Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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19
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Asfar T, Schmidt M, Ebrahimi Kalan M, Wu W, Ward KD, Nakkash RT, Thrasher J, Eissenberg T, Ben Romdhane H, Maziak W. Delphi study among international expert panel to develop waterpipe-specific health warning labels. Tob Control 2019; 29:159-167. [PMID: 30696784 DOI: 10.1136/tobaccocontrol-2018-054718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control. METHODS A panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median. RESULTS Starting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP's harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes. CONCLUSION This study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP's harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.
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Affiliation(s)
- Taghrid Asfar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.,Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, US
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, Tennessee, USA
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria.,School of Public Health, The University of Memphis, Miami, Florida, USA
| | - Rima T Nakkash
- Health Behaviour and Education Department, American University of Beirut, Beirut, Lebanon
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria.,USA Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis-Tunisia, Tunis, Tunisia
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
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20
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Pratiti R, Mukherjee D. Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review. Cardiovasc Hematol Agents Med Chem 2019; 17:82-93. [PMID: 31483237 DOI: 10.2174/1871525717666190904151856] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MA 48532, United States
| | - Debabrata Mukherjee
- Texas Tech University Health Science Center, Department of Internal Medicine, El Paso, TX 79905, United States
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