Hubble-bubble (water pipe) smoking: levels of nicotine and cotinine in plasma, saliva and urine

Waterpipe Tobacco Smoking among university students in Turkey

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Less than half (38.4%) of the participants smoke waterpipe.

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Female participants tend to smoke more waterpipe than male participants.

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Waterpipe tobacco smokers perceived waterpipe smoking less risky than non-smokers.

Introduction

Waterpipe tobacco smoking is common among adults in numerous Mediterranean countries. Waterpipe cafes where people are allowed to smoke waterpipe tobacco are an increasingly popular venue for socializing among young people. The aim of this study was to assess the frequency and patterns of waterpipe tobacco smoking among university students in Turkey, as well as their perception on the health-risk of smoking the waterpipe.

Method

A total of 411 university students in Turkey participated in this study. Participants completed a set of questionnaires to measure frequency, behaviours, and perceptions of the health risks related to waterpipe tobacco smoking.

Results

Less than half (38.4%) of the participants smoke waterpipe. Female participants tend to smoke more waterpipe than male participants. The mean age of first smoking waterpipe was 17 years. Waterpipe tobacco smokers perceived the health risks of smoking the waterpipe to be less addictive and exaggerated compared to non-users; smokers also regarded smoking waterpipe tobacco to help them to relax.

Conclusion

This study provided support that waterpipe tobacco smoking is common among young people in Turkey. There was poor awareness about the risk of waterpipe tobacco smoking among students. Our findings could inform tobacco control in Turkey, especially among young people.

Knowledge and attitude toward waterpipe smoking: scale validation and correlates in the Lebanese adult population

The World Health Organization declared waterpipe smoking as a growing public health concern. Our study aimed to assess waterpipe smoking knowledge and attitude among current waterpipe smokers in comparison with nonsmokers and to evaluate its association with current and cumulative waterpipe smoking. A cross-sectional study was carried between May and December 2018 using a multistage cluster sample across Lebanon. Nonsmokers or exclusive current waterpipe smokers were eligible to participate. A total of 4046 adult individuals participated in the study, 38.3% (n = 1550) being current waterpipe smokers. Current waterpipe smoking was positively associated with female gender [adjusted odds ratio (aOR) 1.79, 95%CI 1.40-2.28] and having a mother who is a regular smoker (aOR 1.47, 95%CI 1.15-1.88) while it was negatively associated with better knowledge about waterpipe smoking harm (aOR 0.95, 95%CI 0.93-0.97) and positive attitude toward waterpipe smoking ban (aOR 0.98, 95%CI 0.96-0.99). Cumulative waterpipe smoking was negatively associated with female gender (β = - 0.012), higher education level (β = - 0.28), and positive attitude toward WPS ban (β = - 0.06). Waterpipe smoking is largely present among the Lebanese population, with waterpipe smokers showing lower knowledge about harm and more intolerant attitude about banning. Health awareness supported by media campaigns and governmental initiatives should be conducted to educate people and change their perceptions regarding waterpipe smoking.

Knowledge, attitudes, harm perception, and practice related to waterpipe smoking in Lebanon

Waterpipe smoking (WPS) is one of the most emerging popular trends in Lebanon, with a prevalence of 36.9%, the highest among all Middle Eastern countries. Thus, the primary objective of the study was to examine the factors associated with knowledge, attitudes, and practice (KAP) related to WPS among a representative sample of waterpipe smokers. The secondary objective was to examine the effect of KAP on cumulative waterpipe dose and dependence. This cross-sectional study was carried out between May and December 2018 and enrolled a representative sample of 1550 waterpipe smokers from all Lebanese districts. The questionnaire used was specifically designed for this study. High knowledge score (Beta = 0.02, p = 0.002) were significantly associated with higher waterpipe harm perception score. In addition, high knowledge score (Beta = 0.32, p = 0.007) were significantly associated with higher attitude score toward smoking ban. Higher waterpipe harm perception score (Beta = - 1.30, p < 0.001), higher attitude (Beta = - 0.21, p < 0.001), and higher knowledge score (Beta = - 0.11, p < 0.001) were significantly associated with lower waterpipe dependence. In addition, higher waterpipe dependence (Beta = 2.02, p < 0.001) was significantly associated with higher cumulative waterpipe smoking, while higher waterpipe harm perception score (Beta = - 1.96, p = 0.009) and higher knowledge score (Beta = 0.27, p < 0.001) were significantly associated with lower cumulative waterpipe smoking. Our main finding was that better knowledge and perception of the harmful effects of waterpipe were related to a better attitude toward smoking bans and a lower waterpipe smoking. Therefore, health care providers and policymakers should join efforts to make awareness campaigns across Lebanon and develop adequate interventions to curb the use of waterpipe among the population.

Waterpipe smoking cessation: knowledge, barriers, and practices of primary care physicians- a questionnaire-based cross-sectional study

BACKGROUND

While cigarette smoking has been considered the most relevant tobacco product worldwide, waterpipe tobacco smoking (WTS) has increased in prevalence globally and calls for more considerable attention now. However, little is known about WTS cessation knowledge and clinical practices among physicians, particularly in Lebanon. This study aims to examine the knowledge, barriers, and cessation practices of primary care practitioners towards WTS.

METHODS

A cross-sectional study where an anonymous self-reported questionnaire was completed by physicians attending the Annual Conference of the Lebanese Society of Family Medicine for family medicine physicians, general practitioners, and internists in Lebanon.

RESULTS

Out of 180 attendees, 105 primary care practitioners (PCPs) responded to the questionnaire. Only 38.1% of the physicians think similar techniques are used for the cessation of smoking of both cigarette and waterpipe. Similarly, 30.5% of the physicians believe that nicotine replacement therapy works in the cessation of waterpipe smoking. There was a statistically significant difference between the percentage of physicians who counsel for cigarette smoking and those who counsel for waterpipe smoking cessation (p = 0.005) where 30% of the physicians tend to counsel against cigarette smoking more than waterpipe smoking.

CONCLUSIONS

This study shows a difference in the attitude and behavior of PCPs towards cigarette and waterpipe smoking cessation. Moreover, there is a lack of knowledge about water pipe smoking cessation techniques. There is a great room for continued medical education to PCPs in their private practice to improve their knowledge.

Respiratory health and quality of life in young exclusive, habitual smokers - a comparison of waterpipe smokers, cigarette smokers and non-smokers

Purpose

Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults’ respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups.

Method

We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured.

Result

The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS.

Conclusion

Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Chronic shisha exposure alters phosphoproteome of oral keratinocytes

Shisha smoking has been epidemiologically linked to oral cancer. However, few studies have investigated the pathobiology of shisha-induced cellular transformation. We studied the effects of chronic shisha exposure (8 months) in an in vitro model using immortalized, non-neoplastic oral keratinocytes (OKF6/TERT1). Quantitative proteomic and phosphoproteomic analyses were performed on OKF6/TERT1 cells treated with shisha extract for a period of 8 months. Pathway analysis was carried out to identify significantly enriched biological processes in shisha-treated cells. Chronic shisha exposure resulted in increased cell scattering phenomenon in OKF6/TERT1 cells. Data analysis revealed differential phosphorylation of 164 peptides (fold change ≥1.5, p ≤ 0.0.5) corresponding to 136 proteins. Proteins associated with mTORC1 and EIF4F complexes involved in initiating protein translation were seen to be enriched upon shisha treatment. Network analysis also highlighted downregulation of proteins involved in Type I interferon signaling in shisha-treated cells. Quantitative phosphoproteomic approach elucidated global perturbations to the molecular milieu of oral keratinocytes upon shisha exposure. Further studies are needed to validate putative targets in oral cancer patients with shisha smoking history.

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.

The Effect of Hookah Use on Buccal Mucosa: Evaluation of Repair Index

Background and aim:

Cigarettes, hookah, and tobacco are the most important etiologic factors for oral cancers and dysplastic lesions. This study was undertaken to determine the correlation between hookah use and the percentage of cells with micronucleus, karyorrhexis, karyolysis, and broken egg in the buccal mucosa; and secondly to compare hookah user and non-user in terms of repair index.

Materials and methods:

The present historical cohort study was carried out on 72 samples taken from 36 hookah users and 36 control subjects. Smear samples were obtained from participants’ buccal mucosa for cytological evaluation using Papanicolaou technique. Then, the percentages of cells with micronucleus, karyorrhexis, karyolysis, and broken egg were recorded and the repair index was calculated. Data were analyzed using Mann-Whitney U test.

Results:

A total of 72 samples taken from 36 hookah users and 36 control subjects were evaluated. The means of micronucleus scores in the buccal mucosa cells of hookah users and controls were 10.7±2.6 and 5.8±2.0, the karyorrhexis scores in the hookah users and controls were 0.1±0.06 and 0.04±0.06, and the karyolysis scores in hookah users and controls were 0.16±0.05 and 0.08±0.06, respectively. These differences were statistically significant between hookah users and controls (P<0.001). The broken egg score was 0.66±0.07 for the hookah users and 0.03±0.04 for the control group, revealing a statistically significant difference (P<0.036). Finally, the repair index values were 0.03±0.01 and 0.05±0.13 in hookah users and controls, respectively. This difference was also significant (P<0.026).

Conclusion:

The percentages of cells with micronucleus, karyorrhexis, karyolysis, and broken egg in the buccal mucosa of hookah users were significantly higher than those in control group; in addition, the repair index of the buccal mucosa cells in hookah users was significantly lower than that in the control group.

Comparison of Periodontal Status Between Male Exclusive Narghile Smokers and Male Exclusive Cigarette Smokers

Studies evaluating the effects of narghile use on the periodontium present conflicting conclusions. This study aimed to compare the periodontal status of exclusive narghile smokers (ENSs, n = 74) to that of exclusive cigarette smokers (ECSs, n = 74). Males aged 20-40 years were recruited to participate in this comparative study. Information concerning oral health habits (number of yearly visits to the dentist, daily toothbrushing frequency) and tobacco exposure were obtained. Clinical measurements were performed on all the existing teeth, except the third molars. The number of remaining teeth and decayed/missing/filled teeth (DMFT) were noted. The plaque levels were recorded using the plaque index of Löe and Silness. The gingival index modified by Löe was used to evaluate gingival inflammation. Teeth mobility was measured using bidigital mobility. The probing pocket depth was measured using a periodontal probe. Periodontal disease was defined as the presence of at least 10 sites with a probing depth ≥5 mm. Student's t and chi-square tests were used to compare, respectively, the two groups' quantitative and qualitative data. The two groups were matched for quantities of used tobacco, age, daily toothbrushing frequency, teeth mobility, number of remaining teeth, plaque index, and DMFT. Compared to the ECS group, the ENS group had a significantly lower number of yearly visits to the dentist (mean ± SD: 0.2 ± 0.5 vs. 0.1 ± 0.2), lower probing pocket depth (mean ± SD: 2.33 ± 0.63 vs. 2.02 ± 0.80 mm), and gingival index (median [interquartile]: 0.46 [0.10-0.89] vs. 0.00 [0.00-0.50]), and it included significantly lower percentages of smokers with periodontal disease (24.3% vs. 9.5%). In conclusion, chronic exclusive narghile smoking has fewer adverse effects on the periodontium than chronic exclusive cigarette smoking.

Inhibition of nicotine-induced Streptococcus mutans biofilm formation by salts solutions intended for mouthrinses

OBJECTIVES

Biofilm formation is critical to dental caries initiation and development. The aim of this study was to investigate the effects of nicotine exposure on Streptococcus mutans (S. mutans) biofilm formation concomitantly with the inhibitory effects of sodium chloride (NaCl), potassium chloride (KCl) and potassium iodide (KI) salts. This study examined bacterial growth with varying concentrations of NaCl, KCl, and KI salts and nicotine levels consistent with primary levels of nicotine exposure.

MATERIALS AND METHODS

A preliminary screening experiment was performed to investigate the appropriate concentrations of NaCl, KCl, and KI to use with nicotine. With the data, a S. mutans biofilm growth assay was conducted using nicotine (0-32 mg/mL) in Tryptic Soy broth supplemented with 1% sucrose with and without 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI. The biofilm was stained with crystal violet dye and the absorbance measured to determine biofilm formation.

RESULTS

The presence of 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI significantly inhibited (p < 0.05) nicotine-induced S. mutans biofilm formation by 52%, 79.7%, and 64.1%, respectively.

CONCLUSIONS

The results provide additional evidence regarding the biofilm-enhancing effects of nicotine and demonstrate the inhibitory influence of these salts in reducing the nicotine-induced biofilm formation. A short-term exposure to these salts may inhibit S. mutans biofilm formation.

Serine residues in the α4 nicotinic acetylcholine receptor subunit regulate surface α4β2* receptor expression and clustering

BACKGROUND AND PURPOSE

Chronic nicotine exposure upregulates α4β2^* nicotinic acetylcholine receptors (nAChRs) in the brain. The goal of this study was to examine the role of three serine residues in the large cytoplasmic loop of the α4 subunit on α4β2^* upregulation in neurons.

EXPERIMENTAL APPROACH

Serine residues S336, S470 and S530 in mouse α4 were mutated to alanine and then re-expressed in primary neurons from cortex, hippocampus and subcortex of α4 KO mice. Mutant and wild type α4 expressing neurons were treated with nicotine (0.1, 1 and 10 μM) and assessed for α4β2^* upregulation.

KEY RESULTS

α4β2^* nAChRs expressing S336A or S470A mutants were deficient at cell surface upregulation in both subcortex and hippocampal neurons. S530A α4β2^* mutants exhibited aberrant surface upregulation in subcortical neurons. None of the mutants affected surface upregulation in cortical neurons or upregulation of total α4β2^* binding sites in any region. Further, dense domains or clusters of α4β2^* nAChRs were observed in the neuronal surface. The impact of nicotine exposure on the intensity, area, and density of these clusters was dependent upon individual mutations.

CONCLUSIONS AND IMPLICATIONS

Effects of α4 nAChR mutants on surface upregulation varied among brain regions, suggesting that the cellular mechanism of α4β2^* upregulation is complex and involves cellular identity. We also report for the first time that α4β2^* nAChRs form clusters on the neuronal surface and that nicotine treatment alters the characteristics of the clusters in an α4 mutant-dependent manner. This finding adds a previously unknown layer of complexity to the effects of nicotine on α4β2^* expression and function.

Hookah Use and Perceptions among Young Adult Hookah Users

Background

Despite declining cigarette use, hookah use has increased substantially among youth and young adults. This is alarming, as hookah can lead to the same health risks as cigarettes and expose users to a high amount of smoke, nicotine, and toxicants. Determining patterns of hookah use and perceptions in young adults is important in prevention efforts.

Methods

Structured in-person interviews were conducted for this qualitative study in June 2016. Twenty-three hookah users between the ages of 18 and 29 years living in Austin, TX who were not currently enrolled in a college or university completed the interview. NVivo 11 Pro was utilized to code transcribed transcripts for common themes among participants.

Results

When trying hookah for the first time, all participants had used flavored tobacco, with fruit flavors being most popular at initiation and for current use. Many participants initiated hookah use under the age of 18 years old. While only one participant initiated hookah use alone, one-third of participants had smoked hookah alone, not in the company of others. The majority of participants owned or previously owned their own hookah device. Common motivational factors for hookah use involved being social, taste, and the calming/relaxation effect. Participants perceived hookah use to be both harmful and addictive; however, many participants were unsure if hookah was more harmful to health than cigarettes.

Conclusion

Young adults who are not currently enrolled in college may have similar hookah use behaviors and risk perceptions as do college students, yet non-college students in this sample are using hookah alone and report owning a hookah device. This study supports the need for research on the effect of policy changes on hookah use, receptivity to warning labels, and programs to correct misperceptions.

Five Cases of Carbon Monoxide Poisoning Due to Narghile (Shisha)

Narghile known in different names as shisha, hookah, hubble-bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.

University students' perceived risk of and intention to use waterpipe tobacco

Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50-0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported 'to socialize' as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts.

Indoor Air Quality

Many health care providers are concerned with the role environmental exposures play in the development of respiratory disease. While most individuals understand that outdoor air quality is important to their health status, many are unaware of the detrimental effects indoor air pollution can potentially have on them. The Environmental Protection Agency (EPA) regulates both outdoor and indoor air quality. According to the EPA, indoor levels of pollutants may be up to 100 times higher than outdoor pollutant levels and have been ranked among the top 5 environmental risks to the public. There has been a strong correlation between air quality and health, which is why it is crucial to obtain a complete environmental exposure history from a patient. This article focuses on the effects indoor air quality has on the respiratory system. Specifically, this article will address secondhand smoke, radon, carbon monoxide, nitrogen dioxide, formaldehyde, house cleaning agents, indoor mold, animal dander, and dust mites. These are common agents that may lead to hazardous exposures among individuals living in the United States. It is important for health care providers to be educated on the potential risks of indoor air pollution and the effects it may have on patient outcomes. Health problems resulting from poor indoor air quality are not easily recognized and may affect a patient's health years after the onset of exposure.

Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study

Environmental factors, pesticides, alcohol and smoking are linked to asthma in children. The association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children aged less than 16 years old. This is a cross-sectional study, conducted between January and May 2015, using a sample of Lebanese students from private schools in Beirut and Mount Lebanon. Out of 700 distributed questionnaires, 527 (75.2%) were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study. A significant association was found between waterpipe smoking and diagnosed asthma (p = 0.003; OR_a = 13.25; 95% CI 2.472–71.026). Alcohol during pregnancy, waterpipe smoking during pregnancy and parents respiratory problems significantly increased the risk of respiratory problems by approximately 5 times, 6 times and 2 times respectively (p = 0.016; OR_a = 4.889; 95% CI 1.339–17.844, p = 0.021; OR_a = 6.083; 95% CI 1.314–28.172, p = 0.004; OR_a = 1.748; 95% CI 1.197–2.554 respectively). Waterpipe smoking, alcohol during pregnancy, recurrent otitis and humidity at home seem to be significantly correlated with asthma in children. Spreading awareness by health care professionals is needed to permit a reduction of the prevalence of these allergic diseases, especially asthma, in children.

Validation of asthma control questionnaire and risk factors affecting uncontrolled asthma among the Lebanese children's population

OBJECTIVES

To validate the Arabic version of the Asthma Control Test (ACT) in asthmatic children in Lebanon and identify risk factors that might affect asthma control in these children.

METHODS

This study, conducted between December 2015 and April 2016, included 300 children.

RESULTS

A high Cronbach's alpha was found for the full scale (0.959). The correlation factors between each item of the ACT scale and the whole scale ranged between 0.710 and 0.775(p < 0.001 for all items). Low mother's educational level as well as the history of asthma in the mother and the father would significantly increase the risk of uncontrolled asthma (p = 0.001; Beta = 1.862; p < 0.001; Beta = 3.534; p < 0.001; Beta = 1.885respectively). Cigarette smoking during breastfeeding and waterpipe smoking by the mother during pregnancy were both significantly associated with uncontrolled asthma (p = 0.005; Beta = 2.105 and p = 0.041; Beta = 2.325 respectively). The high mother's level of education was significantly associated with more asthma control (p = 0.008; Beta = -0.715).

CONCLUSION

The Arabic version of the asthma control questionnaire is a valid tool to use in pediatric patients in the Lebanese population to assess asthma control. Waterpipe smoking during pregnancy and cigarette smoking during breastfeeding, as well as the lower education level are risk factors for uncontrolled asthma. Spreading awareness among health care professionals, as well as reinforcing health education seem to be an important step toward a better asthma control.

Assessment of Prevalence, Beliefs, and Habits of Hookah Smoking Among People with a Medical Background Compared to People with a Non-medical Background: A Cross-sectional Self-administered Questionnaire-based Study

INTRODUCTION

Hookah smoking has seen a reemergence in popularity in the last 30 years, particularly in the young urban population. This study aimed to compare the prevalence of and the attitude and beliefs about hookah smoking of people with a medical background and compare it with people from a non-medical background.

MATERIALS AND METHODS

An anonymous questionnaire with ten questions about various aspects of hookah smoking was formulated using Google forms®, which was then circulated via Facebook®, Whatsapp® and emails to the intended participants and all responses were recorded and analyzed.

RESULTS

The total number of respondents were 470. The number of respondents with a medical background was 45.31%. The percentage of the respondents with a medical background who smoked a hookah was 28.63%, while the same percentage of the respondents with a non-medical background was 63.42. The perception of hookah being less harmful than a cigarette was not found to be statistically different between the two groups. Respondents with a medical background were more ignorant of the presence or absence of tobacco in the hookah they smoked. The average duration of the hookah smoking habit, the frequency of its use per month, and the average lengths of the hookah smoking session were 3.52 years (95% CI of 3.21 to 3.82), 1.946 (95% CI 1.799 to 2.093), and 58.90 minutes (95% CI of 54.42 to 63.37), respectively.

CONCLUSION

The knowledge about the ill effects of smokeless tobacco should be integrated into the structured teaching curriculum of undergraduate medical and dental courses as they prepare future physicians and dental surgeons for an anti-tobacco campaign.

Periodontal bone height of exclusive narghile smokers compared with exclusive cigarette smokers

OBJECTIVE

To compare the periodontal bone height (PBH) of exclusive narghile smokers (ENS) with that of exclusive cigarette smokers (ECS).

METHODS

Tunisian males aged 20-35 years who have been ENS for more than five narghile-years or ECS for more than five pack-years were recruited to participate in this comparative cross-sectional study. Information about oral health habits and tobacco consumption were gathered using a predetermined questionnaire. Plaque levels were recorded in four sites using the plaque index of Loe and Silness. The PBH was measured mesially and distally from digital panoramic radiographs of each tooth and expressed as a percentage of the root length. A PBH level ≤ 0.70 was applied as a cutoff reference value signifying bone loss. Student t-test and Chi(2) test were used to compare quantitative and qualitative data of both groups.

RESULTS

There were no significant differences between the ENS (n=60) and ECS (n=60) groups regarding age and the consumed quantities of tobacco (28 ± 4 vs. 27 ± 5 years, 7 ± 3 narghile-years vs. 8 ± 3 pack-years, respectively). Compared with the ECS group, the ENS group had a significantly higher plaque index (mean ± SD values were 1.54 ± 0.70 vs. 1.84 ± 0.73, respectively). However, the two groups had similar means of PBH (0.85 ± 0.03 vs. 0.86 ± 0.04) and tooth brushing frequencies (1.1 ± 0.8 vs. 0.9 ± 0.6 a day, respectively) and had similar bone loss frequencies (15% vs. 12%, respectively).

CONCLUSIONS

Both ENS and ECS exhibited the same PBH reduction, which means that both types of tobacco smoking are associated with periodontal bone loss.

Waterpipe smoking and cancer: systematic review and meta-analysis

OBJECTIVE

Although accumulating evidence suggests harmful effects of waterpipe smoking, there is limited information about its direct association with chronic diseases, notably cancer. We provide an up-to-date systematic review and meta-analysis of the association between waterpipe smoking and cancer.

DATA SOURCES

Systematic search of articles indexed in main biomedical databases: Pubmed, EmBase, Google Scholar and Web of Science, published between 1962 and September 2014. Search keywords included a combination of waterpipe or hookah, sheesha, nargile, hubble-bubble, goza or gaylan, and cancer.

STUDY SELECTION

Focus on observational studies (cohort, case-control, cross-sectional) that evaluated the association between waterpipe smoking and cancer. Studies with mixed exposures excluded.

DATA EXTRACTION

Two investigators independently extracted data and reached consensus on all items.

DATA SYNTHESIS

13 case-control studies met the inclusion criteria and were considered for meta-analysis. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis revealed a positive association between waterpipe smoking and lung cancer (OR=4.58 (2.61 to 8.03); I²=44.67%), and oesophageal cancer (OR=3.63 (1.39 to 9.44); I² =94.49%). The majority of studies had a NOS score of 5-6 or 7, indicating 'fair' or 'good' quality, respectively.

CONCLUSIONS

Our findings support a positive association between waterpipe smoking and cancer risk. However, high-quality studies with standardised exposure measurements are needed to clarify the contribution of waterpipe smoking to chronic diseases. More investments in initiatives for surveillance, intervention and regulatory policy for waterpipe smoking are urgently warranted.

Validation of the Waterpipe Tolerance Questionnaire Among Jordanian School-Going Adolescent Waterpipe Users

Introduction:

Waterpipe use among adolescents has been increasing progressively. Yet no studies were reported to assess the validity and reliability of nicotine dependence scale. The current study aims to assess the validity and reliability of an Arabic version of the modified Waterpipe Tolerance Questionnaire WTQ among school-going adolescent waterpipe users.

Methods:

In a cross-sectional study conducted in Jordan, information on waterpipe use among 333 school-going adolescents aged 11-18 years was obtained using the Arabic version of the WTQ. An exploratory factor analysis and correlation matrices were conducted to assess validity and reliability of the WTQ.

Results:

The WTQ had a 0.73 alpha of internal consistency indicating moderate level of reliability. The scale showed multidimensionality with items loading on two factors, namely waterpipe consumption and morning smoking.

Conclusion:

This study report nicotine dependence level among school-going adolescents who identify themselves as waterpipe users using the WTQ.

Waterpipe tobacco smoking: what is the evidence that it supports nicotine/tobacco dependence?

OBJECTIVE

Waterpipe tobacco smoking (WTS) involves passing tobacco smoke through water prior to inhalation, and has spread worldwide. This spread becomes a public health concern if it is associated with tobacco-caused disease and if WTS supports tobacco/nicotine dependence. A growing literature demonstrates that WTS is associated with disability, disease and death. This narrative review examines if WTS supports nicotine/tobacco dependence, and is intended to help guide tobacco control efforts worldwide.

DATA SOURCES

PUBMED search using: (("waterpipe" or "narghile" or "arghile" or "shisha" or "goza" or "narkeela" or "hookah" or "hubble bubble")) AND ("dependence" or "addiction").

STUDY SELECTION

Excluded were articles not in English, without original data, and that were not topic-related. Thirty-two articles were included with others identified by inspecting reference lists and other sources.

DATA SYNTHESIS

WTS and the delivery of the dependence-producing drug nicotine were examined, and then the extent to which the articles addressed WTS-induced nicotine/dependence explicitly, as well as implicitly with reference to criteria for dependence outlined by the WHO.

CONCLUSIONS

WTS supports nicotine/tobacco dependence because it is associated with nicotine delivery, and because some smokers experience withdrawal when they abstain from waterpipe, alter their behaviour in order to access a waterpipe and have difficulty quitting, even when motivated to do so. There is a strong need to support research investigating measurement of WTS-induced tobacco dependence, to inform the public of the risks of WTS, which include dependence, disability, disease and death, and to include WTS in the same public health policies that address tobacco cigarettes.

Risk Factors Associated With Hookah Use

BACKGROUND

Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement.

METHOD

An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent).

RESULT

Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05).

CONCLUSIONS

Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.

Relationships among factual and perceived knowledge of harms of waterpipe tobacco, perceived risk, and desire to quit among college users

Waterpipe tobacco smoking is increasing in the United States among college students. Through a web-based survey, we explored associations among factual and perceived knowledge, perceived risks and worry about harm and addiction, and desire to quit among 316 college waterpipe tobacco smoking users. Overall, factual knowledge of the harm of waterpipe tobacco smoking was poor, factual and perceived knowledge was weakly correlated, both forms of knowledge were related inconsistently to perceived risks and worry, and neither form of knowledge was associated with the desire to quit. Findings provide preliminary insights as to why knowledge gaps may not predict cessation among waterpipe users.

The growing epidemic of water pipe smoking: health effects and future needs

Water pipe smoking (WPS), an old method of tobacco smoking, is re-gaining widespread popularity all over the world and among various populations. Smoking machine studies have shown that the water pipe (WP) mainstream smoke (MSS) contains a wide array of chemical substances, many of which are highly toxic and carcinogenic for humans. The concentrations of some substances exceed those present in MSS of cigarettes. Despite being of low grade, current evidence indicates that WPS is associated with different adverse health effects, not only on the respiratory system but also on the cardiovascular, hematological, and reproductive systems, including pregnancy outcomes. In addition, association between WPS and malignancies, such as lung, oral and nasopharyngeal cancer, has been suggested in different studies and systematic reviews. Despite its long standing history, WPS research still harbors a lot of deficiencies. The magnitude of toxicants and carcinogen exposures, effects on human health, as well as the addiction and dependence potentials associated with WPS need to be studied in well-designed prospective trials. Unfortunately, many of the tobacco control and clean indoor policies have exempted water pipes. World wide awareness among the public, smokers, and policymakers about the potential health effects of WPS is urgently required. Furthermore, stringent policies and laws that control and ban WPS in public places, similar to those applied on cigarettes smoking need to be implemented.

The LWDS-10J: reliability and validity of the Lebanon Waterpipe Dependence Scale among university students in Jordan

INTRODUCTION

While the Lebanon Waterpipe Dependence Scale (LWDS-11) has shown promise in assessing dependence on waterpipe tobacco smoking (WTS) in Lebanon among adult users, it would be valuable to identify WTS addiction earlier and to explore reliability and validity of these items in other populations.

METHODS

In 2010-2012, we conducted a multiyear survey of 5,853 students from 4 Jordanian universities. We measured WTS, sociodemographic data, and the LWDS-11 items. We conducted exploratory factor analysis with half of the sample and confirmed the resulting model using confirmatory factor analysis with the other half. We examined construct validity with regression models assessing associations between the modified scale and 5 constructs conceptually expected to be associated with dependence.

RESULTS

WTS rates were 35% in the past 30 days and 56% ever. Principal-components analysis of LWDS items in the first half of the sample yielded 10 items representing 3 factors labeled physical dependence, relaxation/pleasure, and social aspects. Cronbach's α was .77 for the total scale and was .75, .70, and .67 for each individual subscale. Confirmatory factor analysis in a structural equation modeling framework confirmed good fit (root mean squared error of approximation = 0.068, and comparative fit index = 0.937). Dependence according to the resulting scale (LWDS-10J) was strongly associated with each of the 5 expected constructs, whether the dependent variable was treated as categorical or continuous.

CONCLUSIONS

The LWDS-11 items exhibited a different factor structure in our sample. However, the modified scale (LWDS-10J) showed promising reliability and construct validity in this population.

Waterpipe smoking: not necessarily less hazardous than cigarette smoking : Possible consequences for (cardiovascular) disease

Context

Cigarette smoking has declined over the last years in modern countries. On the contrary, waterpipe smoking has increased, especially among young people visiting waterpipe bars. Unfortunately, most waterpipe smokers seem to know little about the possible cardiovascular and other health consequences of waterpipe smoking.

Objective

To describe by narrative literature review the known adverse consequences for the human body caused by smoking the waterpipe compared with the consequences of smoking normal cigarettes. Also, to get a picture of public awareness of these consequences as deducted from the literature and a small new survey in the Netherlands.

Results/Conclusions

Tobacco smoking is associated with serious adverse (cardiovascular) health effects, and there is no evidence that these effects are less serious if a waterpipe is used. The increasing use together with the limited amount of awareness and attention for the possible health consequences of smoking the waterpipe is worrisome. Especially considering the increasing acceptance and use of the waterpipe among the youth. Therefore we recommend more systematic research into the possible health hazards of waterpipe smoking. In the meantime education campaigns and materials are needed to raise public awareness on the possible health risks of waterpipe use.

Water-pipe smoking and albuminuria: new dog with old tricks

Water-pipe (WP) smoking is on rise worldwide for the past few years, particularly among younger individuals. Growing evidence indicates that WP smoking is as harmful as cigarette smoking. To date, most of the research has focused on acute health effects of WP smoking, and evidence remains limited when it comes to chronic health effects in relation to long-term WP smoking. Therefore, the aim of this study was to examine the association between WP smoking and albuminuria in apparently healthy individuals. This analysis was conducted on data of a population-based cross-sectional study—the Urban Rural Chronic Diseases Study (URCDS). The study sample was recruited from three sites in Pakistan. Trained nurses carried out individual interviews and obtained the information on demographics, lifestyle factors, and past and current medical history. Measurements of complete blood count, lipid profile, fasting glucose level, and 24-hour albuminuria were also made by using blood and urine samples. Albumin excretion was classified into three categories using standard cut-offs: normal excretion, high-normal excretion and microalbuminuria. Multiple logistic regression models were used to examine the relationship between WP smoking and albuminuria. The final analysis included data from 1,626 health individuals, of which 829 (51.0%) were males and 797 (49.0%) females. Of 1,626 individuals, 267 (16.4%) were current WP smokers and 1,359 (83.6%) were non-WP smokers. WP smoking was significantly associated with high-normal albuminuria (OR  =  2.33, 95% CI 1.68-3.22, p-value <0.001) and microalbuminuria (OR  =  1.75, 95% CI 1.18-2.58, p-value 0.005) after adjustment for age, sex, BMI, social class, hypertension, and diabetes mellitus. WP smoking was significantly associated with high-normal albuminuria and microalbuminuria when analysis was stratified on hypertension and diabetes mellitus categories. WP smoking has a strong association with albuminuria in apparently healthy individuals. More research is warranted to evaluate the temporality of this association between WP smoking and albuminuria.

Waterpipe smoking among middle and high school Jordanian students: patterns and predictors

Despite the increase in attention to waterpipe tobacco smoking, the patterns and predictors of this method of tobacco use among Jordanian youth are not well known. The current study was conducted to assess the patterns and the predictors of waterpipe tobacco smoking among school aged students in one of Jordan's Central Governorates. A cross-sectional survey was conducted to investigate the patterns and predictors of waterpipe tobacco smoking among youth (grades 6, 8, 10 and 12). Using a multistage random sampling more than 1,000 students was selected. Data were collected using the Arabic Youth Tobacco Use Composite Measure (YTUCM). Waterpipe smoking was assessed for "past 12 months", "past month" and "past week". Students' ages ranged from 11 to 18 years, (mean age ± 14.7; SD ± 1.9 years). The percentage of girls who smoked waterpipe was greater for all frequencies of use than it was for boys. Age, gender, and belief that smoking makes more friends were predictors of smoking among study participants. This is the first known study to examine waterpipe smoking among youth aged 11 and 12. Our findings illustrate the need for public health campaigns to reach and educate youth, their families, teachers and school systems regarding the growing recognized health risks of waterpipe smoking.

A comprehensive examination of hookah smoking in college students: use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use

The practice of waterpipe smoking (hookah) has rapidly increased in popularity among young adults yet burgeoning research suggests that its use is associated with nicotine dependence and other negative smoking-related health consequences. Moreover, descriptive studies indicate that consumers may hold the belief that hookah smoking is safer than smoking cigarettes. The current study extended previous work by conducting a comprehensive assessment of patterns and contexts of hookah use, psychological correlates of use, co-occurring substance use as well as social norms and health perceptions surrounding the practice. Participants were 143 ethnically diverse undergraduate students at a large urban US university. Approximately half of the sample (48%) reported life-time use of hookah and 22% reported use within the past 30days. Relative to cigarette smoking, hookah smoking was associated with less perceived harm and addiction potential and higher social approval. Participants who reported life-time hookah use, as compared to those who did not, perceived less associated harm, had a greater number of friends who had tried and approved of hookah, were more likely to use cigarettes, marijuana, and alcohol and in higher frequencies and quantities and were at higher risk for problem tobacco and alcohol use. Among participants who were not current smokers, those with hookah experience were more likely to endorse intent to try a cigarette soon. Hookah users did not differ from non-users on measures of trait anxiety, depression and impulsivity though they were more likely to drink alcohol for coping, social and enhancement purposes than non-users. Implications are discussed for public health initiatives to educate young adults about the potential consequences of hookah smoking.

Shisha smoking and associated factors among medical students in Malaysia

BACKGROUND

The aim of the study was to determine the prevalence of shisha smoking and associated factors among medical students in Malaysia.

MATERIALS AND METHODS

A cross-sectional study was conducted at the Management and Science University from December 2011 until March 2012. The questionnaire consisted of five sections including socio-demographic, social environment, knowledge about shisha, psychosocial factors, and personal shisha smoking behavior. Obtained data were analyzed using Statistical Package for the Social Sciences (SPSS 13). T-test was used to determine the relationships between shisha smoking and socio-demographic characteristic.

RESULTS

A total number of 300 medical students participated in this study. Mean age was 22.5±2.5 years. The majority were female, Malay, single, from urban areas (67%, 54%, 97%, 73%; respectively). The prevalence of shisha smoking among medical students was found to be 20%. The study revealed that many students believed that shisha does not contains nicotine, carbon monoxide, does not lead to lung cancer, dental problems and does not lead to cardiovascular diseases (25%, 20.7%, 22.3%, 29%, 26.7%; respectively). Age and sex were found to be significantly associated with smoking shisha status among medical students (p=0.029, p<0.001; respectively). Furthermore, having parents, siblings and friends smokers of shisha were found to be significantly associated with shisha smoking status (p<0.001, p<0.001, p<0.001; respectively). Furthermore, family problems, problems with friends, financial problems and university life were found to significantly associated with shisha smoking status among medical students (p<0.001, p=0.002, p<0.001, p=0.002; respectively).

CONCLUSIONS

There is a high prevalence of shisha smoking and a poor knowledge about its impact on health among medical students. More attention is needed to focus on medical education in this regard. The policies that are currently employed in order to reduce the cigarettes smoking should be applied to shisha smoking and shisha products.

Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking

BACKGROUND

Smoking tobacco preparations in a water pipe (hookah) is widespread in many places of the world and is perceived by many as relatively safe. We investigated biomarkers of toxicant exposure with water pipe compared with cigarette smoking.

METHODS

We conducted a crossover study to assess daily nicotine and carcinogen exposure with water pipe and cigarette smoking in 13 people who were experienced in using both products.

RESULTS

When smoking an average of 3 water pipe sessions compared with smoking 11 cigarettes per day (cpd), water pipe use was associated with a significantly lower intake of nicotine, greater exposure to carbon monoxide (CO), and a different pattern of carcinogen exposure compared with cigarette smoking, with greater exposure to benzene, and high molecular weight polycyclic aromatic hydrocarbon (PAH), but less exposure to tobacco-specific nitrosamines, 1,3-butadiene, acrolein, acrylonitrile, propylene oxide, ethylene oxide, and low molecular weight PAHs.

CONCLUSIONS

A different pattern of carcinogen exposure might result in a different cancer risk profile between cigarette and water pipe smoking. Of particular concern is the risk of leukemia related to high levels of benzene exposure with water pipe use.

IMPACT

Smoking tobacco in water pipes has gained popularity in the United States and around the world. Many believe that water pipe smoking is not addictive and less harmful than cigarette smoking. We provide data on toxicant exposure that will help guide regulation and public education regarding water pipe health risk.

Social context of smoking hookah among college students: scale development and validation

OBJECTIVE

To develop an instrument that measures the social context of hookah use among college students.

PARTICIPANTS

A pool of 50 potential items, based on 44 in-depth interviews with regular college hookah smokers, was administered to a sample of 274 hookah users between October and December 2011.

METHODS

Participants were approached in hookah bars and asked to complete the survey.

RESULTS

A principle components analysis revealed 3 reliable factors: social facilitation, family/cultural influence, and alternative to smoking cigarettes and drinking. These were examined across different categories of hookah use: Weekly hookah users were more likely to smoke in a context of social facilitation than the other 2 groups. Similar effects were observed for family/cultural influence. Asians were more likely to smoke in a context of family and cultural influence than non-Asians.

CONCLUSIONS

This scale has potential for identifying situation-specific contexts of hookah use that may help in designing effective interventions for college students.

Dependence on tobacco and nicotine products: a case for product-specific assessment

The International Classification of Diseases and the Diagnostic and Statistical Manual for diagnosing tobacco/nicotine dependence emphasize the dependence-producing drug nicotine. These diagnostic tools have been challenged on grounds of poor predictive validity, and they do not differentiate across various forms of nicotine-containing products. In fact, nicotine-containing products (e.g., tobacco cigarettes, smokeless tobacco [ST], waterpipe, electronic cigarettes [ECIGs], and nicotine replacement [NR] products) have very different characteristics both in terms of sensory and behavioral involvement and also in pharmacokinetic and pharmacodynamic effects. For example, a cigarette and a nicotine patch are very different on almost every one of these dimensions. When ability to stop using a nicotine/tobacco product is used as a criterion for dependence, success rates vary considerably across products: Tobacco cigarette cessation is more difficult than ST cessation that in turn is more difficult than NR product cessation. Based on these results, we hypothesize that there is a continuum of dependence as much as there is a continuum of harm, with tobacco cigarettes and NR products on opposite ends of both continua and other products (waterpipe and ECIGs) somewhere in between. In order to capture more precisely the dependence produced by both nicotine and its administration forms, product-specific instruments may be required. The pros and cons of this approach are discussed.

Water-pipe smoking and metabolic syndrome: a population-based study

Water-pipe (WP) smoking has significantly increased in the last decade worldwide. Compelling evidence suggests that the toxicants in WP smoke are similar to that of cigarette smoke. The WP smoking in a single session could have acute harmful health effects even worse than cigarette smoking. However, there is no evidence as such on long term WP smoking and its impact on chronic health conditions particularly cardiovascular and metabolic conditions. Therefore, we conducted this study to investigate the relationship between WP smoking and metabolic syndrome (MetS). This was a cross-sectional study carried out in Punjab province of Pakistan using the baseline data of a population-based study – Urban Rural Chronic Diseases Study (URCDS). Information was collected by trained nurses regarding the socio-demographic profile, lifestyle factors including WP smoking, current and past illnesses. A blood sample was obtained for measurement of complete blood count, lipid profile and fasting glucose level. MetS was ascertained by using the International Diabetic Federation’s criteria. We carried out multiple logistic regressions to investigate the association between WP smoking and MetS. Final sample included 2,032 individuals – of those 325 (16.0%) were current WP smokers. Age adjusted-prevalence of MetS was significantly higher among current WP smokers (33.1%) compared with non-smokers (14.8%). Water-pipe smokers were three times more likely to have MetS (OR 3.21, 95% CI 2.38–4.33) compared with non-smokers after adjustment for age, sex and social class. WP smokers were significantly more likely to have hypertriglyceridemia (OR 1.63, 95% CI 1.25–2.10), hyperglycaemia (OR 1.82, 95% CI 1.37–2.41), Hypertension (OR 1.95, 95% CI 1.51–2.51) and abdominal obesity (OR 1.93, 95% CI 1.52–2.45). However, there were no significant differences in HDL level between WP smokers and non-smokers. This study suggests that WP smoking has a significant positive (harmful) relationship with MetS and its components.

The detrimental danger of Water-Pipe (Hookah) transcends the hazardous consequences of general health to the driving behavior

OBJECTIVE

To determine whether the consumption of tobacco used in Water-Pipe by drivers increases the risk of a motor vehicle collision as a consequence of hypoxia.

DESIGN

Analytical case-control study.

DATA SOURCES

Seventy exclusive Water-Pipe smokers (Experimental Group--EG)--mean age ± SD: 29.47 ± 10.45 years; mean number of weekly WPS, (6.9 ± 3.7); mean duration of WPS (WPS) is (7.5 ± 2.1 years)--and thirty non-smoker (Control Group--CG; mean age ± SD: 36.33 ± 13.92 years) were recruited during 2011 from two Arab villages located in the Galilee, northern Israel.

METHODS

We performed a case-control study exclusively among Water-Pipe smokers with an appropriate non smokers control group. Demographic questionnaire, Pulse Oxymeter for blood oxygenation measure and a driver simulator for measuring various participants driving behaviors were utilized. Statistical analysis for analyzing the different variables, Pearson's x2 analysis for the comparison of categorical variables, continuous variable is compared using Student's t-test and for testing the correlation between the different variables and bivariate correlation analysis were applied.

RESULTS

In the (EG) following WPS, we observed increase in the pulse rate--from 80 to 95 (t = 11.84, p < 0.05) and decrease in saturation level from 97.9 to 97.32, the decrease is statistically significant (t = 3.01, p < 0.05) versus no change in (CG). An increased number of accidents among EG (OR is 1.333 with CI of 1.008-1.776), while in CG, an insignificantly decrease (t = 3.08, p < 0.05). In EG an increase in centerline crossings (OR is 1.306 with CI of 1.016-1.679), also the total time not being within the lane was increased and the estimated (OR: 1.329; CI: 1.025-1.722). WPS increases the number of accidents by 33% and Hypoxia can cause driving behavioral turbulences.

CONCLUSION

The results show that WPS has a significant impact on driving behavior and on the risk of being involved in road accidents and causing driving to become riskier and less careful and stable. To the best of our knowledge, this is the first time such relationships have been tested. After WPS the total number of traffic accidents and driving violations increase. The results show a significant increase in the pulse rate immediately after WPS with a decrease in the saturation rate (the level of blood oxygenation); these changes continue half an hour after WPS.

Waterpipe tobacco and cigarette smoking among university students in Jordan

SETTING

While waterpipe and cigarette smoking have been well studied in Syria and Lebanon, data from Jordan are limited.

OBJECTIVES

To characterize the relative prevalence of waterpipe tobacco and cigarette smoking among university students in Jordan, and to compare the demographic and environmental factors associated with each form of tobacco use.

DESIGN

We surveyed 1845 students randomly recruited from four universities in Jordan. We used multivariable logistic regression controlling for clustering of individuals within universities to determine associations between demographic and environmental covariates and waterpipe tobacco and cigarette use.

RESULTS

Waterpipe tobacco smoking rates were 30% in the past 30 days and 56% ever, while cigarette smoking rates were 29% in the past 30 days and 57% ever. Past 30-day waterpipe tobacco smoking rates were 59% for males and 13% for females. Females had substantially lower odds than males of being current waterpipe (OR 0.12, 95%CI 0.10-0.15) or cigarette (OR 0.08, 95%CI 0.05-0.14) smokers. Current cigarette smoking was more significantly associated with markers of high socio-economic status (SES) than waterpipe tobacco smoking.

CONCLUSION

Waterpipe tobacco smoking is as common as cigarette smoking among Jordanian university students. While cigarette smoking is consistently associated with high SES, waterpipe tobacco smoking is more evenly distributed across various populations.

Hookah use: going down in smoke

This article provides a review of tobacco smoking using a hookah, an emerging threat to public health, especially among young adults. Knowledge deficits persist in regards to this form of smoking, because many perceive it as less harmful than cigarette smoking and little research is available. Knowledge about hookah smoking can be instrumental in guiding health professionals to address this practice with their clients and in their communities. A failure to address all tobacco products as unique, individual entities undermines any success in public policy efforts to control tobacco use.

Water pipe smoking among the young: the rebirth of an old tradition

This article provides information on the growing threat of water pipe smoking (hookah) around the world and in the United States. Historically an activity of Middle Eastern older adults, the most recent growth in water pipe smoking (WPS) has been among adolescents and young adults. Associated with its use is a growing list of health problems. To date no interventions have been specifically designed for this form of tobacco use and they are sorely needed. Nurses must continue to teach No Tobacco Use in any form and that means no water pipe smoking must be part of every health message.

Assessment of tobacco dependence in waterpipe smokers in Egypt

SETTING

Waterpipe smoking is increasing worldwide. Nevertheless, little is known about nicotine dependence in tobacco smokers who use waterpipes.

OBJECTIVE

To assess evidence of dependence among non-cigarette smoking waterpipe smokers in Egypt.

METHODS

A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We adapted the Fagerström test for nicotine dependence and the Reasons for Smoking (RFS) scales and related these to smoking behavior.

RESULTS

The mean age of the subjects was 47 ± 14 years, the mean age at smoking initiation was 22 ± 9 years, and average daily consumption was 4 ± 8 hagars (tobacco units). The time to the first smoke of the day (P < 0.001), smoking even when ill (P = 0.003), time to tobacco craving (P < 0.001), and hating to give up the first smoke of the day (P = 0.033) were each significantly associated with the number of hagars smoked per day. The RFS subscales of addictive smoking, smoking to relieve negative affect, and smoking for stimulation were also associated with these variables.

CONCLUSION

The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.