Narghile Smoking Research Articles

Maternal Smoking: Determinants and Associated Morbidity in Two Areas in Lebanon

This study assessed the factors related to smoking during pregnancy in two areas in Lebanon, and the association of smoking to selected maternal and newborn health related factors. This was a secondary analysis of data on 538 women who delivered in nine hospitals in two areas in Lebanon. Women were interviewed about their smoking practices, and on demographic and psychosocial variables. 396 women were followed up and re-interviewed about their smoking status, and the mother's and baby's health after delivery. Smoking during pregnancy included both cigarettes and narghile smoking. About 25.7% of women were smoking some kind of tobacco during pregnancy. Older women, Muslim women, women with poor education, those who had financial difficulty, nervousness, lower support, and delay in seeking prenatal care were more likely to smoke during pregnancy. Women who smoked during pregnancy were more likely to have a low birth weight baby and to stop breastfeeding. It is important to address smoking among women in general, and not only during pregnancy. We discuss the role of public and private sectors in smoking cessation and interventions.

Exposure of pre-school children to passive cigarette and narghile smoke in Beirut

Narghile is a resurging smoking device. However, little research has been done to assess passive smoking exposure. The objective of the present study is to evaluate the exposure of pre-school age children in Beirut to parental passive smoking from cigarette and/or narghile. Data were collected from 1057 pre-school age children attending 16 day cares and 7 nursery schools in the city of Beirut. The overall prevalence of parental smoking (cigarette and/or narghile) was 53.3%. Ten per cent of respondents reported smoking only narghile. Fathers were significantly more likely than mothers to smoke cigarettes. However, there was no significant difference between fathers and mothers with respect to smoking narghile only. Education was a significant predictor for smoking cigarettes but not for smoking narghile. Narghile smoking appears to follow different gender and social patterns than cigarette smoking. Further research is needed to establish the determinants of narghile smoking, in order to develop adequate prevention policies.

Hubble Bubble Equals Trouble: The Hazards of Water Pipe Smoking

A Narghile, one of the names for a water pipe, is an instrument for tobacco smoking that has became a trend among the youth in Israel. The mistaken opinion that smoking a Narghile is not as dangerous as smoking cigarettes makes the youngsters and their parents take it lightly and contributes to the expansion of its use. The objective of this paper was to review the literature on the health risks of Narghile smoking. A literature search of Medline (PubMed) and the Internet on the health hazards of Narghile smoking was conducted. The health hazards that the Narghile smoker is exposed to include interference with oxidation, damage to genetic compounds, increased risk of developing malignancies, infectious diseases, damage to the fetus and newborn, and exposure to commonly abused chemicals. It is concluded that increased awareness of the expanded use of the Narghile is imperative and education programs about the prevention of cigarette smoking and substance abuse should also include Narghile smoking.

Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior

Narghile, or water-pipe smoking (WPS), has been practiced extensively for approximately 400 years. It is common in the Arabian Peninsula, Turkey, India, Pakistan, and other countries. In recent years, there has been a revival of WPS, notably among youth. Most US health professionals are unfamiliar with the practice and health consequences of WPS. Therefore, this trend presents a new challenge for adolescent health care providers. The composition of the tobacco used in WPS is variable and not well standardized. Studies that have examined narghile smokers and the aerosol of narghile smoke have reported high concentrations of carbon monoxide, nicotine, "tar," and heavy metals. These concentrations were as high or higher than those among cigarette smokers. The few scientific data regarding the adverse health consequences of WPS point to dangers that are similar to those associated with cigarette smoking: malignancy, impaired pulmonary function, low birth weight, and others. Additional dangers not encountered with cigarette smoking are infectious diseases resulting from pipe sharing and the frequent addition of alcohol or psychoactive drugs to the tobacco. Public health strategies for controlling the emerging epidemic of WPS include carrying out epidemiologic and toxicologic research; implementation of laws to limit acquisition and use; and health education, targeting adolescents in particular.

Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe

A smoking machine protocol and yields for “tar”, nicotine, PAH, and CO are presented for the standard 171-puff steady periodic smoking regimen proposed by Shihadeh et al. [Shihadeh, A., Azar, S., Antonios, C., Haddad, A., 2004b. Towards a topographical model of narghile water-pipe café smoking: A pilot study in a high socioeconomic status neighborhood of Beirut, Lebanon. Pharmacology Biochemistry and Behavior 79(1), 75]. Results show that smokers are likely exposed to more “tar” and nicotine than previously thought, and that pyronsynthesized PAH are present in the “tar” despite the low temperatures characteristic of the tobacco in narghile smoking. With a smoking regimen consisting of 171 puffs each of 0.53 l volume and 2.6 s duration with a 17 s interpuff interval, the following results were obtained for a single smoking session of 10 g of mo’assel tobacco paste with 1.5 quick-lighting charcoal disks applied to the narghile head: 2.94 mg nicotine, 802 mg “tar”, 145 mg CO, and relative to the smoke of a single cigarette, greater quantities of chrysene, phenanthrene, and fluoranthene. Anthracene and pyrene were also identified but not quantified. The results indicate that narghile smoke likely contains an abundance of several of the chemicals thought to be causal factors in the elevated incidence of cancer, cardiovascular disease and addiction in cigarette smokers.

Are waterpipe users interested in quitting?

Waterpipe smoking has increased dramatically worldwide in recent years, with an estimated 100 million daily users. Research on this traditional Middle Eastern tobacco use method is in its infancy, and little is known about users' cessation-related attitudes and experiences. A random sample of 268 narghile (waterpipe) smokers (40% female; mean age = 30 years; range = 18-68) was obtained from cafes and restaurants in Aleppo, Syria. The majority of users (86.5%) believed they could quit using waterpipes at any time, but that belief was inversely related to perceived dependence, with only 48.7% of those who thought they were "very hooked" believing they could quit. Interest in quitting was expressed by 28.4% of subjects, with the majority (89.2%) reporting health concerns as a primary reason, and 59.2% having made an unsuccessful quit attempt in the past year. In a logistic regression model, independent predictors of interest in quitting included being married, having smoked for fewer years, not increasing the frequency of smoking over time, and having family members who do not smoke a waterpipe and disapprove of its use. Results indicate that a sizable percentage of waterpipe users express interest in quitting and have tried unsuccessfully in the past to quit. Waterpipe use needs to be considered in developing effective tobacco use cessation programs in the Middle East.

A portable, low-resistance puff topography instrument for pulsating, high-flow smoking devices

A smoking topography instrument appropriate for pulsating high flow rate smoking devices, such as the narghile water pipe, has been developed and tested. Instrument precision and repeatability was determined using a digitally controlled smoking machine, and the added draw resistance due to the topography instrument was measured over the range of expected puff flow rates. The maximum error in any topography variable was found to be less than 5%. The instrument was successfully demonstrated in a pilot field study of 30 volunteer narghile smokers. The pilot study yielded an average smoker puff volume, duration, and interpuff interval of 0.531, 2.47 sec, 16.28 sec, respectively.

Otoscopic appearances and tympanometric changes in narghile smokers

Narghile (water-pipe) smoking requires the generation of significant negative intrapharyngeal pressure, which may be transmitted to the middle ear through the Eustachian tube. A total of 80 ears from regular narghile smokers were examined otoscopically and by tympanometry. Seventy ears from heavy cigarette smokers were similarly examined and served as a control group. There was a highly significant increase in the prevalence of attic retractions (P < 0.01) in the narghile smokers. The tympanometric changes were not significantly different between the two groups (P > 0.05).

Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria.

To assess the beliefs and attitudes related to narghile (waterpipe) smoking that are likely to contribute to its increased popularity among young people in Syria. In 2003, a cross-sectional survey was administered to university students in Aleppo, using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 +/- 2.1; response rate 98.8%). The most common positive perceptions of narghile were related to its smell and taste. Negative perceptions of narghile included the smoke produced, the pollution, and perceived adverse health effects. Students believed the popularity of narghile to be part of a rising regional trend in its use, due to its being an appealing way to spend leisure time socializing with friends. More students (49.7%) believed narghile to be more harmful to health than cigarettes, compared with 30% who believed the opposite. Respiratory disease was the most commonly cited health effect of narghile smoking. Family attitudes regarding tobacco use by younger members were more permissive about narghile compared with cigarettes, and, surprisingly, were more permissive about females smoking narghile than males doing so. The rise in narghile smoking as a trendy social habit appears to be occurring despite considerable appreciation of its potential health risks. Permissiveness of adult family members towards narghile use by young female members, especially in the presence of a strong taboo against female cigarette smoking may contribute to the continuous spread of narghile smoking among women in Syria.

Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users

Aims: To evaluate factors related to level of narghile (waterpipe) use as a first step towards modeling tobacco dependence among narghile users. Design: Cross sectional survey done in 2003 using interviewer-administered anonymous questionnaires. Setting: Cafes/restaurants serving narghiles in Aleppo, Syria. Participants: Narghile smokers (161 men and 107 women; mean age, 30.1 ± 10.2, 161; age range, 18–68 years; response rate, 95.3%) randomly selected from the 17 cafes/restaurants sampled. Measurements: Frequency of narghile use (daily, weekly, monthly) was assessed as a function of several factors potentially indicative of dependence, including situational characteristics (where, when, and with whom smoking occurs; seasonality of use, and sharing of narghile), attitudes, and experience with quitting narghile use, escalation of use over time, future intentions regarding use, perception of being “hooked” on narghile, and cognitions/behaviors engaged in to support use (carrying one’s own narghile; think of narghile when it is not available; considering narghile for selection of cafes/restaurants). Findings: Frequency of narghile use was strongly correlated with participant’s subjective judgment of how hooked they are on narghile (coefficient, 0.5). Predictors of narghile use frequency according to multinomial logistic regression were: male gender, smoking mainly alone versus with others; smoking mainly at home versus outside; smoking more frequently since initiation, being hooked on narghile, carrying narghile, and considering it for cafe/restaurant choice. Conclusions: Our data reveal two main domains of a tobacco dependence syndrome likely to be relevant to narghile; the first reflects the effects of nicotine contained in narghile tobacco, and is not very different from what is seen with other tobacco products, and the second is unique to narghile and is related mainly to its social dimension, with more intensive smokers showing an increasingly individual pattern of narghile smoking.

Characteristics of cigarette smoking and quitting among university students in Syria

Background. No study to date in Syria has documented the smoking and quitting characteristics in a representative sample of university students, and this study aims to fill this void. Design. In 2003, a cross-sectional survey was carried out among students at Aleppo University using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 ± 2.1 years; response rate, 98.8%). Experiences and attitudes related to smoking and quitting were assessed for two popular forms of tobacco use in Syria-cigarettes and narghile (waterpipe). Results. Current cigarette smoking was reported by 30.9% of male and 7.4% of female students and daily smoking by 24.8% of male and 5.2% of female students. Narghile smoking was seen among 25.5% of men and 4.9% of women, mostly on an occasional basis. More than half of current smokers (56%) believed they could quit cigarettes, 75.2% were interested in quitting, and 78% of those had made a quit attempt in the past year. Important correlates of cigarette smoking among students were being older, male, and smoking narghile, while being older and from a poorer family were associated with increased interest in quitting. Interestingly, peers' smoking was associated with current smoking among students, but inversely with their willingness to quit. Conclusions. Cigarette smoking is mainly a problem of male students, whose narghile smoking is likely to be dramatically increasing as well, sometimes practiced as a substitute for cigarettes. The findings that most smokers in this sample are interested in quitting smoking and have tried unsuccessfully to do so indicate that cessation support for youths in this country is urgently needed.

Gender and smoking status-based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria

Background. Narghile (waterpipe) smoking is increasing across the Eastern Mediterranean region (EMR), though little is known about the social attitudes and perceptions related to this method of tobacco use, and how those attitudes and perceptions are influenced by gender. Methods. Data from two cross-sectional surveys conducted in 2003 in Aleppo, Syria, were used to examine these issues. Overall, 855 participants were included (439 men, 416 women; mean age, 24.4±7.1 years; response rate, 97%). The current analysis focuses on responses to four similar nine-item questions tapping perceptions related to narghile smoking by women or men, and cigarette smoking by women or men. Scores on the nine items were summed to yield a total score to gauge participants' perceptions about narghile and cigarette. Results. Generally, participants were less positive about women smoking relative to men smoking, and cigarette smoking relative to narghile smoking. Cigarette smoking by women was the behavior least associated with positive perceptions. Individuals who resided in the city, were economically better-off, and were Christian, had higher perception scores (i.e., more positive attitudes) toward all forms of smoking, whereas older and married participants had higher perception scores for narghile only. Smoking status of participants, especially narghile smoking, was also associated with more positive perceptions toward smoking in general. Conclusions. We conclude that preliminary analysis shows that views on different forms of smoking in Syria differ by gender and smoking status.

Tobacco use by university students, Lebanon, 2001.

The objective was to determine the prevalence of smoking [cigarettes and/or narghile (i.e. water-pipe)] among university students and to examine multiple correlates. Cross-sectional. Beirut, Lebanon. A proportionate random sample of 1964 students from public and private universities in Beirut, Lebanon. Participants completed a self-administered anonymous questionnaire that included demographic and scholastic items and health behavioral aspects, including smoking, alcohol, physical activity, weight control measures and seat belt use. The overall prevalence of smoking was 40% (21.1%, 7.6% and 11.3% of the students were smoking only narghile, only cigarettes and both cigarettes and narghile, respectively). Regression analyses showed that males, those of non-Lebanese origin, pursuing undergraduate degrees, performing risky weight control measures and drinking excessive amounts of alcohol had increased odds of smoking cigarettes. Also, age, high level of paternal education and field of study were significant predictors. Narghile smoking was significantly higher among males who drank excessive alcohol. The authors advocate a collaborative effort to alleviate the consequences of smoking among university students.

Exposure of Children to Environmental Tobacco Smoke (ETS) and Its Association with Respiratory Ailments

Objectives. To assess the impact of domestic passive smoking (cigarettes or narghile) on the development of respiratory ailments among children ages 10–15 years. Methods. Students were recruited from five private schools in Beirut, and information on demographic, in-home smoking, and students' respiratory tract illnesses (cough, wheezing, runny nose, or nasal congestion) were collected from each participant. Results. Of 625 students surveyed, 438 (70.1%) had at least one individual smoking at home. Compared with the nonexposed group, the odds ratio of having respiratory illness for children exposed to narghile or cigarette smoke were 2.3 (95% Confidence Iinterval [CI] 1.1–5.1) and 3.2 (95% CI 1.9–5.4), respectively. Conclusions. In addition to the well-established effect of smoking, domestic passive smoking of the misconceived “innocuous” habitual smoking device, narghile, is associated with significant respiratory health ailments.

"Vous devriez venir le matin, il y a des gens biens, des sportifs !" Quand le sport habille les sociabilités publiques à Beyrouth

This study of the sea-front Corniche at Beirut analyses the multiplicity of activities undertaken along this area which is visited by a wide range of people. Sporting activities dominate. Every day, at all hours, joggers, families picnicing, narghile smokers, women in veils or in shorts and solitary strollers pass, avoid or observe each other, creating new forms of contact, of self- expression and of social recognition. Currently new areas specifically reserved for sports are developing. Confined within a limited permimetre, these areas result from private initiatives and the commercialisation of sporting activities. In the context of the continued growth of privatised and specialised sporting and recreational areas, will urban sporting activities still enable integration (in all its different forms) into an urban society increasingly threatened by different forms of segregation ?

Study of narghile smoking in relation to cancer of the lung.

Study of narghile smoking in relation to cancer of the lung.