Waterpipe Smoking Research Articles

Risk of Tobacco Smoking and Consumption of Energy Drinks on Obesity and Central Obesity Among Male University Students

BackgroundObesity is one of the leading causes of morbidity and premature death. The prevalence of obesity and being overweight in young adulthood is increasing exponentially globally, including Palestine. Consumption of energy drinks (EDs) and tobacco smoking are highly prevalent among Palestinian young adults. Although different studies have demonstrated that the use of caffeine and tobacco products is highly prevalent among Palestinians, especially university students, the adverse effects of these products on obesity have not been thoroughly investigated.MethodologyMale students from An-Najah National University in the West Bank were recruited to fill out a self-administrated questionnaire in this cross-sectional study conducted in 2021. Obesity was measured as total adiposity by calculating body mass index (BMI) and as central obesity by measuring waist circumference. To determine the association between obesity and ED consumption and tobacco smoking, we used adjusted multiple logistic regression models. Shapiro-Wilk’s test was used to assess the normality of the data.ResultsA total of 396 students filled the questionnaire, with a response rate of 89.4%. The prevalence of obesity and central obesity was 42% and 35.75%, respectively. The prevalence of ED consumption, cigarette smoking, and waterpipe smoking was 59.6%, 39.6%, and 43.2%, respectively. ED consumers were more likely to be cigarette smokers (odds ratio (OR) = 3.827, P < 0.001), waterpipe smokers (OR = 4.578, P < 0.001), and chocolate consumers (OR = 3.524, P = 0.001). Central obesity was associated with waterpipe smoking (OR = 2.126, P = 0.044), increased age (OR = 1.367, P = 0.001), and increased BMI (OR = 1.927, P < 0.001). On the other hand, cigarette smokingincreased the risk of being underweight (OR = 6.255, P = 0.012), and ED consumption decreased the risk of being obese (OR = 0.183, P = 0.017).ConclusionsWaterpipe smoking was a risk factor for increased central obesity, and ED consumption was associated with decreased; however, smoking was associated with the underweight BMI category. Given the undesirable health consequences of consuming the closely associated tobacco and EDs, stricter measures are needed to prevent access to these products.

Factors associated with the onset of smoking and alcohol consumption: A cross-sectional study among Lebanese adolescents in schools

ObjectivesThis study aimed to evaluate factors and profiles associated with the earlier onset of cigarette/waterpipe smoking and alcohol consumption among Lebanese adolescents in schools. MethodsA total of 4000 adolescents (mean age = 15.31 ± 2.01 years) participated in this cross-sectional study. The standardized questionnaire was taken from the Health Behavior in School Children (HBSC) study in different countries (France, Belgium, and the USA) and adjusted to the Lebanese population. K-means clustering analysis was conducted to classify participants into three clusters according to their patterns (surrounded by smokers, surrounded by drinkers, and ease of talking to family members and friends) and Cox regression analyzes were conducted. ResultsParticipants were divided into three clusters. Cluster 1 (16.75% of participants) included adolescents with the lowest ease of talking to a family member or friend, with the latter smoking and drinking a lot (worst cluster). Cluster 2 (54.95%) included adolescents with moderate ease of talking to a family member and more to friends, surrounded by low-to-moderate smoking and alcohol consumption, particularly for a best friend (positive influence cluster). Finally, cluster 3 (28.30%) included adolescents with low ease of talking to friends, moderate ease of talking to a family member, and low-to-moderate smoking and alcohol consumption (low influence cluster). The results of the Cox regressions (taking the age at onset of smoking cigarettes and waterpipes as the dependent variables) showed that older age at onset of cigarette and waterpipe smoking was significantly associated with female participants and those belonging to clusters 2 and 3 compared to cluster 1. Moreover, a younger age at first alcohol use and getting drunk was significantly associated with living outside Beirut, whereas female gender and belonging to clusters 2 or 3 compared to cluster 1 were significantly associated with older age at first alcohol use and getting drunk. ConclusionThis study identified risk factors (ease of talking as well as smoking and alcohol-drinking status of parents, siblings, and friends) and profiles related to early alcohol and cigarette/waterpipe use. These risk factors and profiles could help implement prevention campaigns to reduce substance use and improve adolescent health.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): The case for Tunisia.

INTRODUCTIONThe World Health Organization (WHO) had launched the Framework convention on Tobacco Control (FCTC) in 2003 in order to curve the epidemic of tobacco use worldwide. Since most smokers begin to smoke before the age of 18 years, Global Youth Tobacco Survey (GYTS) has been developed in order to monitor tobacco smoking among adolescents. Our aim was to assess smoking among Tunisian youth using GYTS 2017 data.METHODSGYTS is cross-sectional, two cluster school-based survey to produce a representative sample of students aged 13–15 years. It was conducted in 2017 in 67 secondary schools in Tunisia. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics.RESULTSLifetime cigarettes and waterpipe prevalence were 7.8% (14.4% of boys, 1.6% of girls, p<0.001) and 7.2% (13% of boys, 2.8% of girls, p<0.001), respectively. Among cigarette smokers, 62.5% were able to buy their own cigarettes. Overall, 23.5% of cigarette smokers and 41.5% of waterpipe smokers were not able to buy their products because of their age. Sixty percent of smokers wanted to quit and 56.4% had already tried to stop. Half of the respondents were exposed to SHS in their homes and 62.1% in indoor public places.CONCLUSIONSIn Tunisia, tobacco prevalence among youth is high. Youth have free access to tobacco products and smoke-free regulations are only partially respected.

Association between waterpipe smoking and obesity: Population-based study in Qatar.

INTRODUCTIONOver the past decade obesity prevalence has been increasing rapidly in the Gulf region (GR) including Qatar, becoming one of the major health issues in the region. Concomitantly, waterpipe (WP) smoking is increasing worldwide especially in the GR, and although the effect of cigarette smoking on body weight is well-established, studies indicating an association between WP smoking and obesity are scarce. Thus, we explored the association between WP smoking and obesity in comparison with cigarette smokers and healthy population in Qatar.METHODSWe performed a cross-sectional study using data from Qatar Biobank and analyzed anthropometric measurements among 879 adults (aged 18–65 years) that included WP smokers, cigarette smokers, dual smokers and never smokers. Body composition was measured using bioelectrical impedance analysis and reported as lean mass, fat mass, and body fat percentage.RESULTSOverall, 12% (n=108) were WP smokers, 22% (n=196) were cigarette smokers, 9% (n=77) smoked both WP and cigarettes and 57% (n=498) were never smokers. Age, sex, history of diabetes, and hypertension, in addition to nationality were considered as confounding factors. Our analysis revealed that WP smokers had a significantly higher BMI (kg/m2) and fat mass when compared with cigarette smokers (p<0.05). Moreover, compared to cigarette smoking, WP smoking had a higher significant effect on BMI (β=3.8, SE=0.38; and β=5.5, SE=0.46; respectively), and fat mass (β=5.1, SE=0.79; and β=9.0, SE=0.97; respectively). However, WP users were similar to never-smokers in terms of body fat percent.CONCLUSIONSOur data indicate that compared to never smokers, daily WP users have higher BMI and fat mass, and are likely to be obese.

Waterpipe tobacco smoking among university students in Turkey

IntroductionWaterpipe 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. MethodA 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. ResultsLess 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. ConclusionThis 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.

Comparative Study on the Chronic Vascular Responses Induced by Regular Versus Occasional Waterpipe Smoke Inhalation in Mice.

Waterpipe smoke (WPS) is the second most prevalent form of smoking in the world. There are ample evidences about the vascular alterations caused by regular WPS (Reg-WPS). Nonetheless, comparison of the chronic vascular response induced by regular versus occasional WPS (Occ-WPS) exposure is very scarce. We investigated, in BALB/c mice, the effects of Occ-WPS (30 minutes/day, 1 day/week) versus Reg-WPS (30 minutes/day, 5 days/week) for 6 months on thrombogenicity and platelet aggregation in vivo and in vitro. Moreover, various markers of endothelial integrity, inflammation and oxidative stress were assessed by enzyme-linked immunosorbent assay and colorimetric assay. Control mice were exposed to air. Our results showed that either Occ-WPS or Reg-WPS exposure shortened the thrombotic time in pial microvessels in vivo. Moreover, in pial venules, this effect was more marked in Reg-WPS group (-47%) compared with Occ-WPS (-34%). Similarly, exposure to either Occ-WPS or Reg-WPS reduced the prothrombin time and activated partial thromboplastin time. Platelet count was increased only in Reg-WPS exposure. Exposure to either Occ-WPS or Reg-WPS induced platelet aggregation in vitro. In addition, there was a statistically significant difference between Occ-WPS and Reg-WPS groups in platelet count and aggregation. Plasma concentration of tissue factor (+98%), P-selectin (+14%) and E-selectin (+16%) were significantly increased in Occ-WPS group compared with air exposed group. Likewise, compared with air group Reg-WPS caused an increase in concentration of tissue factor (+193%), P-selectin (+21%) and E-selectin (+42%). Nevertheless, only Reg-WPS induced a decrease (-38%) in the plasma concentration of tissue plasminogen activator. Notably, our results showed a statistically significant difference between Occ-WPS and Reg-WPS groups in the concentration of tissue factor. Erythrocyte numbers, hemoglobin concentration, hematocrit and lactate dehydrogenase activity were augmented only in Reg-WPS group compared with either control or Occ-WPS groups. Likewise, only Reg-WPS induced an increase in proinflammatory cytokines, tumor necrosis factor-α and interleukin-1β compared with either control or Occ-WPS groups. However, markers of oxidative stress including 8-isoprostane and total antioxidants were enhanced in both Occ-WPS and Reg-WPS compared with control group. Our data confirm the vascular toxicity of the chronic Reg-WPS exposure and shows that even occasional chronic exposure to WPS caused thrombosis, platelet aggregation, endothelial alterations and oxidative stress. The latter findings are an additional cause of concern about the long-term toxicity of occasional waterpipe smoking.

Waterpipe smoke-induced hypercoagulability and cardiac injury in mice: Influence of cessation of exposure

Waterpipe tobacco smoking has gained worldwide popularity, particularly among youths. Several clinical and experimental studies have reported that waterpipe smoking (WPS) injures the cardiovascular system. However, the impact of smoking cessation (CS) on the cardiovascular toxicity induced by WPS received scant attention. Hence, we assessed, in C57BL/6 mice, the cardiovascular effects of WPS exposure for 3 months followed by 3 months of SC, as compared with mice exposed for either 3 months to WPS or air (control). WPS exposure induced hypertension, prothrombotic events both in vivo and in vitro and increased the plasma concentrations of tissue factor, fibrinogen and plasminogen activator inhibitor-1. These effects were significantly alleviated by SC. In heart tissue, the levels of troponin I, creatine kinase, lipid peroxidation, 8-isoprostane, tumor necrosis factor α, inteleukin 6, DNA damage and cleaved caspase-3 were significantly increased by WPS exposure. These actions were significantly reduced in the group of mice exposed to WPS followed by SC. Similarly, the increase in the level of nuclear factor κ-β induced by WPS exposure was significantly mitigated by SC. Immunohistochemical analysis of the hearts showed that WPS exposure increased the expression of nuclear factor erythroid-derived 2-like 2 by cardiomyocytes. The latter effect was significantly reduced by SC. Taken together, our data show that SC is associated with amelioration of WPS induced hypertension, prothrombotic events and cardiac oxidative stress, inflammation, DNA damage and apoptosis.

Joint Waterpipe and Cigarette Smoking as Key Correlate of History of Depression in Iranian Population: A Cross-Sectional Study.

Research on the association between waterpipe smoking and depression is limited. This study aimed to explore the prevalence and adjusted associated correlates of depression among Iranian adult. We analyzed data from 974 participants of a population-based cross-sectional study enrolling 18-50-year-old residents of Tehran, Iran in 2015. Data on lifetime self-reported history of depression, smoking behaviors, socioeconomic status, self-rated health, physical activity, stressful life events as well as a number of relevant confounders was obtained. Logistic regression models were employed for estimating adjusted odds ratios (ORs) and their 95% confidence intervals (CI). The mean (SD) age of the study sample was 32.55 (8.58) years. Of 974 recruited adults, 52.36% were female. The lifetime prevalence of depression in the general population was 17.0%. In general, 21.77% and 24.79% of participant reported lifetime history of cigarette and waterpipe smoking, respectively. While only cigarette smoking (OR = 1.94, 95% CI: (1.04-3.61) and only waterpipe smoking (OR = 1.65, 95% CI: (.95-2.86) were significantly associated with depression, joint cigarette and waterpipe smoking (OR= 3.76, 95% CI: (1.99-6.08) was the strongest correlate of depression followed by female gender (OR = 3.28, 95% CI: (2.08-5.15) and poor self-rated health (OR = 2.47, 95% CI: (1.73-3.53). The prevalence of self-reported depression in general population of Tehran is considerably higher than its global mean. We reported joint cigarette and waterpipe smoking as a significant correlate with depression in the general population. Future health promotion interventions should highlight the disadvantages of joint cigarette and waterpipe smoking targeting adults and especially females.

The Effect of Water-Pipe and Cigarette Smoking on Exhaled Nitric Oxide

Context:Fractional exhaled nitric oxide can be used as a biomarker of some respiratory diseases.Aims:This study was conducted to compare exhaled nitric oxide in cigarette and water-pipe smokers with nonsmokers.Methods:This cross-sectional study was conducted on 549 adult subjects as a sub-study of Shahedieh cohort in Yazd. Participants were divided into 5 groups according to their smoking habits: non-smokers (n = 202), cigarette smokers (n = 121), water-pipe smokers (n = 129), cigarette ex-smokers (n = 58), water-pipe and cigarette smokers (n = 39). The smokers were also categorized into heavy and light smokers. Fractional exhaled nitric oxide was compared between the groups.Statistical Analysis Used:The data were analyzed by SPSS (ver. 20) using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests.Results:Fractional exhaled NO was lower in all smokers than nonsmokers, but cigarette smokers showed the least level of NO than other groups. Fractional exhaled NO was not significantly lower in water-pipe smokers than nonsmokers.Conclusions:Cigarette smoking significantly affect fractional exhaled NO, but water-pipe smoking did not significantly affect exhaled NO level.

Comparison of Repair Index in Cigarette and Waterpipe Smokers: A Bio-Monitoring Assessment Using Human Exfoliated Buccal Mucosa Cells.

Background:Repair index (RI) using DNA changes reveals the activity of carcinogenesis. Cigarette and waterpipe smoking are important contributors to oral cavity malignancy. The RI in cigarette and waterpipe smokers has not been compared so far. The aim of this study was to compare the RI in cigarette and waterpipe smokers using the human exfoliated buccal mucosa cells.Methods:The exfoliated buccal mucosa cells of 60 cigarette and waterpipe smokers and 20 nonsmokers were evaluated in a case-control study. The number of micronuclei (MN), broken egg (BE), karyorrhexis (KR), and karyolysis (KL) were counted in 1000 cells from randomly selected fields. The RI = (KL + KR)/(MN + BE) was calculated and compared between subjects and controls. Data were analyzed by one-way analysis of variance (ANOVA), Tukey's Honest Significant Difference (HSD), and Spearman's correlation coefficient test at P < 0.05 probability level.Results:The difference of MN (P < 0.0001), BE (P < 0.0001), KR (P < 0.0001), and KL (P < 0.0001) count was significant between cigarette smokers, waterpipe smokers, and nonsmokers. The RI was significantly different between groups (P = 0.007). The RI was significantly higher in cigarette smokers compared to waterpipe smokers (P = 0.04) and nonsmokers (P = 0.009).Conclusions:The RI was significantly higher in cigarette smokers compared to waterpipe smokers. The finding suggests that due to higher interrupted cellular hemostasis, the risk of carcinoma in waterpipe smokers can be greater than that in cigarette smokers.

Waterpipe Smoking in Pregnant Women of Zahedan City in 2020: Prevalence and Associated Factors.

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. 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. 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). 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.

The Levels of Salivary IgA and Lactoferrin and Some Salivary Parameters in Waterpipe Smokers and Cigarette Smokers

Background: Waterpipe and cigarette are two types of tobacco consumption, their smoking is associated with many adverse effects it has a detrimental effect on saliva and causes a reduction in salivary pH and flow rate in addition to their controversial effect on salivary IgA and lactoferrin. Materials and Methods: unstimulated saliva was collected from 84 subjects in the early morning between 8-10 am. Subjects were divided equally into three group’swaterpipe smokers, cigarette smokers, and non-smokers all of the participants are adult male aged between 25-60 years, Sandwich ELISA technique was used for detection and estimation the level of salivary IgA and lactoferrin. Result: IgA and Lactoferrin results showed significantly(p≤0.01), higher concentration in cigarette and waterpipe smokers group than nonsmokers Results also showed that Salivary flow rate(SFR) and pH was higher in the non-smoker’s group followed by waterpipe and cigarette smokers groups with a highly significant difference (p≤0.01), The correlation between Lactoferrin and salivary IgA also showed a significant (p≤0.01),moderate positive correlation in the cigarette group only. Conclusions:Smokingincrease Salivary IgA and lactoferrin concentrations while it reduces SFR and pH of saliva, a significant positive correlation was founded between lactoferrin and salivary IgA only in cigarette smokers

Heavy Metals in Waterpipe Smoke and the Related Health Risks - A Review

Excessive intake of heavy metals has harmful effects on health and waterpipe smoking could be one of the intake routes. Regarding the growing trend of waterpipe smoking in the world, in this study the heavy metal exposure related to waterpipe smoke and the health risks were surveyed in the published literature. Science Direct, Google Scholar and PubMed databases were searched using the keywords of heavy metals, hookah, shisheh and waterpipe. The results showed high concentrations of heavy metals in waterpipe smoke, tobacco, and charcoal. Also, high levels of heavy metals are reported in blood and toenails of the waterpipe cafes’ employees and for the smokers. The expected cancer risk for Cd, Cr, Ni, and as was higher than 1×10-6, and non-cancer risk for Cr was greater than 1. Burning of tobacco and charcoal is source of heavy metals in waterpipe smoke

Does waterpipe smoking increase the risk of Helicobacter pylori infection?

Background:In this study, we aimed to evaluate whether waterpipe smoking can be associated with the transmission of Helicobacter pylori infection or not.Materials and Methods:Between March 2018 and April 2019, 445 patients aged over 18 years old who were admitted to outpatient clinics with dyspeptic complaints were recruited for the study. Patients are divided into two groups – Group 1 is H. pylori-positive patients and Group 2 is negative. Waterpipe smoking, smoking, age, gender, and educational status were compared among groups.Results:Two hundred and sixty-one women (58%) and 184 men (42%), totally 445 patients, tested for H. pylori infection. Seventy-nine of 261 (30%) women and 60 of 184 (32%) men had H. pylori positive. One hundred and sixty-two of 445 (36%) patients were smoking cigarette and 66 of 445 (14%) patients were using waterpipe tobacco. Waterpipe smoking individuals were found to be associated with the H. pylori positivity (P < 0.001); whereas, age, gender, educational level, and smoking were not found to be statistically significant (all P > 0.05). In binary logistic regression analysis, waterpipe tobacco smoking was found to be the only independent predictor of H. pylori infection (P < 0.001, odds ratio = 5.51, confidence interval: 3.158–9.617).Conclusion:Waterpipe smoking seems to be an important risk factor for H. pylori infection and may be one of the reasons of high prevalence of H. pylori infection.

Association of cigarette and water-pipe smoking with increased visceral adiposity, glycemic intolerance and hematological derangement in Iraqi healthy smokers

The present study aims to investigate the impacts of cigarette smoking (CS) and water-pipe smoking (WPS) on the visceral adiposity index (VAI), hematological characteristics, and glycemic tolerance in Iraqi healthy smokers. A total of 528 healthy males from different locations of Baghdad city were allocated to three groups; nonsmokers (176), cigarette smokers (178), and WP smokers (174). Baseline characteristics, anthropometric and hematological markers and were reported. Glycemic control was evaluated using the glucose tolerance test. The evidence of elevated VAI, disrupted hematological markers, and impaired glucose tolerance was significantly (P<0.001) different compared with non-smokers and related to the duration of smoking. The impacts of WPS seem to be significantly greater than CS in certain parameters (hemoglobin, hematocrit, methemoglobin, and 2-hour glucose tolerance values). In conclusion, CS and WPS negatively impacted body fat distribution, glucose tolerance, and hematological markers. There is a positive association between the rate of smoking and obesity, glycemic intolerance in both groups.

Exhalation of alternative tobacco product aerosols differs from cigarette smoke-and may lead to alternative health risks.

BackgroundVariation in alternative tobacco product (ATP) constituents, heating potential, and consumer behaviors have made it difficult to characterize their health risks. To date, most toxicity studies of ATPs have used established cigarette endpoints to inform study design. Furthermore, to assess where ATPs fall on the tobacco harm continuum, with cigarettes representing maximum potential risk, studies have tended to compare the relative biological responses to ATPs against those due to cigarettes.Objectives1) To characterize the exhalation profiles of two popular ATPs: electronic cigarettes (e-cigarettes) and hookah waterpipes (hookah) and 2) to determine if ATP exhalation patterns were representative of cigarette exhalation patterns.MethodsExhalation patterns were recorded (mouth only, nose only, or both mouth and nose) among individuals observed in the New York City tri-state area using a recognizable tobacco product (cigarette, e-cigarette, or hookah). Cigarette smokers and e-cigarette vapers were observed on city streets; water-pipe smokers were observed inside Manhattan hookah bars.ResultsE-cigarette vapers practiced exclusive nasal exhalation at far higher rates than did cigarette smokers (19.5% vs 4.9%). Among vapers, e-cigarette device type was also significantly associated with exhalation profile. Overall, cigarette smokers exhaled from their nose approximately half to one-third as often as ATP users (hookah and e-cigarettes, respectively).ConclusionsNasal exhalation of tobacco emissions appears to be a shared characteristic across several types of ATPs. It is therefore plausible that ATP-specific consumer behaviors may foster unique upper respiratory health consequences that have not been observed in smokers. Thus, product-specific behaviors should inform the prioritization of biological endpoints used in studies evaluating ATP toxicity and health effects.

Micronucleus Assay of Buccal Mucosa Cells in Cigarette and Waterpipe Smokers in Duhok, Iraq

Micronucleus Assay of Buccal Mucosa Cells in Cigarette and Waterpipe Smokers in Duhok, Iraq

Investigating the transfer rate of waterpipe additives to smoke as an integral part of toxicological risk assessments

Waterpipe, also known as hookah, narghile or narghila, shisha or hubbly bubbly, is a tobacco-smoking device. Waterpipe tobacco is heated and consumed by a process of inhaling tobacco smoke, that bubbles through water before being inhaled. To date, limited studies have examined the transfer of waterpipe additives from tobacco to smoke. This study was designed to investigate the filtration ability of water in the waterpipe’s bowl to define exposure to additives in waterpipe smoke, which is an essential requirement to perform toxicological risk assessments of waterpipe additives. Within this study, a standard smoking protocol (ISO 22486) was used to evaluate the transfer of > 40 additives from experimental and commercially available samples. These results are the first to provide such an extensive dataset of information showing transfer rates varying between 6% and 61% depending on the additive. Various physicochemical parameters of the additives including water solubility, partition coefficient, molecular weight, boiling point, and vapor pressure were also evaluated to seek to identify any correlation to transfer rate that may be later used to predict transfer. The amount of additive transfer from waterpipe tobacco to the smoke was found to be moderately correlated to vapor pressure (Pearson correlation coefficient = 0.33) with subsequent multivariate analysis using step-wise selection indicating 39% of the transfer rate variance can be explained collectively by the additive boiling point, molecular weight, vapor pressure and water solubility. These findings underscore the complexity of additive transfer and highlight the necessity of exposure assessment for meaningful waterpipe additive risk assessments.

Perception and assumptions of young waterpipe smokers in Mumbai, India.

Hookah smoking has been on raise all over the world, including India, especially among youngsters. There is growing evidence suggesting the high school children experimenting this form of tobacco. The objective of this study was to investigate the characteristics, behavior, and perceptions related to hookah smoking among the hookah smokers in Mumbai. A cross-sectional survey was conducted among 200 randomly selected young adults between the age group of 15-35 years in Mumbai who visited different dental clinics. The questionnaire was distributed as Google Forms online in the month of November and December 2019 and those who submitted completed responses were included in the study. Only 114 participants returned with the completed forms in the time period of 2 months. The results showed that the majority of participants were between 20 and 24 age, comprising 58% who were having the habit of hookah smoking. Among which 24% females, 76% males had history of hookah habit. Eight percent of males started smoking hookah from very young age. Males (29.89%) shared one hookah pot with four members. Forty percent of the participants stated that they are interested to smoke again because of hookah flavor. Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among youngsters. Most products are being sold without any warnings, and there is no means to control the selling of the products to minors. Educational intervention is urgently needed to create awareness among youth about the harmful effects of hookah smoking.

Early Respiratory Symptoms of Water-Pipe (Shisha) Smoking in Medical Students of Karachi

Objective:&#x0D; Water pipe smoking WPS (Shisha) is becoming increasingly acceptable in the youth and is contributing to the burden of respiratory diseases. The aim of this study was to assess the frequency of early respiratory symptoms in relation to the severity and duration of WPS smoking in the medical students of Karachi.&#x0D; Methods:&#x0D; This cross-sectional study was conducted in medical colleges of Karachi. A self-administered questionnaire collected information about smoking habits and respiratory symptoms from students. &#x0D; Results:&#x0D; Out of 250 participants, 68.8 % (n=172) were short term smokers. 31.6% (n=79) reported to have smoked shisha monthly. The main reason of smoking shisha for 26% (n=65) was just to fill in the free time with friends. 39.4% (n=88) intend to quit shisha smoking in future. 32.4% (n=81) of the students experienced shortness of breath, 30.4% (n=76) Dry cough, 30.4% (n=76) Scratchy sensation in the throat, 23.6% (n=59) rapid breathing, 20% (n=50) chest tightness and 13.6% (n=34) hoarse voice after shisha consumption. The association of these symptoms with duration and severity of shisha exposure remained insignificant. &#x0D; Conclusion: &#x0D; The results of this study show that smoking shisha can bring about the early respiratory symptoms. Education is important in creating awareness about WPS hazards.&#x0D; Key words:&#x0D; Water-pipe; Shisha; Smoking; Medical students; Respiratory symptoms