Waterpipe Smoking Research Articles

The Fasa Registry on Systolic Heart Failure (FaRSH): Feasibility Study and the First 5-year Reports

Background: The literature on patients with heart failure (HF) from the Middle East, besides a few existing registries, is scarce. We report, for the first time in our country, a hospital-based registry for systolic HF. Materials and Methods: This was a web-based registry on HF, conducted in Vali-Asr Hospital affiliated with Fasa University of Medical Sciences, Fasa, Iran. The goal of this registry was to define overall baseline clinical characteristics and natural history of hospitalized patients with systolic HF, to evaluate current management schema and implementation of practice guidelines, and to determine the correlation between genetic predisposition environmental effects, individuals’ characteristics of health, lifestyle, morbidity, and mortality in relation with the effects of medication. Results: To date, 2378 individuals with a mean of age 67.08±13.07 years have been registered. Among which, 1381 (58.07%) patients were diagnosed with denovo HF. Most of the patients (60.1%) were male, and 8.9% had admissions during the past 30 days. The most common causes of HF were ischemic heart disease (86.5%) and hypertension (5.3%). Most patients had NYHA class one (44.3%) and three (20.4%). Overall, near 30% had diabetes and more than 38% had hyperlipidemia. Most individuals have been not a history of cigarette smoking (68.7%) or water-pipe smoking (96.9%). Also, 22.2% were current opium users, and 3.2% were previous opium users. Conclusions: The findings of this registry could make a realistic view of HF as a chronic disease with a burden. Therefore, policymakers can design programs and guidelines to prevent disease and better survival and quality of life. [GMJ.2021;10:e2111]

Water Pipe Tobacco Smoking and Risk of Coronary Artery Disease: A Systematic Review and Meta-Analysis

Waterpipe smoking has become a vitally important public health issue in the world with a false assumption that it has a less harmful effect. The aim of this study was to systematically review the association between waterpipe tobacco smoking and the risk of coronary artery disease (CAD). Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case reports, case series, and reviews. With the fixed model effect, we conducted a meta-analysis to evaluate the association between waterpipe smoking and coronary artery disease. Heterogeneity among studies was assessed by the I2 square test. Publication bias was assessed by Egger test. P<0.05 was set as significant level. Among 248 paper records identified through a database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach a statistical significance (OR=1.18, 95% CI: 0.98-1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of waterpipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). Heavy Water pipe smoking was associated with coronary artery disease based on clinical findings. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.

Incidence of and factors associated with metabolic syndrome, south-east Islamic Republic of Iran.

Metabolic syndrome is an important cause of cardiovascular disease. Mortality from cardiovascular disease is 12.82 deaths/100 000 population in Zahedan, south-east Islamic Republic of Iran. This study aimed to determine the incidence of metabolic syndrome and its predicting factors in Zahedan city. All participants without metabolic syndrome in a 2009 study in Zahedan, available in 2017, were included in this study. Metabolic syndrome was diagnosed based on the criteria of several organizations. Anthropometric indices and blood pressure were measured and blood tests were done. Age-standardized incidence of metabolic syndrome was calculated and its predictors were evaluated in a logistic regression analysis. Mean age (standard deviation) of the participants was 45.46 (12.63) years in 2017. The incidence of metabolic syndrome varied from 17.21% to 27.18% depending on the criteria used and it was higher in women. High age-standardized incidence was associated with large waist circumference (55.81%) and high blood pressure (25.32%). The highest adjusted odds ratios (OR) for metabolic syndrome were for high triglycerides (OR = 23.75; 95% confidence interval (CI): 9.92-56.84%), large waist circumference (OR = 22.42; 95% CI: 9.03-55.70%), high blood pressure (OR = 16.91; 95% CI: 8.54-33.50%) and high fasting blood sugar (OR = 13.22; 95% CI: 6.74-25.94%). Waterpipe smoking, sex, low-density lipoprotein and wrist circumference were also associated with metabolic syndrome. The incidence of metabolic syndrome has increased in Zahedan. Effective, interventions, including to promote healthy diet, physical activity and avoidance of waterpipe smoking, are needed to control this condition.

Peri-implant parameters and bone metabolic markers among water-pipe users treated with photodynamic therapy

AimThe study aimed to evaluate the efficacy of Mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri‑implantitis among waterpipe smokers (WPS) and non-smokers with peri‑implantitis Material and methodsParticipants were stratified into two groups. Group 1: Subjects who smoked water pipes for the last 2 years with peri‑implant disease were treated with aPDT adjunct to MD and group 2: Participants who did not use water pipes in the last 2 years but have periimplantitis (controls) were treated with MD only. Participants were scrutinized with peri‑implantitis (PI) in one dental implant at least based on the inclusion and exclusion criteria. Using structured questionnaire information was gathered from participants. All participants underwent mechanical debridement (MD). Participants of WPS underwent antimicrobial photodynamic therapy (aPDT). Peri implant inflammatory parameters (PI, BI, PD, and CBL) were assessed in all participant at baseline, 3 months and 6 months follow-up. Periimplant sulcular fluid was collected for assessment of bone metabolic biomarkers RANK-L and OPG. For immunological and clinical peri‑implant parameters analysis of variance (ANOVA) and Kruskal-Wallis test were used. For multiple comparisons, Bonferroni post hoc test was deployed. ResultsClinical periodontal parameters at baseline were significantly different in the control group PI (49.8 ± 10.5), BI(46.8 ± 7.7), and PD (5.0 ± 1.8) compared to WPS PI (56.1 ± 12.0), BI (40.9 ± 8.3), and PD (5.6 ± 1.5) (p < 0.05). At 3 months follow-up after PDT, PI (19.1 ± 7.7) and PD (3.9 ± 1.4) were significantly lower in the control group compared to WPS group PI (23.5 ± 8.4) and PD (4.5 ± 1.2) (p < 0.05). Whereas, BI of control (16.3 ± 6.8) and WPS group (17.1 ± 5.3) at 3 months follow-up was comparable (p > 0.05). At six months follow up following PDT, PI (15.7 ± 5.5) and PD (3.4 ± 1.2) was significantly lower in the control group compared to participants with water piped users PI (18.6 ± 7.4) and PD (3.9 ± 1.3) (p < 0.05). No significant difference was noted in BI in both groups (p > 0.05). Participants treated with PDT adjunct to MD demonstrated significantly reduced mean RANK-L levels at both 3 and 6 months (p<0.05). ConclusionaPDT adjunctive to MD improved periodontal parameters i.e., plaque index, pocket depth, and crestal bone loss along with metabolic marker RANK-L in water pipe smokers compared to non piped smokers.

Overactive bladder syndrome in nulliparous female university students: prevalence and risk factors including waterpipe smoking.

The objective was to assess the prevalence of symptoms of overactive bladder syndrome (OAB) among healthy nulliparous female university students, and to evaluate the correlation of these symptoms with a variety of factors, including waterpipe (WP) smoking. This is a cross-sectional study. A questionnaire was administered to evaluate symptoms of OAB in healthy nulliparous female university students. Variables assessed included body mass index (BMI), cigarette smoking, WP smoking, consumption of alcohol, coffee, and tea with and without artificial sweeteners, soft drinks, and energy drinks. Adjusted odds ratio were calculated to determine the correlation of these variables with OAB symptoms. A total of 767 out of 2,900 females responded to the questionnaire. Bothersome frequency was reported in 32.3%, and nocturia in 47.5% of the women. Urgency and urgency urinary incontinence (UUI) were present in 25.5 and 24.7% of the study participants respectively. Urgency was associated with WP smoking (p value 0.048). Bothersome frequency was associated with artificial sweeteners used with coffee and tea (p value 0.013). UUI was associated with cigarette smoking (p value 0.034) and elevated BMI (p value < 0.001). OAB symptoms were not found to be significantly associated with soft drink and energy drink consumption. A lower prevalence of nocturia (p value 0.009) and urgency was associated with alcohol consumption (p value 0.017). More than two-thirds (69.2%) of WP smokers expressed readiness to decrease WP smoking if this would improve their lower urinary tract symptoms (LUTS). Overactive bladder is common in healthy young nulliparous women and is associated with multiple risk factors, including WP smoking.

Health literacy of ethnic minority in remote China: precise intervention is needed

Health literacy of ethnic minority in remote China: precise intervention is needed

What Factors are Associated With Waterpipe Smoking Cessation? A Secondary Data Analysis.

Waterpipe smoking is gaining popularity and becoming a major global public health concern. An understanding of factors that predict waterpipe smoking cessation is necessary for targeting tobacco control efforts. This is a secondary data analysis of a randomized controlled trial comparing the efficacy of varenicline against placebo in helping waterpipe smokers to quit. A total of 510 adult daily waterpipe smokers were recruited to the trial in 2016. Logistic regression models were applied to assess factors (i.e., demographic, environmental, behavioral, and physiological) associated with primary outcome (waterpipe smoking cessation) and secondary outcomes (waterpipe cessation alongside abstinence from cigarette and short-term and long-term waterpipe smoking cessation). Cessation was defined as 7-day point prevalence abstinence from smoking reported at 5,12, and/or 25 weeks follow-ups. Over a period of six months, 189 (39.2%) participants abstained from waterpipe smoking for at least one week. Being male (adjusted odds ratio (aOR):2.99 (95%CI:1.47-6.08)), dual smoker (waterpipe and cigarettes) (aOR:2.98 (95%CI:1.87-4.74)), more withdrawal symptoms measured by the Mood and Physical Symptoms Scale (aOR:1.08 (95%CI:1.02-1.13)), less nicotine dependency measured by Lebanon Waterpipe Dependency Scale (aOR:0.90 (95%CI:0.85-0.96)), having a history of quit attempt (aOR:2.14 (95%CI:1.16-3.96)), smoking restriction in the house (aOR:2.69 (95%CI:1.01-7.14)), and not sharing waterpipe with others (aOR:2.72 (95%CI:1.31-5.66)) predicted waterpipe smoking cessation. In addition to nicotine dependency, social factors such as home restrictions on smoking, and not sharing waterpipe were identified as predictors of waterpipe smoking cessation. To help waterpipe smokers quit, social environment may be just as or even more important than well-known physical and psychological factors. A range of factors, predominantly social factors play a significant role in facilitating or deterring waterpipe smokers from quitting smoking. Our findings suggest that interventions that focus on social as well as physical/psychological factors may encourage waterpipe smokers in achieving abstinence.

Effect of Water-Pipe Smoking on the Normal Development of Zebrafish.

Background: Among all types of tobacco consumption, Water-Pipe Smoking (WPS) is the most widely used in the Middle East and second-most in several other countries. The effect of WPS on normal development is not yet fully understood, thus the aim of this study is to explore the acute toxicity effects of WPS extract on zebrafish larvae. Methods: In this study, we compared the effects of WPS smoke condensates at concentrations varying from 50 to 200 µg/mL on developmental, cardiac, and behavioural (neurotoxicity) functions. Gene expression patterns of cardiac biomarkers were also evaluated by RT-qPCR. Results: Exposing zebrafish embryos to 50, 100, 150 and 200 µg/mL WPS for three days did not affect the normal morphology of Zebrafish embryos, as the tail flicking, behavioural and locomotion assays did not show any change. However, WPS deregulated cardiac markers including atrial natriuretic peptide (ANP/NPPA) and brain natriuretic peptide (BNP/NPPB). Furthermore, it induced apoptosis in a dose-dependent manner. Conclusion: Our data demonstrate that WPS can significantly affect specific cardiac parameters during the normal development of zebrafish. Further investigations are necessary to elucidate the pathogenic outcome of WPS on different aspects of human life, including pregnancy.

A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic.

During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods.

Assessment of the Relationship of Depression With Tobacco and Caffeine Use Among University Students: A Cross-Sectional Study.

BackgroundUniversity students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in the last decade. However, depression among tobacco and caffeine users remains underrecognized and neglected.MethodologyA self-administrated questionnaire and the Beck Depression Inventory were used to assess the association of depression and the use of cognitive enhancers and psychoactive substances among university students at An-Najah National University in 2020.ResultsThe response rate to the questionnaires was 78.8% (n = 1,051; 38.8% males, 61.2% females). The overall prevalence of depression was high (30.6% males, 34.7% females). The prevalence of cigarette smoking (39.2% males, 3.9% females), waterpipe smoking (43.1% males, 21.6% females), energy drink consumption (59.6% males, 29.7% females), coffee consumption (85.5% for each gender), tea consumption, and chocolate consumption was high, with significant differences in accordance to gender and academic fields. The multinomial logistic regression results revealed that cigarette smokers were more likely to have a higher risk of severe (odds ratio [OR] = 4.5, p = 0.001), moderate (OR = 3.27, p < 0.001), and mild depression (OR = 2.24, p = 0.002) than non-smokers. Severe depression was less prevalent among medical students than health sciences and non-medical students (OR = 0.215, p = 0.015). Moreover, males were less likely to have moderate (OR = 0.5, p = 0.012) and mild (OR = 0.48, p = 0.001) depression than females.ConclusionsOverall, the results of this study revealed the high prevalence of depression and the detrimental effects of smoking on students. Moreover, the findings suggest the urgent need to address depression and risk factors among Palestinian university students by educating them about mental health, identifying high-risk students, and offering easily accessible psychological help. Further, it is crucial to broaden the focus of studies to include students from various academic fields instead of focusing on medical students.

The adverse health effects of waterpipe smoking in adolescents and young adults: A narrative review.

Waterpipe (WP) smoking has rapidly grown in popularity in the United States and other Western countries with the fastest uptake among younger individuals. This growth has been encouraged by the misperception that WP smoke is harmless or less harmful than cigarette smoke. To better understand how WP affects the health of young people, we conducted a narrative review of the literature focusing on the adverse health effects of WP smoking in adolescents and younger adults. We searched scientific literature databases including PubMed, MEDLINE, EMBASE, and ISI Web and selected papers that met the inclusion criteria. Sixty-three papers met the inclusion criteria and were selected for review. Data were abstracted from the selected papers into a standardized table. The evidence demonstrates that WP smoking can cause acute lung infection and injury, and carbon monoxide (CO) poisoning, in adolescents and young adults. It is also associated with adverse subclinical effects in this sub-population, including oral and systemic genotoxicity, lung function decline, and the alteration of vascular and hemodynamic functions. Limited evidence that is available indicates associations with psychological and neurological effects and asthma. No identified publications examined the association between WP use and type 2 diabetes, a condition that is associated with cigarette smoking among young people. WP smoking by younger individuals can result in their hospitalization due to systemic CO poisoning and acute lung disease, and induce subclinical adverse effects in the oral cavity, pulmonary system, and in circulation, that are involved in the pathogenesis of local and systemic chronic diseases.

Prevalence of Tobacco use among Tunisian adolescents: a cross-sectional national survey

Abstract Introduction Tobacco use initiation mostly begins before the age of 18 years old. Being concerned by the increasing prevalence of smoking among adolescents, WHO developed the Global Youth Tobacco Survey. It focuses on youth addiction to tobacco products. This survey was carried out 4 times in Tunisia. GYTS 2017 is the most recent among them. Aim Describe the different tobacco products prevalence and access of smokers to tobacco products and to smoke cessation. Methods It is a school-based survey uses a two stages cluster sample design to produce a representative samples of students aged from 13 to 15 years old. It was conducted in April and May 2017 in 67 secondary school all over the country. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics. Results One out of four students had ever tried to smoke a cigarette; 37.4% of boys vs. 10% of girls (p &amp;lt; 0.001). Lifetime cigarettes prevalence was 7.8%; 14.4% of boys vs. 1.6% of girls (p &amp;lt; 0.001). As for water pipe, 12.7% had ever tried to smoke, even for one or two snuffs. Lifetime water pipe use prevalence was 7.2% (13% of boys vs. 2.8% of girls, p &amp;lt; 0.001). Among cigarettes smokers, 62.5% were able to buy their own cigarettes. Therefore, 23.5% of cigarettes smokers and 41.5% of water pipe smokers were not able to buy their products because of their age. Sixty percent of smokers want to quit and 56.4% had already tried to stop during the year prior to the survey. Seventy-two percent had asked help to quit smoking. Eighteen percent had requested advice from a professional. Conclusions Cigarette and water pipe use prevalence among youth is alarming in Tunisia. Selling tobacco products to minors is not prohibited. Implementing such a law is necessary to reduce adolescents' access to cigarettes, and consequently, reduce tobacco use prevalence. Teenagers should benefit from smoke cessation programs, as well as adults. Key messages Tobacco prevalence among youth is alarming in Tunisia. Prohibiting tobacco sale to minors is necessary.

Вредное влияние курения кальяна на сердечно-сосудистую систему

Курение кальяна является относительно новой, но актуальной проблемой медицины, поскольку в Украине, как и во всем мире, отмечается катастрофический рост его употребления. В структуре табакокурения, которое остается основным модифицируемым фактором сердечно-сосудистого риска, в последние годы произошли изменения с увеличением доли альтернативных табачных продуктов, среди которых кальян занимает второе место по частоте. Потребители воспринимают кальян как вид социальной активности и интересного времяпрепровождения, но недооценивают его вред для здоровья и способность вызывать зависимость. А общество более толерантно относится к употреблению альтернативных табачных продуктов, чем традиционных сигарет, в том числе молодежью. Хотя на сегодня существуют данные относительно связи курения кальяна с развитием артериальной гипертензии, ишемической болезни сердца, инфаркта миокарда, сердечной недостаточности и смертностью от этих причин. Целью данного обзора является оценка факторов, способствующих распространению курения кальяна, его эффектов на сердечно-сосудистую систему и возможностей прекращения курения.

Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature.

The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country. We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally. A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations. Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.

Withdrawal Symptoms among Cigarette and Waterpipe Smokers: A Study in Natural Setting.

Background:The rates of tobacco use, including cigarette and waterpipe smoking, are surging in the Eastern Mediterranean region. The use of these products causes nicotine dependence that makes even short-term tobacco abstinence difficult due to aversive symptoms. During the daytime fasting of the month of “Ramadan”, people accept significant disruption in regular activities, including tobacco smoking. Thus, daytime during Ramadan (before sunset) is likely associated with abstinence symptoms emerging among tobacco smokers. We assessed this hypothesis by measuring tobacco/nicotine abstinence symptoms and craving among smokers of cigarettes or waterpipes during Ramadan.Methods:A cross-sectional survey-based study was conducted on a convenience sample of adults. Participants were assessed for general information about tobacco smoking, dependence, and nicotine desire or craving, and withdrawal symptoms using the Minnesota Nicotine Withdrawal Scale (MNWS) and the Tiffany-Drobes Questionnaire on Smoking Urges.Results:The study sample included 632 exclusive cigarette smokers and 161 exclusive waterpipe tobacco smokers. After fasting and abstaining from tobacco during the day, approximately 75% of cigarette smokers and 20% of waterpipe smokers reported smoking within the first 30 minutes. In addition, 10% of cigarette smokers and 30% of waterpipe smokers reported smoking within the first 60 minutes. Regarding smoking urge, no significant difference was found between cigarette and waterpipe smokers. For nicotine craving and withdrawal, significant differences between cigarette and waterpipe smokers were found when comparing mean scores for each of the following items: (i) urge to smoke, (ii) craving nicotine, (iii) hunger, (iv) desire for sweets, and (v) depression/feeling blue (P-values < 0.05).Conclusion:This study provided evidence from the month of Ramadan that waterpipe smoking is associated with abstinence-induced smoking urge and withdrawal symptoms that are comparable to cigarette smoking. More interdisciplinary research must be focused on developing interventions to reduce tobacco smoking, including waterpipe.

The estimation of the viable count of mutans streptococcus in waterpipe smokers and cigarette smokers

Background: Waterpipe and cigarette are two products of tobacco consumption, tobacco use has detrimental effects on the oral cavity, numerous studies around the world have reported a significant relationship between smoking and increase dental caries and viable count of cariogenic bacteria, Materials and Methods: unstimulated saliva was collected from 84 subjects and divided equally into three groups waterpipe smokers, cigarette smokers, and non-smokers all of the participants are adult male aged between 25-60 years, dental caries was measured by use DMFT index, while S.mutans and S.sobrinus were isolated by using a selective medium SB 20M (Sugar bacitracin-20 modified) agar Results: this present study showed a significant (p≤0.01). higher DMFT, DT, MT, and FT among cigarette smokers group than both waterpipe smokers and non-smokers groups. The viable count of S mutans was significantly (p≤0.01).higher in the cigarette smokers group followed by the waterpipe smokers group and then the non-smoker's group, while the viable count of S sobrinus showed no statistical differences (P&gt;0.05) between groups. The correlation of DMFT with S.mutans, and S sobrinus count, were significantly positive (p ≤0.05), in the cigarette smokers group only Conclusion: Dental caries increase in cigarette smokers, where the DMFT and S mutans viable count are less affected by waterpipe than cigarette smoking, a positive correlation is found between DMFT and .mutans streptococcus count only in cigarette smokers

Water pipe smoking among female in Iran : A survey Pattern of use, risk perception and environmental factors

Vulnerable people with chronic conditions should be a priority of policy and interventions. Very often, however, they are hard-to-reach and reluctant “to come to see us”.

Aspects associated with waterpipe smoking in Iranian youths: a qualitative study

BackgroundWaterpipe is one of the oldest methods of tobacco smoking, which has become the public health challenge, especially in the Eastern Mediterranean countries such as Iran. This study aimed to investigate the waterpipe smoking (WPS) in the young people of Kermanshah in 2020, using a qualitative method.MethodsThis was a qualitative study conducted with the approach of content analysis. Participants were young waterpipe user aged 17 to 25 years selected by purposeful sampling method in Kermanshah city, located in the west of Iran. Data were collected through semi-structured interviews in face-to-face and audio-recorded methods based on an interview guideline during June to August 2020. Then researchers transcribed verbatim and analyzed the content of the interviews thematically.ResultsIn this study, 23 young people who were waterpipe users at the time of the study participated. The results showed that social aspects in three sub-categories were involved in WPS including “socio-cultural aspects”, “socio-environmental aspects”, and “social relations”. Individual aspects of waterpipe use as second category also consisted of two sub-categories including “motivational aspects” and “lack of psycho-protective aspects”.ConclusionsIt seems that the implementation of the policy of reducing access to waterpipe in public environments is effective in reducing waterpipe consumption. It is suggested that educational and interventions, based on targeted models and theories be implemented in order to increase young people’s belief and perception on dangers of WPS, and to improve their self-efficacy to smoking cessation.

Lebanese Waterpipe Dependence Scale (LWDS-11) validation in a sample of Lebanese adolescents

BackgroundSalameh et al. developed the Lebanese Waterpipe Dependence Scale (LWDS-11) that assesses nicotine dependence among adult waterpipe smokers. In view of the high waterpipe use among Lebanese youth and other neighboring countries, it was deemed necessary to check the psychometric properties of the LWDS-11, originally adapted to the Lebanese population, to measure nicotine dependence among adolescents.MethodsTwo cross-sectional investigations were conducted; Study 1 (January and May 2019) enrolled a total of 449 students who were exclusive waterpipe smokers; this sample was used to conduct the exploratory factor analysis. Study 2 enrolled another sample composed of 243 waterpipe smoking adolescents. This sample was independent from the first one and was used to conduct the confirmatory analysis.ResultsThe results also showed that 312 (69.5%) [95% CI 0.652–0.738] had high waterpipe dependence (scores of ≥10). Results of the factor analysis in sample 1 showed that all LWDS-11 items were extracted following the factor analysis. Items converged over a solution of one factor; total variance explained = 70.45%, αCronbach = 0.96). The results of the confirmatory factor analysis were as follows: the Maximum Likelihood Chi-Square = 129.58 and Degrees of Freedom = 45, which gave a χ2/df = 2.88. For non-centrality fit indices, the Steiger-Lind Root Mean Square Error of Approximation (RMSEA) was 0.08 [0.071–0.106]. Moreover, the Comparative Fit Index (CFI) value was 0.77.ConclusionThe preliminary results suggest that the LWDS-11 has good psychometric properties to measure waterpipe dependence among adolescents. We hope this tool would serve the benefit of research and epidemiology.

Latent class analysis of initial nicotine dependence among adult waterpipe smokers.

Waterpipe (WP) tobacco smoking increases the risk of smoking-related health problems. In this study, we sought to identify the unobserved class memberships of WP-associated initial nicotine dependence (ND) symptoms and assess the predictors of each latent class. This cross-sectional study was conducted among a convenience sample of 900 current (past 30-day) WP smokers who were recruited from 94 WP-serving venues surrounding Tehran and Ardebil metropolitans in Iran. All participants completed a self-administrated questionnaire. We performed latent class analysis using PROC LCA in SAS to identify class memberships of initial ND symptoms using 10-item Hooked on Nicotine Checklist. Five latent classes were identified as non-dependent (25.4 %), low dependent (7.1 %), low-moderate dependent (19.6 %), moderate dependent (15.6 %), and high dependent (32.2 %). Using flavored WP tobacco significantly increased the odds of belonging to low-moderate dependent class [adjusted OR (aOR) = 1.89; 95 % confidence interval (CI): 1.07-3.34] compared to non-dependent class. Also, having academic education decreased the odds of belonging to low-moderate dependent (aOR = 0.43; 95%CI: 0.26-0.67) and moderate dependent (aOR = 0.39; 95%CI: 0.23-0.67) class in comparison to non-dependent class. Also, WP smoking initiation at an older age was associated with belonging to high dependent (OR = 2.05; 95%CI: 1.39-3.03) class compared to non-dependent. This study revealed that nearly half of WP smokers fell under moderate and high-dependent classes. Our findings showed that some items of HONC had more role in the clustering of participants based on ND symptoms. The WP-specific cessation programs and targeted clinical trials should consider the diversity of ND levels among smokers to achieve successful quit rates among these smokers. Additionally, limiting flavors would be a strong strategy to limit the rate of ND, especially among young people who are eager to smoke flavored WP tobacco.