Waterpipe Smoking Research Articles

Shisha related burns: A paediatric case series

IntroductionThe majority of burn injuries in the paediatric age group occur in the home environment and are preventable. Water pipe smoking, commonly known as shisha, is an old practice of tobacco smoking dating from the 16th century with the use of hot coals and water in social gatherings at homes or cafes. The increasing use of shisha worldwide in youth raises public health concerns regarding its detrimental health effects and potential for serious thermal injury. Our aim is to identify and classify epidemiological trends of shisha related burns in the paediatric age group across New South Wales and the Australian Capital Territory. MethodsA retrospective review from January 2009 – December 2019 at The Children’s Hospital at Westmead Burns Unit. All burn injuries of age less than 16 years that attended or were referred to the unit were included in this study. ResultsThere were 10 patients who presented with a shisha related burn injury. There was an equal distribution of males to females with all burns occurring in the home or a park. The most common types of injury were a full thickness or mid-dermal burns respectively, three of which required split thickness skin grafting. ConclusionsShisha smoking is part of many cultures that has many potential burn hazards to children and family. Educational awareness targeted to shisha users can bring a better understanding about its potential for burn injury in children.

Attitudes and Knowledge of the Harmful Effects of Waterpipe Tobacco Smoking among university students: A study from Jordan.

Waterpipe tobacco smoking (WTS) is an emerging behavior worldwide, especially among the youth. It continues to spike in the Middle-Eastern region. WTS is associated with many harmful health-related outcomes.Objective: Herein, the attitude, knowledge, and factors affecting the knowledge of university students toward the detrimental effects of WTS were examined. This was a cross-sectional study where university students filled an online questionnaire that was available between October 2019 and May 2020. A total of 966 questionnaires were filled. About 40% of participants were current waterpipe smokers. Around 30% of participants stated that WTS is not addictive, and about third of them indicated that smoking waterpipe is an essential part of social gathering and is socially accepted behavior. Half of participants (55.8%) were knowledgeable about the major harmful consequences of WTS. Older students were more knowledgeable as compared to younger ones. In contrast, students from non-medical colleges and waterpipe smokers were less knowledgeable in comparison to those in medical colleges and non-smokers, respectively. More targeted health campaigns to control the use of WTS among university students should be implemented.

LINE-1 methylation mediates the inverse association between body mass index and breast cancer risk: A pilot study in the Lebanese population

IntroductionLebanon is among the top countries worldwide in combined incidence and mortality of breast cancer, which raises concern about risk factors peculiar to this country. The underlying molecular mechanisms of breast cancer require elucidation, particularly epigenetics, which is recognized as a molecular sensor to environmental exposures. PurposeWe aim to explore whether DNA methylation levels of AHRR (marker of cigarette smoking), SLC1A5 and TXLNA (markers of alcohol consumption), and LINE-1 (a genome-wide repetitive retrotransposon) can act as molecular mediators underlying putative associations between breast cancer risk and pertinent extrinsic (tobacco smoking and alcohol consumption) and intrinsic factors [age and body mass index (BMI)]. MethodsThis is a cross-sectional pilot study which includes breast cancer cases (N = 65) and controls (N = 54). DNA methylation levels were measured using bisulfite pyrosequencing on available peripheral blood samples (N = 119), and Multivariate Imputation by Chained Equations (MICE) was used to impute missing DNA methylation values in remaining samples. Multiple mediation analysis was performed to assess direct and indirect (via DNA methylation) effects of intrinsic and extrinsic factors on breast cancer risk. ResultsIn relation to exposure, AHRR hypo-methylation was associated with cigarette but not waterpipe smoking, suggesting potentially different biomarkers of these two forms of tobacco use; SLC1A5 and TXLNA methylation were not associated with alcohol consumption; LINE-1 methylation was inversely associated with BMI (β-value [95% confidence interval (CI)] = −0.04 [−0.07, −0.02]), which remained significant after adjustment for age, smoking and alcohol consumption. In relation to breast cancer, there was no detectable association between AHRR, SLC1A5 or TXLNA methylation and cancer risk, but LINE-1 methylation was significantly higher in breast cancer cases when compared to controls (mean ± SD: 72.00 ± 0.66 versus 70.89 ± 0.73, P = 4.67 × 10−14). This difference remained significant after adjustment for confounders (odds ratio (OR) [95% CI] = 9.75[3.74, 25.39]). Moreover, LINE-1 hypo-methylation mediated 83% of the inverse effect of BMI on breast cancer risk. ConclusionThis pilot study demonstrates that alterations in blood LINE-1 methylation mediate the inverse effect of BMI on breast cancer risk. This warrants large scale studies and stratification based on clinic-pathological types of breast cancer.

Exercise Self-efficacy, Perceived Benefits, and Barriers to Exercise Among Patients Following Acute Myocardial Infarction.

Increasing patient adherence to regular exercise post acute myocardial infarction (AMI) is a major goal after hospitalization. It is therefore essential to identify perceived benefits and barriers to exercise and its association with exercise self-efficacy among patients post AMI. The purpose of this study was to identify the perceived benefits and barriers to exercise and the predictors of exercise self-efficacy among patients after AMI. A cross-sectional study design was used with a convenience sample of 254 patients, recruited from the 3 main hospitals in Jordan. Instruments included the Exercise Benefits and Barriers Scale and the Exercise Self-Efficacy Scale. Mean scores were computed to determine the perceived benefits and barriers responses. Multiple linear regression was conducted to explore the predictors of exercise self-efficacy. Data were collected over 5 months. The greatest perceived benefits were related to personal factors, for example, "I enjoy exercise" (2.45 [0.98]), and physical performance, for example, "My muscle tone is improved with exercise" (2.44 [0.86]) and "Exercise increases my stamina" (2.43 [0.86]). The greatest perceived barriers were related to environmental barriers, for example, "Lack of exercise places" (2.67 [0.82]), and internal factors related to physical exertion itself, for example, "Concerned about getting tired during exercise participation" (2.65 [0.72]). The Exercise Self-Efficacy Scale showed that patients post ST-elevation AMI had higher exercise self-efficacy than those with other treatment modalities (AMI, 44.71 [19.07] vs 36.59 [17.34]; P = .001). Patients treated by primary percutaneous coronary intervention had higher exercise self-efficacy, 49.2 (18.61), than patients treated by thrombolysis and percutaneous coronary intervention, 39.28 (18.3), and patients treated by medications other than thrombolytic therapy, 36.59 (17.4) (F2,251 = 11.612, P = .001). The multiple linear regression model explained approximately 29% of the variance in exercise self-efficacy (F11,242 = 7.914, P < .001). Five variables contributed significantly to the prediction of self-efficacy: type of AMI (standardized β = -0.173, t = -3.311, P = .01), perceived exercise benefits (standardized β = 0.322, t = 4.912, P = .01), perceived exercise barriers (standardized β = -0.291, t = -4.521, P = .01), being Argela smokers (water pipe smoking) (standardized β = -0.132, t = -2.617, P = .029), and cholesterol level (standardized β = -0.158, t = -2.174, P = .003). Primary perceived benefits of exercise reported were in the areas of personal factors and improved physical performance. The main perceived barriers to exercise were in the areas of environmental factors and physical exertion. Identification of benefits and barriers to exercise, type of AMI, and treatment modalities of AMI as predictors of exercise self-efficacy is a significant step for developing appropriate interventions that effectively improve exercise self-efficacy and exercise among post-AMI patients.

Immunoglobulin G Immunity to Hepatitis A Virus in Liver Transplant Candidates: A Serosurvey from Iran

Background: Becoming infected with hepatitis A virus (HAV) is deadlier in patients with end-stage liver disease. Objectives: This study aimed to determine the seroprevalence of chronic immunity to HAV in liver transplant (LT) candidates to determine whether HAV vaccination is necessary for them or not. Methods: This cross-sectional study was conducted on adult LT candidates who were referred to the LT center of Shiraz, Iran. The patients were interviewed for filling the data collection forms. These forms consisted of demographic information, medical backgrounds, etiology of chronic liver disease, a model for end-stage liver disease (MELD) score, laboratory findings, and abdominal sonography report. Furthermore, a 3-cc blood sample was obtained from each patient, and anti-HAV IgG was detected by Enzyme-linked Immunosorbent assay (ELISA) using standard Diapro kits. Univariable and multivariable data analyses were performed using SPSS version 20. A P-value of less than 0.05 was considered the significant cutoff in regression analysis. Results: A total of 291 patients with a mean age of 47.73 ± 12.9 years were recruited in this study of whom, 197 (67.7%) patients were males, 237 (81.4%) were married, 229 (78.7%) were educated lower than 12 years, 250 (85.9%) were living in urban areas, and (221) 75.9% had access to sanitary water in their living area. anti-HAV IgG was detected in 269 (92.4%, 95% CI: 89.4 - 95.4%) patients. Multivariable analysis showed that lower knowledge of hepatitis A transmission routes (OR: 11.9, 95% CI: 1.39 - 101.8, P = 0.024), no waterpipe smoking (OR: 9.5, 95% CI: 1.6 - 55.5, P = 0.014), and older age (OR: 1.12, 95% CI: 1 - 1.24, P = 0.03) were the main predictors of HAV immunity, in sequence. Conclusions: Most LT candidates are HAV IgG positive, but due to the growing number of LT candidates and high mortality of HAV in non-immune cases, LT candidates should be checked for HAV IgG, especially younger or waterpipe smoking patients who are less immune. Also, all non-immune patients should be vaccinated against HAV, if possible.

Comment on "Waterpipe Smoking among Herat University Students: Prevalence, Attitudes, and Associated Factors".

Comment on "Waterpipe Smoking among Herat University Students: Prevalence, Attitudes, and Associated Factors".

Headspace GC-MS and LC-MS based metabolomic study of waterpipe smoke of unflavored and peach-flavored Moâssel with an insight into their health hazards

Headspace GC-MS and LC-MS based metabolomic study of waterpipe smoke of unflavored and peach-flavored Moâssel with an insight into their health hazards

Ameliorative effects of curcumin and caffeic acid against short term exposure of waterpipe tobacco smoking on lung, heart and kidney in mice.

This study aims to evaluate the chemopreventive activity of two antioxidants (curcumin [CUM] and caffeic acid [CAF]), focusing on how these antioxidants could reduce cytotoxicity induced by short term secondhand exposure of waterpipe tobacco smoking. Forty-eight adult male BALB/c albino mice were equally divided into four groups. Antioxidants were delivered intraperitoneally, and the exposure to waterpipe smoking (WPS) was performed using a smoking machine. This experiment lasts for 14 consecutive days. Serum were collected from mice before dissection to quantify the activity of some liver enzymes, kidney function tests and proinflammatory cytokines. Lung, heart, and kidney were isolated and processed for light microscopy technique. Parallel treatment of CUM or CAF along with exposure to WPS showed less inflammation, less vacuolized, and more inflated alveoli, less deteriorations in cortex part of kidney, and less disintegration of cardiac myofibers in comparison to waterpipe only. Besides, CUM and CAF significantly reduced the activity of aspartate aminotransferase and proinflammatory cytokines. CUM and CAF were found to have anti-inflammatory and ameliorative effects against the cytotoxicity induced by exposure to waterpipe tobacco smoking, and CUM showed better chemopreventive activity than CAF.

Ameliorative Effect of Turmeric and Cocoa Extract against Acute Second hand Exposure of Tobacco Smoking on Hepatocytes and Enterocytes in Albino Rats: Ultra structural Study

Background and aims: Smoking posse’s serious health problems because there is no specific substance alleviate its toxicity. The aim of this study was to investigate the effective plant extract containing antioxidants(turmeric and cocoa), that may reduce the cytotoxicity induced by secondhand exposure of cigarettes and waterpipe smoking. Material and Methods: Seventy-two adult male albino rats were equally divided into 9 group (n=8 per group). Extracts were delivered to each group intraperitoneal, and the exposure to cigarette and waterpipe smoking was performed using a smoking machine for a period of 30 days. After the exposure period, tissues of interest (liver and small intestine) were removed and processed for transmission electron microscopy. Results: Oral treatment of turmeric and cocoa extract with smoking exposure showed less vacuolization and better cellular architecture with regular nuclear envelope of hepatocytes, reduce or absence of blebbing, retain the normal shape and size of mitochondria, increase the proportion of euchromatic chromatin in nuclei,but turmeric extract showed better enhancement in term of reducing vacuolization. turmeric or cocoa crude extract preserve the typical length of microvilli with a uniform organization from the apical part of enterocytes and decreased vacuolization in the cytosol of enterocytes. However, mitochondria appeared less polymorphic in shapes with distinct cristae and matrix in enterocytes of the turmeric treated group than the cocoa once. Conclusion: Tobacco smoking-induced adverse effects on hepatocytes and enterocytes, this study showed that treatment with turmeric and cocoa attenuatethe toxicity of tobacco smoking.

Gender-specific differences in plasma ferritin in adolescents smoking cigarettes versus waterpipe smoking: the Irbid-TRY Project.

Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp.

Socioeconomic inequality in prevalence of cigarette and Water-pipe smoking among Iranian adults: A blinder- Oaxaca decomposition Analysis

Background: To assess the association between socioeconomic inequality and the prevalence of tobacco smoking among Iranian adults in 2010. Methods: Data from the fifth national STEPS survey (WHO STEPwise approach to NCD Surveillance) were analyzed. A Blinder-Oaxaca decomposition method was applied to assess the association between socioeconomic inequality and the prevalence of daily cigarette and water pipe (WP) smoking among Iranian men and women. Results: From 10,615 participants in the survey, 4,203 (39.5%) participants appeared to be in the first and fifth quintiles of socioeconomic status (SES). For men, the prevalence of daily cigarette smoking was higher among those with low SES (23.1%) than those with high SES (11.1%) (P&lt;0.001). The observed difference was mainly attributed to the educational level (8.6%). We found no significant difference in high compared to low SES women for cigarette smoking (P value= 0.881). Although there was no difference between high and low SES men for daily WP smoking, low SES women had a higher prevalence of WP smoking (4.4%) than high SES women (1.3%) (P value=0.027). Education level was the major factor (3.3%) to explain the corresponding difference. The difference in WP smoking in high and low SES men was not statistically significant (P value= 0.199). Conclusion: Cigarette smoking in men and WP smoking in women are associated with SES in Iran. Education was the main factor explaining the differences in the prevalence of cigarette and WP smoking in Iranian men and women. Results from this study must be considered as a pivotal basis for designing a tobacco control program at national and sub-national levels.

Water-pipe as a Risk Factor for Genital Warts? A Case Report

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the world. HPV infection can cause some types of cancer including female genital cancers (cervical cancer, vulvar) and male genital cancer as well as oropharyngeal cancers and genital warts. Cigarette smoking is a risk factor of cervical cancer or genital warts. Case presentation: This case report present a young woman who developed extensive genital warts a year after starting water-pipe smoking. These genital warts healed spontaneously after cessation of water-pipe smoking. Conclusion: The primary hypothesis that could be propounded, is that water-pipe smoke plays a role as an independent risk factor in developing genital warts, similar to cigarette smoke. In addition, water pipe smking may transmit different infections, including HPV infection through sharing the mouth tips of the water pipe between the users.

Effect of smoking cessation on chronic waterpipe smoke inhalation-induced airway hyperresponsiveness, inflammation, and oxidative stress.

Waterpipe smoking (WPS) prevalence is increasing globally. Clinical and laboratory investigations reported that WPS triggers impairment of pulmonary function, inflammation, and oxidative stress. However, little is known if smoking cessation (SC) would reverse the adverse pulmonary effects induced by WPS. Therefore, we evaluated the impact of WPS inhalation for 3 mo followed by 3 mo of SC (air exposure) compared with those exposed for either 3 or 6 mo to WPS or air (control) in C57BL/6 mice. To this end, various physiological, biochemical, and histological endpoints were evaluated in the lung tissue. Exposure to WPS caused focal areas of dilated alveolar spaces and foci of widening of interalveolar spaces with peribronchiolar moderate mixed inflammatory cells consisting of lymphocytes, macrophages, and neutrophil polymorphs. The latter effects were mitigated by SC. Likewise, SC reversed the increase of airway resistance and reduced the increase in the levels of myeloperoxidase, matrix metalloproteinase 9, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor-α, interleukin (IL)-6, and IL-1β in lung tissue induced by WPS. In addition, SC attenuated the increase of oxidative stress markers including 8-isoprostane, glutathione, and catalase induced by WPS. Similarly, DNA damage, apoptosis, and the expression of NF-κB in the lung induced by WPS inhalation were alleviated by CS. In conclusion, our data demonstrated, for the first time, to our knowledge, that SC-mitigated WPS inhalation induced an increase in airway resistance, inflammation, oxidative stress, DNA injury, and apoptosis, illustrating the benefits of SC on lung physiology.

Transitions in hookah (Waterpipe) smoking by U.S. sexual minority adults between 2013 and 2015: the population assessment of tobacco and health study wave 1 and wave 2

BackgroundTobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts.MethodsWe analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013–2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014–2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2.ResultsEver and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p < 0.0001). Among SM adults who reported hookah use at Wave 1, 46% quit hookah use at Wave 2; 39% continued hookah use and did not transition to other products while 36% of heterosexual adults quit hookah use at Wave 2 and 36% continued hookah use and did not transition to other products. Compared with heterosexuals, SM adults reported higher use of hookah plus e-products (Wave 2 usage increased by 65 and 83%, respectively).ConclusionsCompared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have implications for stronger efforts to increase awareness of the harmful effects of hookah as well as vaping, specifically tailored among SM communities.

Preventing and controlling water pipe smoking: a systematic review of management interventions

BackgroundWater pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide.MethodsA systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories.ResultsAfter deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels.ConclusionThe current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.

Pattern of Tobacco Smoking Among Egyptian Patients With Bipolar Disorder

Background: Individuals with bipolar disorder (BD) have a higher prevalence of tobacco smoking than the general population. In Egypt, the accurate data about the pattern of tobacco smoking and prevalence of nicotine dependence among BD patients are still scarce. Objective: The objective of this study was to detect the pattern of tobacco smoking and to assess the occurrence of nicotine dependence syndrome among Egyptian cigarette and waterpipe smoker patients suffering from BD. Methods: A cross-sectional study using a semistructured interview to assess 100 patients with BD at the inpatient department and the outpatient mood clinic of The Institute of Psychiatry, Ain Shams University. The assessment tools included the Mini-International Neuropsychiatric Interview, Sixth Edition (M.I.N.I.), the Young Mania Rating Scale (YMRS), the Fagerström Test for Nicotine Dependence (FTND), and the Lebanon Waterpipe Dependence Scale (LWDS-11). Results: Of the 100 recruited bipolar patients (43% women and 57% men), it was found that 45% of bipolar cases were cigarette smokers, 18% were waterpipe smokers, and 17% smoked both cigarette and waterpipe with a statistically significant difference. Bipolar I in the acute phase showed the most prevalent type of BDs with moderate (31%) and high (13.8%) nicotine dependence. Bipolar II cases have never smoked neither cigarette nor waterpipe; 5% of patients with bipolar I smoked waterpipe during disease activity. Conclusion: Patients with BD have a relatively high frequency of nicotine (cigarettes and waterpipe) dependence (17%) in relation to the general population (1.0%), especially bipolar I type.

Estimating the Marginal Causal Effect and Potential Impact of Waterpipe Smoking on Risk of Multiple Sclerosis Using the Targeted Maximum Likelihood Estimation Method: A Large, Population-Based Incident Case-Control Study.

There are few if any reports regarding the role of lifetime waterpipe smoking in the etiology of multiple sclerosis (MS). In a population-based incident case-control study conducted in Tehran, Iran, we investigated the association between waterpipe smoking and MS, adjusted for confounders. Cases (n=547) were patients aged 15-50 years identified from the Iranian Multiple Sclerosis Society between 2013 and 2015. Population-based controls (n=1,057) were persons aged 15-50 years recruited through random digit telephone dialing. A doubly robust estimation method, the targeted maximum likelihood estimator (TMLE), was used to estimate the marginal risk ratio and odds ratio for the association between waterpipe smoking and MS. The estimated risk ratio and odds ratio were both 1.70 (95% confidence interval: 1.34, 2.17). The population attributable fraction was 21.4% (95% confidence interval: 4.0, 38.8). Subject to the limitations of case-control studies in interpreting associations causally, these results suggest that waterpipe use, or strongly related but undetermined factors, increases the risk of MS. Further epidemiologic studies, including nested case-control studies, are needed to confirm these findings.

Shared breastfeeding & other early multiple sclerosis risk factors: A case-control study

Background: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease. Etiology is thought to be multifactorial with genetic and environmental factors interplay. Our objective in this study is to evaluate culture specific and other early life risk factors for MS. We examined the association between MS and breastfeeding including shared breastfeeding, parental consanguinity, being born abroad or living abroad during childhood, prematurity, vaccination, tonsillectomy, rank among siblings, number of siblings, number of household members (HHM) at birth, and age first time joining school.Methods: This is an age and sex matched case-control study that was conducted in Riyadh, Kingdom of Saudi Arabia (KSA). We enrolled 300 cases and 601 controls. A structured questionnaire about demographics, consanguinity and potential environmental factors was answered by participants. Data was analyzed using logistic regression adjusting for covariates occurring later in life such as waterpipe smoking and performing Hajj.Results: About two thirds of the cases and the controls were females. Mean age was 34.8 (9.2) for the cases and 33.6 (10.6) for the controls. We found that shared breastfeeding (OR=0.58; 95% CI, 0.35-0.96, p = 0.033), and older age first joining school (OR=0.83; 95% CI, 0.73-0.94, p = 0.005) were associated with decrease risk of MS. While longer duration of breastfeeding by biological mother (OR=1.03; 95% CI, 1.01-1.04, p = 0.001), rank among siblings of ≥6 (OR=1.69; 95% CI, 1.11-2.56, p = 0.014), and larger number of HHM at birth (OR=2.32; 95% CI, 1.64-3.28, p = 0.001) were associated with increased risk. Patients with MS were less likely to receive formula with breastfeeding than controls (OR=0.72; 95% CI, 0.51-0.99, p = 0.046). No association was found with breastfeeding by biological mother, number of siblings, prematurity, being born abroad or living abroad during childhood, vaccination, consanguinity, or tonsillectomy.Conclusion: The findings of this case-control study add to the accumulating evidence that early life factors could modify the risk of developing MS. Among these, novel associations with shared breastfeeding and number of HHM at birth are suggested. Future studies are needed to verify the observed results.

Markers of oxidative stress and toxicant exposure among young waterpipe smokers in the USA.

Waterpipe (aka hookah) tobacco smokers are exposed to toxicants that can lead to oxidative DNA and RNA damage, a precursor to chronic disease formation. This study assessed toxicant exposure and biomarkers of DNA [8-oxo-7, 8-dihydro-2'-deoxyguanosine (8-oxodG)] and RNA [8-oxo-7,8-dihydroguanosine (8-oxoGuo)] oxidative damage during smoking of flavored and non-flavored waterpipe tobacco. Thirty waterpipe smokers completed two counterbalanced 2-h lab waterpipe smoking sessions (flavored vs. non-flavored waterpipe tobacco). Urinary concentrations of 8-oxodG and 8-oxoGuo and expired carbon monoxide (eCO) were measured before and after the smoking sessions. A significant increase in the urinary concentrations of 8-oxodG (from 2.12 ± 0.83 to 2.35 ± 0.91 ng/mg creatinine, p = 0.024) and 8-oxoGuo (from 2.96 ± 0.84 to 3.45 ± 0.76 ng/mg creatinine, p = 0.003) were observed after smoking the non-flavored and flavored waterpipe tobacco, respectively. Our results also showed that the mean ± SD of eCO increased significantly after smoking the flavored (from 1.3 ± 1.1 to 20.3 ± 23.6 ppm, p < 0.001) and non-flavored waterpipe tobacco (from 1.8 ± 1.2 to 24.5 ± 26.1 ppm, p < 0.001). There were no significant differences in the means of 8-oxodG (p = 0.576), 8-oxoGuo (p = 0.108), and eCO (p = 0.170) between the flavored and non-flavored tobacco sessions. Smoking non-flavored and flavored waterpipe tobacco leads to oxidative stress and toxicant exposure. Our findings add to the existing evidence about the adverse effects of waterpipe tobacco smoking (WTS) and the need for strong policies to inform and protect young people from the risks of WTS.

Signaling alterations in oral keratinocytes in response to shisha and crude tobacco extract.

Tobacco consumption in smoking and non-smoking forms has been consequential in the rise of oral cancer cases. Among different forms, epidemiological studies from Middle Eastern countries and rural parts of northern India have reported increasing association of oral cancer with waterpipe (hookah) smoking. However, molecular mechanisms and role played by waterpipe smoking in the onset of oral carcinogenesis remains unexplored. In this study, immortalized normal human oral keratinocytes were chronically treated with extracts of two varieties of waterpipe tobacco-crude tobacco and processed shisha. Phenotypic changes and molecular aberrations were examined using cell culture-based assays and mass spectrometry-based quantitative proteomic analysis, respectively. Bioinformatics analysis was utilized to analyze proteomics data and identify dysregulated pathways. Our data indicate that chronic treatment with waterpipe tobacco extracts increased proliferation, invasion, migration, and significant dysregulation of protein expression in oral keratinocytes. Altered expression of proteins involved in interferon signaling pathway were observed with both varieties of tobacco. Overexpression of cholesterol metabolism and vesicle-mediated transport proteins were identified exclusively in cells treated with crude tobacco extract. Bioinformatics analyses revealed different oncogenic response in oral cells based on the type of waterpipe tobacco used. This study may serve as a useful resource in understanding the early onset of oral cancer attributed to waterpipe smoking.