Waterpipe Use Research Articles

Nargile Kullanımında Riskler, Tehditler ve Önleyici Yaklaşımlar

<p class="ql-align-justify">Although the damages of tobacco use have been proven all over the world and in our country, the use of water pipes in our country has increasingly attracted attention as a tobacco product in recent years. The liquid use of water pipe tobacco, which is growing fast Turkey, is generally more favored by young people, despite the high concentrations of heavy metals; carbon monoxide, tar and nicotine found in the water pipes. In one sip of water pipe, the smoker inhales an average of 0.15 to 1.0 litters of tobacco, which corresponds to about 100 times the amount of tobacco in cigarettes. Furthermore, recent studies suggest that the usage of water pipes is associated with various diseases, such as cardiovascular disease, infections, respiratory diseases, nicotine addiction and lung cancer. In order to eliminate the widespread use of water pipes, it would be appropriate to raise the awareness among young people.&nbsp;

Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review.

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.

Sex and Polytobacco Use among Spanish and Turkish University Students.

Polytobacco use has become increasingly popular among young adults, particularly males, and can be defined as the concurrent use of regular cigarettes and other tobacco products (e.g., e-cigarettes). The present study investigated the use of legal smoking products (cigarettes, waterpipe and electronic cigarettes) among young adults (n = 355) in Spain and Turkey. The survey measured demographics, lifetime and past month tobacco use, waterpipe and e-cigarette use, whether waterpipes and e-cigarettes contained nicotine and reasons for using these substances. The majority of the Turkish (men = 80% and women = 63.9%) and Spanish sample (men = 61.4% and women = 69.3%) were polytobacco users. The most common reason for using e-cigarettes was “to experiment, to see what is like” (Turkish sample: men 66.7% and women 57.1; Spanish sample: men 72.7% and women 93.8%). The most common reason to use regular cigarettes was “to relax and relieve tension” (Turkish sample: men 88.9% and women 77.6%; Spanish sample: men 78.1% and women 76%), while for waterpipe users, the most common reason was “to experiment, to see what it is like” (Turkish sample: men 93.3% and women 80%; Spanish sample: men 78.9% and women 93.8%). The implications for prevention and future research are discussed.

Cigarette, waterpipe, and electronic cigarette use among college fraternity and sorority members and athletes in the United States

Objective To examine the association between fraternity/sorority membership and athlete status with tobacco use by tobacco product type. Participants: Undergraduate college students who participated in the Spring 2017 National College Health Assessment-II Survey (n = 47,821). Methods: Prevalence of current (past-30 day) cigarette smoking, waterpipe tobacco smoking (WTS), and e-cigarette (ECIG) use was examined. Logistic regressions examined associations between fraternity/sorority membership and participation in collegiate athletics with tobacco use. Results: Fraternity/sorority members had the highest current use rates for cigarettes, waterpipe tobacco, and ECIGs and were nearly twice as likely to report cigarette smoking, WTS, and ECIG use relative to non-fraternity/sorority members. Relative to non-varsity athletes, varsity athletes were less likely to report cigarette smoking and WTS, but not ECIG use. Conclusions: Fraternity/sorority members appear to be at risk for use of multiple tobacco products. Varsity athlete status may be protective for some tobacco products, but does not appear no for ECIG use. ECIGs may appeal to groups typically at low risk for other tobacco products.

Waterpipe Use Prevalence Rate in Turkey: A Meta-analysis Study

Abstract Background The aim of the study was to perform a meta-analysis of studies about the waterpipe use prevalence in Turkey. Methods PubMed, Web of Science, Turkey Citation Index, TR Index and the Cochrane Library databases were screened both in Turkish and English languages to identify relevant studies by using keywords ’waterpipe use’, ’prevalence’ and ’Turkey’. Inclusion criteria; original and cross-sectional design, studies that done during and after the year 2010, studies that given the number of participants and number of people using waterpipe and studies that done in Turkey. Open Meta Analyst demo program was used to calculate the prevalence rate of the study groups. Since the articles were p &amp;lt; 0.001 in the heterogeneity test, prevalence rate and 95% confidence intervals were calculated from the number of cases using the random effects model in group analysis. Results As a result of first literature review 26 articles were reached. Duplications were eliminated and summaries of the remaining articles were read as double-blind. Ten studies were included in the study that were suitable for inclusion criteria and quality evaluation. Seven of the studies were conducted only in university students, while 3 were community-based. As a result of the analysis, 2399 of 8845 university students used waterpipe (31.0%; 95% CI: 27.3-34.7), while 356 of the 33,129 individuals used waterpipe (1.2%; 95% CI: 0.04-2.0) in community-based studies. Conclusions As a result of the comprehensive literature research, it was found that the studies on waterpipe use were less in literature and prevalence was higher than expected in university students. Key messages In university students, the use of waterpipe was more common than the community, and intervention studies about the use of waterpipe were needed. Waterpipe use and surveillance studies in the communities are important for taking preventive measures and monitoring health outcomes.

Substance use among high school students in Erbil City, Iraq: prevalence and potential contributing factors.

Substance use among adolescents, especially smoking and alcohol consumption, has become a public health concern in the Kurdistan Region, Iraq, in the past 10 years. This study aimed to determine the prevalence of substance use and certain associated factors among high school students in Erbil City, Kurdistan Region, Iraq. A cross-sectional study was conducted using a multistage cluster sampling technique to collect a sample of 3000 students. A modified version of the School Survey on Drug Use from the United Nations Office on Drugs and Crime was used for data collection. Binary logistic regression models were used to identify risk factors for substance use. The lifetime prevalence rates of cigarettes smoking, waterpipe smoking and alcohol consumption were 27.6%, 23.6% and 3.7%, respectively. Male gender, age 17-19 years, smoker in the family, and easy accessibility of cigarettes were significantly associated with cigarette smoking. Factors significantly associated with waterpipe smoking were male gender, age 17-19 years, waterpipe smoker in the family, waterpipe smoker friend, and easy accessibility. Male gender, alcohol dependent in the family, alcohol-dependent friend, easy accessibility of alcohol, and low family income were significant predictors of alcohol consumption. The prevalence of cigarette smoking and waterpipe use was high in the studied sample. Possible explanations for this finding might be the use of flavoured tobacco associated with aromatic smell, and the misconception that waterpipe smoking is less toxic and addictive than cigarette smoking.

The effects of hookah/waterpipe smoking on general health and the cardiovascular system

Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but “appealing” flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.

Prevalence and correlates of concurrent use of cigarettes, electronic cigarettes, and waterpipes among Serbian youth.

INTRODUCTIONConcurrent use of tobacco products is associated with an increased risk of nicotine dependence and smoking-related health complications. Growing popularity of concurrent use of cigarettes and electronic cigarettes and/or waterpipe tobacco is of concern, especially due to the adolescents’ exposure to nicotine and call for the better understanding of patterns and predictors of multiple product use.METHODSThis is a secondary analysis of cross-sectional data obtained through the 2017 Global Youth Tobacco Survey conducted in Serbia on a nationally representative sample of 3362 students aged 13–15 years. Students were categorized into eight groups based on their experience with cigarette, e-cigarette and waterpipe use. To explore differences in sociodemographic and psychosocial characteristics, students were further placed in four groups: non-users; exclusive cigarette users; users of e-cigarette and/or waterpipe who do not smoke cigarettes; cigarette and other product users.RESULTSWe show that among the 13–15 years old students, the most common pattern of tobacco/nicotine use is waterpipe and/or e-cigarette use with no cigarette smoking (7.5%, 95% CI: 6.6–8.4) followed by exclusive cigarette use (5.8 %, 95% CI: 5.0–6.6). Among cigarette smokers, 52.8% were exclusive cigarette smokers. Having the majority of their friends smoking is a mutual predictor for exclusive cigarette (AOR=33.2, 95% CI: 14.52–75.90) waterpipe and/or e-cigarette (AOR=2.57, 95% CI: 1.56–4.25) and cigarette and other products use (AOR=52.3, 95% CI:12.28–223.22) compared to no use of any product, and the same in the case of exposure at the point-of-sale marketing: exclusive cigarette vs not any product users (AOR=1.82, 95% CI: 1.22–2.73); waterpipe and or/e-cigarette vs not any product users (AOR=1.64, 95% CI:1.18–2.28); and cigarette and other products vs not any product users (AOR=3.40, 95% CI: 1.99–5.80).CONCLUSIONSTobacco control interventions should address dual- and poly-tobacco use with special focus on inter-personal factors and protection from exposure to advertising of e-cigarettes and waterpipes.

Lifetime prevalence and correlates of smoking behavior in Iranian adults\u2019 population; a cross-sectional study

AbstactBackgroundThere are few if any reports concerning the joint use of waterpipe, cigarette and exposure to second-hand smoking in Tehran, Iran. Here, we simultaneously investigated the prevalence and predictors of smoking habits in Iranian adults.MethodsIn this population-based cross-sectional study, we recruited 1057 Iranian adults between August 2013 and February 2015, in Tehran, a multi-ethnic city. Participants were selected using random digit dialing. Three separate logistic regression models were applied to estimate the adjusted odds ratios (95% CI).ResultsExposure to second-hand smoking was the most prevalent smoking type (37, 95% CI: 35–41%) followed by cigarette (23.9% (95% CI: 21–27%)) and water-pipe smoking (20.25% (95% CI: 18–23%)) in adults in Tehran. Almost 3.3 and 4.5% of adults reported three and two types of lifetime smoking behaviors, respectively. Age, sex, history of depression along with lifetime alcohol intake was the important predictors of all three types of smoking. Lifetime alcohol consumption was associated with increased prevalence of all three types of smoking (p for trend < 0.009). Lifetime drug abuse was also associated with increased prevalence of cigarette smoking (OR = 2.04, 95% CI: 1.61–2.59, p < 0.001).ConclusionsLifetime prevalence of waterpipe, cigarette and exposure to second-hand smoking is moderately high. Dual smoking behaviors are increasing in Iranian adults. An apparent age-related difference in pattern of waterpipe and cigarette smoking was observed. These findings highlight the need for further educational and preventive programs especially for dual smoking in Iranian young adults. This could provide practical information for evaluating and reforming the tobacco control programs and policies in Iran.

Contributions of charcoal, tobacco, and syrup to the toxicity and particle distribution of waterpipe tobacco smoke

The use of waterpipes in the United States is increasing in a largely unregulated market. The shisha smoked in a waterpipe is a complex matrix of tobacco, flavorings, and humectant with smoke generated by an external heat source. This study explored the relationship between shisha components and the particulate matter size distributions and toxicity of smoke generated with heating. Standard waterpipe puff topography of charcoal- or electronic- heated whole shisha and shisha components generated smoke particulate matter that was characterized using a TSI Engine Exhaust Particle Sizer. Relative toxicity of the whole smoke was determined via measurement of lysosomal integrity and measures of membrane integrity following acute exposure of type II alveolar cells at the air-liquid interface. All waterpipe aerosols exhibited a unimodal particle size distribution, the peak and concentration of which varied depending upon the shisha components present. Acute exposure to charcoal-heated whole shisha, flavoring syrup, or humectant smoke, or electronic-heated whole shisha smoke caused significant alveolar cell damage and death, indicating neither tobacco nor charcoal are needed for these cytotoxic effects to occur.

Knowledge and factors related to smoking among university students at Hodeidah University, Yemen.

INTRODUCTIONTobacco smoking, especially among university students, remains a significant issue worldwide. This survey aims to investigate and evaluate the smoking behavior and smoking-related knowledge and their relationship in students of Hodeidah University, Yemen.METHODSA cross-sectional study was performed among students at Hodeidah University. Using a global youth tobacco survey and a global health professional survey, data were collected from three colleges (Commerce and Economics, Engineering, and Medicine) from April to June 2017, from 420 randomly chosen students.RESULTSThe smoking prevalence among university students was 33.1% (cigarettes 13.6%, waterpipe 9.3%, and 10.2% for dual cigarettes and waterpipe use), with a higher rate of smoking among males than females (36.3% vs 28.0%, p<0.001). The percentage of individuals participating in the three types of smoking among males and females, respectively, were 18.9% vs 5.0% for cigarettes, 1.9% vs 21.1% for waterpipe, and 15.4% vs 1.9% for dual cigarettes and waterpipe use, with a student mean age of 21.93 ± 2.55 years. The regression outcome revealed that year of study was highly associated with smoking (OR=0.87, 95% CI: 0.85–0.89, p<0.001). Age (OR=0.96, 95% CI: 0.94–0.99, p<0.05), residence (OR=1.05, 95% CI: 1.00–1.09, p<0.05) and family income (OR=1.03, 95% CI: 1.00–1.06, p<0.05) were also significant predictors of smoking.CONCLUSIONSAccording to this study, most of the male students were cigarette users, while female students were waterpipe users. The prevalence of waterpipe use among females, as opposed to males, is an issue of concern. Policy makers may need to initiate anti-smoking programmes in Yemeni universities.

Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association.

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.

The Attitudinal and Motivational Effects of Anti-waterpipe Messages.

Objectives: Waterpipe smoking can lead to negative health outcomes. In this study, we examined responses to anti-waterpipe smoking public service announcements (PSAs). Methods: In a pilot study, current waterpipe smokers (N = 20) and susceptible waterpipe never smokers (N = 25) were randomized to view either 3 anti-waterpipe PSAs, created by the Truth campaign, or 3 control videos. Participants answered questions pertaining to message acceptance at 3 time-points and perceived risk and motivation to quit or avoid waterpipe at 4 time-points. Results: Participants were recruited from the community (N = 45; Mage = 22.4 years). Whereas waterpipe smokers and never smokers who viewed the PSAs significantly increased in acceptance of (p < .05) and positive attitudes towards (p < .05) the messages with increased viewing of the mes- sages, waterpipe never smokers did so at a significantly higher rate (p < .05). Waterpipe never smokers who viewed the PSAs had increased perceived severity and susceptibility of health harms of waterpipe compared to the control (ps < .05). We also found gender differences. Conclusions: The 3 tested PSAs from the Truth campaign show evidence of effectiveness against waterpipe use.

Waterpipe tobacco smoking trends among middle and high school students in the United States from 2011 to 2017

BackgroundWaterpipe smoking has increased in popularity globally. Despite evidence regarding the harmful effects of waterpipe smoking, there is a common belief that it is less harmful than traditional cigarettes. Little is known about trends in waterpipe use in the U.S. This study examined national trends in waterpipe smoking among middle and high school students. MethodsWe used the 2011–2017 National Youth Tobacco Survey data (n = 140195). For trend analyses, logistic regression was used for the prevalence of waterpipe ever use and current use. Joinpoint regression analysis was performed to identify where significant changes in trend occurred. Additionally, we examined the correlates of waterpipe smoking. ResultsOverall prevalence of adolescent waterpipe ever and current use increased significantly from 7.6% and 2.8% in 2011 to 14.6% and 6.4% in 2014, then decreased significantly to 7.7% and 2.5% in 2017. This trend was consistent in most subgroups including male, female, Hispanic, White, middle school, and high school students. Joinpoint occurred in 2015 for Black adolescents. For example, current waterpipe use increased significantly from 1.4% in 2011 to 4.1% in 2015, declining to 2.5% in 2017. Multivariable analysis showed that cigarette smoking, e-cigarette use, curiosity about waterpipes, and tobacco smoke exposure at home were associated with ever and current waterpipe tobacco use among all participants as well as male and female subgroups. ConclusionsFindings indicate a decreasing trend of ever and current waterpipe tobacco use, which began in 2014 or 2015 for all groups included in the analyses.

Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees

IntroductionFew studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. MethodWe collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. ResultsParticipants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. ConclusionWaterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees.

Soft tissue status and crestal bone loss around conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smokers: 8-years' follow-up results.

We hypothesized that crestal bone loss (CBL) and peri-implant soft tissue inflammation are increased when conventionally-loaded dental implants are placed in cigarette and waterpipe smokers compared to nonsmokers. The present 8-years' follow-up retrospective clinical study evaluated the stability of the conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smoking and nonsmoking population group. Self-reported cigarette-smokers, waterpipe users along with never-smokers have been included. Data pertaining to gender, age, duration and frequency of cigarette-smoking, and usage of waterpipe were collected using a preformed questionnaire. Probing depth (PD), bleeding on probing (BOP), and peri-implant plaque index (PI) were recorded measuring mesial and distal CBL on digital bitewing radiographs. Study power estimated with group comparisons performed using the Kruskal-Wallis and Bonferroni post-hoc adjustment tests. Statistically significant P-values of less than 0.05 were considered. Forty-one cigarette-smokers, forty waterpipe-users, and forty-two never-smokers with mean ages of 44.5 ± 4.3, 41.2 ± 4.7, 43.3 ± 2.8 years, respectively, were included. The mean duration of smoking habit and duration of each session of cigarette-smoking was 5.5 ± 0.3 years and 7.7 ± 1.2 minutes, respectively. The mean period of waterpipe use and time of each session of was 10.6 ± 0.8 years and 20.2 ± 3.1 minutes, respectively. Among cigarette-smokers, waterpipe-users and never-smokers, the implants had been in function for 8.5 ± 0.3, 8.6 ± 0.3, and 8.5 ± 0.5 years, respectively. PD, CBL, and peri-implant PI were positively more among cigarette and waterpipe smoking users (P < 0.05) than with never-smokers. Peri-implant bleeding on probing was significant among never-smokers (P < 0.05) compared to waterpipe-users and cigarette-smokers. There was no difference in Peri-implant PI, PD, and CBL in cigarette-smokers and waterpipe-users. Cigarette-smokers and waterpipe users are vulnerable to peri-implant soft tissue inflammation and CBL than never-smokers. There is no variation in the severity of peri-implant soft tissue inflammation and CBL in waterpipe and cigarette users.

Tobacco and waterpipe use among university students in Saudi Arabia: impact of tobacco sales ban.

Waterpipe smoking is a method of tobacco consumption that continues to spread globally. In 2002, a ban of tobacco sales was adopted in the Saudi Arabian cites of Mecca and Medina. This study aimed to examine prevalence of waterpipe and cigarette smoking among students of Taibah University, the biggest in Medina, where the tobacco sales ban has been implemented. A structured questionnaire was distributed between February and April 2015 to examined tobacco use among Taibah University students. The prevalence of current and ever waterpipe use was 24.2% and 36.04%, respectively, compared with 31.9% and 42.7% for current and ever cigarette smoking. This prevalence is similar to that reported in other Saudi cities where tobacco sales are allowed. Multivariate analysis showed that waterpipe use was higher among senior students; those with pocket money spending of > 500 Saudi Arabia riyal (SAR)/month; and if > 5 individuals were living in the household. In addition, waterpipe use was lower among students with monthly household income of 5000-9000 SAR. In contrast, current cigarette smoking was more frequent in those aged > 22 years; among male students; in those with pocket money spending of > 500 SAR/month; and those who lived away from their parents. Waterpipe and cigarette smoking, despite the ban on tobacco sales, is still common among Taibah University students in Medina, Saudi Arabia.

Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents

Introduction: Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents ‘attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use. Methods: Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis. Results: Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one’s owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents’ and siblings’ smoking behaviors influenced adolescent waterpipe use. Conclusion: Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.

Effectiveness of a Peer-Led Behavioral Intervention Program on Tobacco Use-Related Knowledge, Attitude, Normative Beliefs, and Intention to Smoke among Adolescents at Iranian Public High Schools.

Background:Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14–17 years old.Methods:A school-based cluster randomized controlled intervention study was conducted among 1st, 2nd, and 3rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students’ smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire.Results:The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention.Conclusions:Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.

Application of Social Cognitive Theory to Prevent Waterpipe Use in Male High-school Students in Kerman, Iran.

Background:The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents.Methods:This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking.Results:Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention.Conclusions:Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.