Waterpipe Use Research Articles

Gastroesophageal Disease and Environmental Exposure: A Systematic Review.

Environmental exposure-associated disease is an active area of study, especially in the context of increasing global air pollution and use of inhalants. Our group is dedicated to the study of exposure-related inflammation and downstream health effects. While many studies have focused on the impact of inhalants on respiratory sequelae, there is growing evidence of the involvement of other systems including autoimmune, endocrine, and gastrointestinal. This systematic review aims to provide a recent update that will underscore the associations between inhalation exposures and upper gastrointestinal disease in the contexts of our evolving environmental exposures. Keywords focused on inhalational exposures and gastrointestinal disease. Primary search identified n = 764 studies, of which n = 64 met eligibility criteria. In particular, there was support for existing evidence that PM increases the risk of upper gastrointestinal diseases. Smoking was also confirmed to be major risk factor. Interestingly, studies in this review have also identified waterpipe use as a significant risk factor for gastroesophageal reflux and gastric cancer. Our systematic review identified inhalational exposures as risk factors for aerodigestive disease, further supporting the association between environmental exposure and digestive disease. However, due to limitations on our review's scope, further studies must be done to better understand this interaction.

Waterpipe Tobacco Smoking and Multiple Sclerosis: A Systematic Review and Meta-Analysis.

Multiple sclerosis (MS), as an autoimmune disease of the central nervous system, has a significant burden among people worldwide. Tobacco smoking is one of the most prevalent habits of patients with different diseases including those with MS, and among the methods of use, waterpipe tobacco smoking is gaining popularity. Herein, we aimed to systematically evaluate the association between waterpipe smoking and MS. Relevant studies were identified to be included in this systematic review and meta-analysis through a systematic search in PubMed, Scopus, Web of Science, and Embase. Studies were screened by the title/abstract and then by their full text. Extraction of data was performed for relevant studies. Odds ratios (ORs) and their 95% confidence intervals (CIs) of the association between waterpipe smoking and MS were used to pool the results observed in each study. After the screening, a total of five studies were included in our systematic review, comprised of 3,087 individuals, among which there were 1,135 cases with MS. Random-effect meta-analysis revealed that ever-smoking waterpipe had a significant association with MS (OR: 1.73, 95% CI: 1.38-2.17, p value <0.0001). Similarly, past waterpipe smoking was significantly higher in those with MS, compared with controls (OR: 2.17, 95% CI: 1.61-2.92, p value <0.0001). Based on the reported results, smoking both tobacco and waterpipe had an additive association with MS. Finally, no association was found between the Expanded Disability Status Scale (EDSS) and waterpipe smoking. Waterpipe as one of the common ways of tobacco smoking becoming popular has an association with MS, and even the use of waterpipe for a certain period in the lifetime has a significant correlation with MS. Further large-scale studies are needed to confirm these findings. These results could help clinicians in risk-stratifying the patients and to provide better care for the MS population.

Cigarettes and waterpipe use and risk of colorectal cancer in Iran: the IROPICAN study.

We aimed to investigate the association between cigarettes and waterpipe use and colorectal cancer (CRC) in an Iranian population. We analyzed data from a multicenter hospital-based case-control study in Iran (IROPICAN). Data on tobacco smoking, including cigarettes, and waterpipe smoking, were collected in detail. Multivariate logistic regressions estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between cigarette and waterpipe smoking and CRC, accounting for confounders including age, sex, socioeconomic status, opium use, marital status, family history of cancer, red meat, fiber, body shape at age 15 and perceived physical workload, and each other of the two exposures. The study population consisted of 3215 controls and 848 cases, including 455 colon and 393 rectum cancers. We found no association between CRC and cigarette smoking (OR, 0.8; 95% CI, 0.6-1.0) or waterpipe smoking (OR, 1.1; 95% CI, 0.9-1.5). Analysis by categories of cigarette pack-year and frequency of waterpipe smoking (head-year) did not show associations. We observed an inverse association between colon cancer and cigarette smoking (OR, 0.6; 95% CI, 0.5-0.9). There was, however, no significant association by pack-year categories. Cigarette and waterpipe smoking was not associated with CRC in the Iranian population. Further studies are needed to better understand the role of waterpipe on CRC.

Assessing the Causal Relationship between Waterpipe Smoking and Bladder Cancer.

Rates of waterpipe use increase with very little data reporting any potential health consequences. The current study, a large case-control study, of 4,194 patients from Iran denotes an elevated risk of bladder cancer in exclusive waterpipe smokers compared with non-users. Additional studies are needed to further understand the risk waterpipe smoking has on bladder cancer. See related article by Hadji et al., p. 509.

Presence of microplastics in the groundwater of volcanic islands, El Hierro and La Palma (Canary Islands)

The increasing amount of plastic litter worldwide is a serious problem for the environment and its biodiversity, ecosystems, animal and human welfare and the economy. The degradation of these plastics leads to microplastics (MPs), which have been reported for the first time in groundwater in the Canary archipelago. This research investigates the presence of MPs at nine different points on La Palma and El Hierro, where samples were collected in galleries, wells and springs during the month of December 2022. Six different polymers were found with Fourier transform infrared spectroscopy (FTIR) – polypropylene (PP), polyethylene (PE), cellulose (CEL), polyethylene terephthalate (PET), polystyrene (PS) and polymethyl methacrylate (PMMA). The particle concentrations found ranged from 1 to 23 n/L, with a maximum particle size of 1900 μm, the smallest being 35 μm. PP and PE were the most common polymers found in the analysis, associated with the use of packaging, disposable products, textiles and water pipes, related to poorly maintained sewerage networks where leaks occur, allowing these MPs to escape into the environment and end up in groundwater. The detection of microplastic pollution in groundwater emphasises environmental hazards, including biodiversity disruption and water source contamination. Additionally, it presents potential risks to human health by transferring contaminants into the food chain and through respiratory exposure.

Portfolio analysis of global tobacco control research funding at the National Cancer Institute, 2000-2019.

Research in low- and middle-income countries (LMICs), where the majority of global tobacco users reside, is critical to addressing the global tobacco epidemic. This analysis describes the global tobacco control research portfolio funded by the National Cancer Institute from fiscal years 2000 to 2019. We used the National Institutes of Health Query, View, Report database to identify extramural grants relevant to global tobacco control research. Abstracts were analyzed to describe grant characteristics, including topic areas, tobacco products, countries, and regions of focus. Bibliometric and co-authorship network analyses were performed for publications associated with relevant grants. Of the 93 relevant grants with foreign (non-US) involvement, the majority (83.9%) supported research in upper and lower middle-income countries. The majority of grants (86.0%) focused on cigarettes, with a small subset of grants addressing smokeless tobacco, waterpipe use, or other non-cigarette products. Most grants focused on at least one of the six tobacco control policy measures in the World Health Organization MPOWER package; almost half (48.4%) focused on monitoring tobacco use and around one-third (32.3%) focused on offering tobacco cessation treatment, while other MPOWER measures received less attention in the research portfolio. While most of these grants, and the funding initiatives that supported them, emphasized research in low- and middle-income countries (LMICs), only 3 of 93 grants were awarded directly to LMIC-based institutions. There is a critical need for research to develop and test strategies to adapt, implement, and scale up evidence-based interventions across diverse LMIC settings. This study identified gaps in research activity that should be addressed to strengthen global tobacco control research capacity.

The Diversity in Tobacco Use Among Women of Reproductive Age (15-49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016-2018.

Tobacco use in women of reproductive age group (15-9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI -1.6 to -0.1) lower whereas it was 0.33 kg (95% CI -0.9 to 0.3) higher for ST users. Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

Prevalence and Incidence of Metabolic Syndrome and Its Components Among Waterpipe Users.

To determine the associations between waterpipe use, duration, and intensity of use with prevalence and incidence of metabolic syndrome and its components (increased waist circumference, triglycerides, fasting glucose, blood pressure and decreased high-density lipoprotein cholesterol). We conducted cross-sectional and prospective analyses using data from the Pars Cohort Study in southern Iran, encompassing 9,264 participants at the baseline, and 5,002 randomly selected in a repeated follow-up. We used multivariate logistic regression models adjusted for age, sex, education, wealth score, physical activity and cigarette pack-years to report odds ratios (OR) and 95% confidence intervals (CI). Among 9,264 participants, 3,119 (33.7%) had metabolic syndrome, and 3,482 (37.6%) had ever smoked waterpipe, with both more common in women than in men. In adjusted models, former waterpipe use was significantly associated with prevalence (OR = 1.43, 95% CI: 1.23-1.68) and incidence (OR = 1.57, 95% CI: 1.19-2.06) of the metabolic syndrome while current waterpipe use was not. Past use was associated with increased risk in all components of metabolic syndrome; current use was associated with increases in all except high blood glucose and hypertension. Past waterpipe users had higher waterpipe use intensity (before quitting) in comparison with current users (2.3 vs. 2.0 waterpipes per day, p < 0.01) and had started waterpipe smoking at a younger age (27.2 vs. 30.1years, p < 0.01). Waterpipe use was associated with metabolic syndrome and its components, especially among former users potentially due to higher intensity and earlier initiation of use.

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study.

The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss. A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis. Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers. The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.

Insights into Cigarette and Waterpipe Use among Houston-Based Arab Immigrants and Refugees

Insights into Cigarette and Waterpipe Use among Houston-Based Arab Immigrants and Refugees

Parental Smoking, Water Pipe and Alcohol Use Before Childbirth and Multiple Sclerosis Onset: A Case-Control Study

Parental Smoking, Water Pipe and Alcohol Use Before Childbirth and Multiple Sclerosis Onset: A Case-Control Study

Effects of Pictorial Health Warning Labels on Intention to Quit Waterpipe in Lebanon: A Mediation Analysis.

Pictorial health warning labels (HWLs) on waterpipe (WP) tobacco packages represent a better strategy for communicating the health risks associated with WP use and promoting quit intention than text-only. However, the mechanism by which these warnings lead to higher intentions to quit remains unknown. This study explores how pictorial warnings versus text-only induces higher quit intention among a sample of young adult WP smokers in Lebanon. An online randomized cross-over experimental study was conducted in August 2021 among 276 young adult WP smokers who were exposed to two conditions: pictorial HWLs and text-only warnings on WP tobacco packages in random order. After each image, participants completed post-exposure assessments of health communication outcomes (eg, attention and negative affect). Using serial and parallel mediation analysis, we examined the role of attention, negative affect, cognitive elaboration, and perceived harm in mediating the relationship between exposure to HWLs and intention to quit. Using serial mediation, exposure to pictorial warnings versus text-only was found to affect intention to quit through the following pathways: attention and negative affect, which accounted for 17.28% of the total effect, and through negative affect and cognitive elaboration, which accounted for 21.53% of the total effect. Results of parallel mediation showed that the indirect effect pathways via negative affect (β = 0.063; [95% bootstrap CI = 0.004 to 0.149]) and cognitive elaboration (0.047; [0.001 to 0.114]) were statistically significant. The findings call on designing and implementing attention-grabbing, emotionally evocative, and cognitively persuasive pictorial warnings in Lebanon and other countries to curb WP tobacco smoking. This is among the first experimental studies looking at multiple mediators underlying the effect of exposure to pictorial HWLs on intention to quit in a sample of current WP smokers in Lebanon. The findings showed that using attention-grabbing, emotionally evocative, and persuasive pictures with a clear textual warning is crucial to maximizing the impact of implementing WP-HWLs regulations in Lebanon and other countries to curb WP tobacco smoking.

Enrichment characteristics and environmental risk assessment of heavy metals in municipal sludge pyrolysis biochar

Pyrolysis treatment of municipal sludge is a promising sludge treatment technology. However, due to the presence of heavy metals in sludge, the practical application of sludge pyrolysis products, especially biochar, is greatly affected. In this paper, the enrichment characteristics of different heavy metals in municipal sludge and its pyrolysis biochar and their leaching characteristics in the environment were studied. The environmental risks of municipal sludge and biochar were also assessed. The experimental results revealed that pyrolysis would promote the enrichment of different heavy metals in sludge in pyrolysis biochar. And with higher pyrolysis temperature, the enrichment is stronger. But for metals with high volatility such as Hg, Cd, Se, increasing the pyrolysis temperature will reduce their enrichment. Pyrolysis can inhibit the heavy metals in sludge leaching, and the effect of pyrolysis temperature on different kinds of heavy metals is different. The leaching rates of Se, As and Cr first increased and then decreased as the temperature of pyrolysis increased. The leaching rate of Cd increased as the temperature of pyrolysis increased. Considering the leaching rate of each heavy metal, the leaching toxicity of heavy metals in pyrolysis biochar is the lowest at the pyrolysis temperature of 400 °C. The risk assessment of municipal sludge and biochar revealed that the most harmful heavy metals in the original sludge were Hg, Cd and Se, followed by Cu and Zn. Sludge pyrolysis into biochar can reduce the content of Hg, Cd and Se. The use of copper and zinc water pipes should be reduced for sewage pipe laying to decrease the contents of Cu and Zn in municipal sludge.

Tobacco Use, Quitting, and Service Access for Northern California Arab Americans: A Participatory Study

Abstract: Background: Cigarette smoking rates have decreased in the United States, particularly in California. Despite representing a large population in the United States and particularly in California, Arab Americans are not typically assessed in tobacco-related health studies. Disparately high smoking rates have been found in community samples of Arab Americans. In a formative participatory research study, we aimed to assess experiences with tobacco products and access to cessation and prevention services for Arab Americans who use commercial tobacco products. Methods: In partnership with a community advisory board, we conducted a brief survey of adult Northern California Arab Americans who use tobacco products, both men and women ( n = 101), followed by assets mapping to identify services, and focus groups with a subset of survey participants ( n = 30), to assess tobacco product use, readiness to quit, and access to culturally appropriate cessation services. Results: The majority of people who smoked did so daily. Waterpipe use was as common as cigarette smoking, and more so for women. Intent to quit was offset by highly normative tobacco use in the social environment, and limited access to culturally appropriate cessation services. Conclusions: Improvement in outreach and services specific to Arab Americans may support prevention and cessation of commercial tobacco products.

Smoking waterpipe, cigarette, and heart disease: a cross-sectional analysis of baseline data from the Kong Cohort Study in the South of Iran

Previous studies have shown the association between smoking and increased risk of cardiovascular diseases, but long-term effects of waterpipe use are unknown and more research is needed. The present study explored the relationship between cigarette and waterpipe smoking and heart disease in southern Iran. This cross-sectional study used the basic data of Bandar Kong Cohort Study (KCS) to test the relationship between waterpipe and cigarette smoking and heart disease in 4009 participants. A multivariate binary logistic regression was run to estimate adjusted odds ratios (ORs) in SPSS 16. The prevalence of tobacco use was 27.7%. The frequency of heart disease was 7.8% percent (n = 314). There was a statistically significant relationship between cigarette smoking and heart disease (OR = 2.11; 95% CI:1.41–3.16). In individuals who only smoked waterpipes, the odds of heart disease were higher than non-smokers. This relationship was not statistically significant (OR = 1.25, 95% CI:0.88–1.78). In those who smoked cigarettes and waterpipe at the same time, the odds of heart disease were higher than non-smokers (OR = 1.42; 95% C.I: 0.83–2.59). In general, cigarette smoking increases the risk of heart disease. As well as waterpipe smoking was associated with heart disease. However, this association was not statistically significant. More studies are required to validate the association between waterpipe smoking and heart disease. Also, waterpipe use was more common at younger ages, and on the other hand, heart diseases have a long latent period, so in this age group, high incidence of heart disease is likely in the future.

Antibodies against Neisseria meningitidis serogroups A, C, W and Y in serum and saliva of Norwegian adolescents

IntroductionThe incidence of invasive meningococcal disease (IMD) among Norwegian 16–19-year-olds was 1–7/100,000 in the decade before the COVID-19 pandemic, with serogroup Y (MenY) dominance. In contrast to many other European countries, meningococcal vaccines are not part of the national immunisation program (NIP) in Norway. This cross-sectional study aimed to measure the degree of natural immunity against Neisseria meningitidis among adolescents in Norway to evaluate the need for introducing tetravalent meningococcal conjugate vaccine (MCV4) in the NIP. Materials and methodsSerum and saliva samples were collected from students in upper and lower secondary schools in Norway in 2018. Samples were analysed for meningococcal capsular polysaccharide (PS)-specific antibodies using a bead-based multiplex immunoassay. PS-specific antibody levels were linked to data on meningococcal carriage, vaccination status and risk factors for carriage (assessed with questionnaire) and analysed by linear regression of log transformed concentrations. A subset of samples from unvaccinated individuals was analysed for serum bactericidal antibodies (SBA). ResultsA total of 1344 participants, median age 16 years (range 12–24), were included in the study. Overall, 60.9% of the participants were female and 1137 (84.6%) were not vaccinated with MCV4. PS-specific antibody concentrations in serum and saliva were low among unvaccinated individuals for all serogroups and only 6.7–20.0% of the subpopulation with high PS-specific antibodies assessed with SBA had protective levels. Unvaccinated MenY carriers had higher levels of MenY anti-PS IgG in serum and IgA in saliva than those not carrying MenY. Use of Swedish snus was associated with lower anti-PS IgG levels in serum and waterpipe use with lower anti-PS IgG levels in saliva. ConclusionUnvaccinated adolescents in Norway have a low degree of natural immunity against the serogroups of N. meningitidis predominating among cases of IMD in this age group. Therefore, introduction of MCV4 for adolescents in the NIP is recommended.

Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use

Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants. Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults? We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48%female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vsbefore exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression. Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13mmHg [95%CI, 1.91-6.36mmHg]; aortic systolic BP by 2.31mmHg [95%CI, 0.28-4.33mmHg]; brachial diastolic BP by 3.69mmHg [95%CI, 1.62-5.77mmHg]; aortic diastolic BP by 3.03mmHg [95%CI, 0.74-5.33mmHg]; and HR by 7.75 beats/min [95%CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02%vs3.06%; P= .03), including after adjusting for BMI and family history of cardiovascular disease (β= 6.12; 95%CI, 0.55-11.69; P= .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day× water-pipe use duration) in water-pipe-years (β= 2.51/water-pipe-year; 95%CI, 0.10-4.92/water-pipe-year; P= .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS. In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.

National screening for anxiety and depression in Saudi Arabia 2022.

Mental health disorders, such as major depressive disorder (MDD) and generalized anxiety disorder (GAD), represent a significant public health concern in Saudi Arabia. This study aims to provide a recent mental health screening prevalence, including anxiety and depression screening in the general public and to explore the associated risk factors. A cross-sectional study was conducted, employing a phone interview survey with 6,015 participants, using a quota sampling strategy to ensure equal representation of both sexes and administrative regions. The study assessed the prevalence of MDD and GAD risk and examined demographic, socioeconomic, and lifestyle factors associated with these mental health disorders. The national prevalence of people at risk of MDD and GAD were found to be 12.7 and 12.4%, respectively. Low diagnosis and treatment rates were observed, with only 1.5 and 0.5% of participants currently diagnosed and treated for depression and anxiety, respectively. Risk factors for MDD and GAD included female sex, lower education and income levels, smoking, and waterpipe use. Protective factors included physical activity, participation in volunteering activities and the practice of daily hobbies in the last 30 days. The relatively high prevalence of MDD and GAD risk and low diagnosis and treatment rates in Saudi Arabia emphasize the need for increased mental health promotion, early detection, and treatment accessibility. The study highlights the importance of addressing modifiable risk factors and fostering protective factors through targeted interventions. Future research should focus on longitudinal associations, potential mediators and moderators, and the development of culturally appropriate and evidence-based interventions to enhance mental health outcomes in the region.

Interventions for waterpipe smoking cessation.

Interventions for waterpipe smoking cessation.

Motivation to stop smoking in the German population between 2016 - 2021 and associated factors: results from a repeated cross-sectional representative population survey (German Study on Tobacco Use, DEBRA study)

ObjectivesWe aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the...