Electronic hookah (waterpipe) vaping reduces vascular endothelial function: the role of nicotine.

Vaping has risen substantially in recent years, particularly among young adults. Electronic (e-) hookahs are a newer category of vaping devices touted as safer tobacco alternatives. Although e-hookah vaping acutely reduces endothelial function, the role of nicotine and the mechanisms by which it may impair endothelial function remain understudied. In a randomized crossover study, we investigated the acute effects of vaping e-hookah, with and without nicotine, as compared with sham on endothelial function assessed by brachial artery flow-mediated dilation (FMD), among 18 overtly healthy young adults. To determine the role of changes in circulating factors in plasma on endothelial cell function, human umbilical vein endothelial cells (HUVECs) were cultured with participants' plasma, and acetylcholine-stimulated nitric oxide (NO) production and basal reactive oxygen species (ROS) bioactivity were assessed. Plasma nicotine was measured before and after the sessions. E-hookah vaping with nicotine, which acutely increased heart rate (HR) by 8 ± 3 beats/min and mean arterial pressure (MAP) by 7 ± 2 mmHg (means ± SE; P < 0.05), decreased endothelial-dependent FMD by 1.57 ± 0.19%Δ (P = 0.001), indicating impairment in endothelial function. Vaping e-hookah without nicotine, which mildly increased hemodynamics (HR, 2 ± 2 beats/min and MAP 1 ± 1 mmHg; P = ns), did not significantly impair endothelial function. No changes were observed after sham vaping. HUVECs cultured with participants' plasma after versus before e-hookah vaping with nicotine, but not without nicotine or sham vaping, exhibited reductions in endothelial cell NO bioavailability and increases in ROS bioactivity (P < 0.05). Plasma nicotine concentrations increased after vaping e-hookah with nicotine (6.7 ± 1.8 ng/mL; P = 0.002), whereas no changes were observed after vaping e-hookah without nicotine or sham (P = ns). Acute e-hookah vaping induces endothelial dysfunction by impairing NO bioavailability associated with increased ROS production, and these effects are attributable to nicotine, not to nonnicotine constituents, present in the flavored e-liquid.NEW & NOTEWORTHY Despite safety claims heavily advertised by the hookah tobacco industry, acute e-hookah vaping induces in vivo endothelial dysfunction by impairing ex vivo NO bioavailability associated with increased ROS production. These effects are attributable to nicotine, not to nonnicotine constituents, present in the flavored e-liquid.

Waterpipe smoking is associated with presence and severity of coronary artery disease: a propensity score-matched study.

BACKGROUND: The prevalence of waterpipe smoking (WPS) has been increasing worldwide. This trend is alarming as WPS can negatively impact cardiovascular health. In the present study, we explored the association between WPS and the presence and severity of CAD. METHODS: This study was a retrospective analysis of patients who underwent diagnostic coronary angiography at Tehran Heart Center between April 2021 and May 2022. Patients with a previous history of percutaneous coronary intervention and coronary surgery were excluded. Waterpipe smokers were matched with non-smokers based on age, gender, and cigarette smoking using a 1:4 propensity score matching model. Stenosis ≥ 50% in any coronary artery was considered a CAD diagnosis. Gensini score was also calculated to measure the severity of the CAD. RESULTS: We reviewed the medical records of 8699 patients, including 380 waterpipe smokers. After matching, 1520 non-smokers with similar propensity scores to the waterpipe smokers were selected. Waterpipe smokers were more likely to have CAD than non-smokers (OR: 1.29; 95% CI: 1.04-1.60, P = 0.021). In addition, WPS increased the natural logarithm of the Gensini score by 1.24 (95% CI: 1.04-1.48, P = 0.014) in patients with atherosclerotic coronary disease. CONCLUSION: WPS may increase the risk of CAD independent of age, gender, and cigarette smoking. In addition, among patients with any degree of atherosclerosis in coronary arteries (GS > 0), WPS may lead to higher average GS, suggesting more severe atherosclerosis.

Prevalence and factors associated with second hand smoke exposure among a sample of pregnant women in Cairo, Egypt.

PURPOSE: This study estimated the prevalence of and factors associated with secondhand smoke (SHS) exposure, and assessed attitudes and knowledge about SHS among pregnant women in Cairo, Egypt. METHODS: Pregnant women in the third trimester were recruited to participate in a survey assessing tobacco smoking and SHS exposure during their current pregnancy. Participants were recruited from three antenatal clinics in Cairo, Egypt, from June 2015 to May 2016. We examined differences in sociodemographic characteristics and SHS exposure, attitudes, and knowledge by smoking/SHS status. We used multivariable ordinary least squares regression to examine the association between husbands' smoking and pregnant women's mean daily hours of SHS exposure, adjusting for women's smoking status, age group, education, and urban (vs. suburban/rural) residence. RESULTS: Of two hundred pregnant women aged 16-37 years, about two-thirds (69%) had a husband who smoked tobacco. During their current pregnancy, most women reported being non-smokers (71%), and 38% of non-smokers reported being SHS-exposed. Non-smokers exposed to SHS tended to live in more rural areas and have husbands who smoked in the home. In adjusted analyses, having a husband who smoked was significantly associated with a greater mean number of hours of SHS exposure per day exposed, and this difference was driven by husbands who smoked in the home (p < 0.001). Women in the SHS-exposed group were less likely than other groups to agree that SHS exposure was harmful to their own or their future child's health; however, all groups agreed that SHS was harmful to newborn health. CONCLUSION: Among our sample of pregnant women in Cairo, Egypt, there was a high rate of SHS exposure as well as misconceptions about the safety of SHS exposure to a developing fetus. Our findings suggest a need for targeted education and gender-sensitive messaging about SHS exposure, along with improved enforcement of existing tobacco control policies.

Exposure to secondhand smoke (SHS) remains a major contributor to health problems in pregnant women and their children. Using a survey, this study sought to estimate how many pregnant women in Cairo Metropolitan Area, Egypt, were exposed to SHS and the factors contributing to that exposure, and to assess attitudes towards SHS. During their current pregnancy, 38% of non-smokers reported being exposed to SHS. Non-smokers exposed to SHS tended to live in more rural areas and have husbands who smoked in the home. Having a husband who smoked as well as a husband who smoked in the home was significantly associated with a greater average number of SHS exposure hours per day. Women in the SHS-exposed group were less likely than other groups to agree that SHS exposure was harmful to their own or their future child's health; however, all groups agreed that SHS was harmful to newborn health. Among pregnant women in Cairo, Egypt, there is a high rate of SHS exposure­often driven by SHS exposure in the home­as well as misconceptions about the safety of SHS exposure to a developing fetus. There is a need for targeted education and gender-sensitive messaging about SHS exposure along, with improved enforcement of existing tobacco control policies.

Determining the perceived risk of lung cancer and chronic obstructive pulmonary diseases (COPD) among hookah users in Iran.

BACKGROUND: Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. METHODS: This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. RESULTS: The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (ß = 3.14, p < 0.0001), 2 or more use of hookah in past month (ß=-3.41, p = 0.025), unskilled workers (ß = 1.79, p = 0.017), married smokers (ß=-1.31, p = 0.026), negative attitude toward hookah (ß = 0.46, p < 0.0001) were the predictive variables regarding to lung cancer perceived risk. In line with COPD the using other type of tobacco (ß = 3.47, p < 0.0001), once a month use of hookah in past month(ß=-3.74, p = 0.041) and twice or more use of hookah in past month (ß=-4.82, p = 0.008), smokers in contemplation stage (ß = 3.91, p < 0.0001), female smokers (ß = 3.08, p < 0.0001), unskilled workers (ß = 2.42, p = 0.007), negative attitude toward hookah (ß = 0.46, p < 0.0001) were the predictive variables to COPD perceived risk. CONCLUSION: In general, the perceived risk of developing lung cancer and COPD among hookah users was low. Therefore, it is necessary to provide widespread information about the potential harm of hookah in causing lung cancer and COPD, at the community level.

A qualitative exploration of experts' views about multi-dimensional aspects of hookah smoking control in Iran.

BACKGROUND: The related literature has primarily addressed cigarette smoking control. It seems that researchers have failed to explore the determinants of hookah smoking (HS) control. In an attempt to fill this gap, the present study explores experts' views about aspects of HS control in Bandar Abbas, a city in the south of Iran. METHODS: The present qualitative study, conducted in 2022 and 2023, used a content analysis. To this aim, 30 experts in tobacco prevention and control were invited to participate in the research. Twenty seven accepted the invitation. In-depth, semi-structured, and face-to-face interviews were held with the experts. A purposive sampling was used and the data collection continued until data saturation. The interviews lasted between 18 and 65 min. MAXQDA 10.0 was used for data management and analysis. RESULTS: The expert interviewees had a mean age of 44.77 ± 6.57 years and a mean work experience of 18.6 ± 6.8 years. A total number of six main categories were extracted from the data, including usin influential figures to control HS, controlling HS by alternative activities, changing beliefs and attitudes toward HS, taking administrative and regulatory measures, and facilitating HS cessation. CONCLUSION: This qualitative study explored the multifaceted ways people adopt to quit HS. Using influential figures to control hookah smoking, promoting alternative activities as a means of control, changing beliefs and attitudes, enforcing administrative regulations, and facilitating quit attempts all play an important role in tackling the prevalence of hookah smoking. These findings emphasize the importance of a comprehensive and multifaceted approach to integrate various interventions to effectively address hookah smoking behavior.

Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study.

Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.

The Burden and Correlates of Waterpipe (Hookah) Smoking among Adolescents and Youth: A Systematic Review.

BACKGROUND: This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations. METHODS: PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10-24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982). RESULTS: A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10-24 years age group was noted to be 18.16% (95% CI, 18.03-18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34-6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers. CONCLUSION: Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.

Differences in Presenting Health Warning Labels on Hookah Venue Menus Between Immersive Virtual Reality and Online Surveys.

BACKGROUND: Virtual reality (VR) platforms can simulate the real world, whereas online surveys are efficient settings for assessing and testing information. In this study, the effects of presenting health warning labels (HWLs) on hookah venue menus were compared between these two message-testing settings. METHODS: Separate studies were conducted in VR (n = 96) and online survey (n = 213) settings. Participants in both studies were randomly assigned to view menus with or without HWLs. This secondary data analysis compared outcomes between settings after propensity score weighting to account for differences in age, race, marital status, and education between studies. RESULTS: Significant between-study differences were noted for the effects of HWLs on people's perceptions of the absolute harm of hookah smoking (p = 0.0363), the relative harm of hookah compared to cigarettes (p < 0.001), the absolute addictiveness of hookah (p < 0.001), and the relative addictiveness of hookah compared to cigarettes (p = 0.0352). When outcome variables differed significantly between the HWL and control conditions in only one of the two studies, smaller p-values were identified for the online survey setting than for the VR setting. CONCLUSIONS: This study represents the first direct comparison of the effects of hookah HWLs between two message-testing settings. HWLs tested in the online survey setting were associated with larger shifts in attitudes and beliefs than those tested in the VR setting, suggesting that the effectiveness of hookah HWLs on attitudes and beliefs may be moderated by the message-testing platform. Additional real-world experiments remain necessary to determine whether either setting can accurately assess the effectiveness of HWLs.

Peronia peronii as a bio-indicator to assess the toxicity of waterpipe tobacco leachates in aquatic and sediment media.

This study was aimed to survey toxicity of waterpipe wastes leachates on Peronia peronii in aquatic and sediment environments as two exposure media. For this, leachates of four tobacco types including burnt traditional tobacco (BTT), fresh traditional tobacco (FTT), burnt fruit-flavored tobacco (BFT) and fresh fruit-flavored tobacco (FFT)) were prepared and used to assess their toxic effects on P. peronei in two aquatic and sediment media. The in-vivo toxic effects of five different concentrations of waterpipe tobacco waste leachates on P. peronii were evaluated. The LC50 values of BTTs leachates to P. peronii were 17.50, 16.05, 11.31 and 9.38 g/L at exposure times of 24, 48, 72 and 96 h, respectively in aquatic media. These values for BFTs leachates were 14.86, 12.38, 9.53 and 7.46 g/L at exposure times of 24, 48, 72 and 96 h, respectively. In the case of sediment media, the LC50 values of BTTs leachates were 15.33, 13.70, 9.09 and 6.70 g/L at exposure times of 24, 48, 72 and 96 h, respectively while these values for BFTs leachates were 12.00, 10.32, 8.20 and 5.65 g/L. Fruit-flavored tobacco leachates had significantly higher toxicity than traditional tobacco leachates for P. peronii. The findings also showed significant differences between the LC50 values of different leachates in different media of water and sediment. The results demonstrated that even small amount of tobacco waste (~ 5 to 6 g/L) can lead to P. peronii mortality and may also pose a hazard to other aquatic and benthic organisms. The results obtained from the present study can be used as a baseline data to assess local effects causing from unsafe disposal of post-consumption tobacco waste in beach areas. In addition, these findings can lead to encouraging decision-makers to focus more on the types of tobacco waste in the municipal solid waste management system and to implement a source separation process for these wastes.

Knowledge, attitude, and frequency of hookah smoking among medical students.

BACKGROUND: Hookah or waterpipe smoking use is a developing trend in the many populations, especially among the young age group. Hookah users are exposed to many of the same toxic compounds or by-products as cigarette users with a higher level of harmful effects. AIM OF THE STUDY: To assess frequency, knowledge, attitude health behavior toward the risks and complication of cigarettes smoking and hookah in particular of Al-Kindy medical students. MATERIALS AND METHODS: A cross-sectional study was conducted from December 2022 to April 2023 to assess frequency of Hookah smoking among 507 medical students at Al-Kindy Medical College. An online questionnaire by Google forms was used to collect the data. RESULTS: The total participants students were 507 who studied at Al-kindy College of Medicine in different stages. Males were constituted 63.1% and the rest were females (36.9%). Regarding smoking habit, 31.95% (162) of them were smoker and the rest 68.05% (345) were not smoker(p = 0.000). Most of them had mixed type of smoking (cigar, hookah, and vape) (14.19%). (0.000) that it had an effect on general health (46.1%), lung (68.8%), larynx (67.1%), heart, blood pressure, diabetes but not bladder, stomach, COVID-19 transmission. There is a significant increase (63.5%) (p = 0.000) regarding their attitude that hookah had a significant amount of tobacco, no benefit of fruity flavors (62.3%), and no relaxation effect (90.53%). CONCLUSIONS: There is a significant decrease in smoking habits among medical students due to their knowledge of its negative effects on health.

Effect of educational intervention based on theory of planned behaviour on promoting preventive behaviours of oral cancer in rural women.

BACKGROUND: Oral cancer has created an alarming situation around the world, and being the 16th most common cancer worldwide, it has become a global concern. The present study aimed to investigate the effect of educational intervention based on a theory of planned behavior (TPB) on promoting preventive behaviors of oral cancer in rural women. METHODS: This quasi-experimental study was conducted on 120 female hookah users referring to rural health centers in Fasa and Shiraz city, Fars province, Iran. The subjects were divided into experimental and control groups by simple random sampling. The educational intervention for the experimental group consisted of 8 training sessions of 50 min. Both groups completed a questionnaire including demographic characteristics and constructs of TPB before and four months after the educational intervention. Data were analyzed using SPSS 22 software through independent t-test, chi-square, and paired t-test (p = 0.05). RESULTS: The mean age of the experimental and control group subjects were 41.12 ± 8.86 and 40.63 ± 9.62 years, respectively (p = 0.185). The mean age of onset of hookah use in the experimental and control group was 24.16 ± 9.50 and 23.35 ± 9.44 years, respectively (p = 0.182). Also, before the educational intervention, there was a significant difference between the experimental and control groups in terms of knowledge (p < 0.189), attitude (p < 0.122), perceived behavioral control (p < 0.142), subjective norms (p < 0.236), behavioral intention (p < 0.126), oral cancer prevention behaviors (p < 0.108) and nicotine dependence (p < 0.218); however, four months after the educational intervention, there was a significant increase in the experimental group in all variables except nicotine dependence (p < 0.005). CONCLUSION: Due to the alarming situation of oral cancer and the prevalence of hookah use among women, educational programs based on TPB could effectively prevent hookah use and oral cancer.

Exploring motivation to quit and risk appraisals of hookah tobacco smoking for self and partner among a member of single and dual smoker couples.

Negative health effects of waterpipe tobacco smoking (WTS) are likely more pronounced in dual rather than single smoker couples. Data on how smokers' perceived harms for self and partner differ between couple types and how these perceptions are associated with motivation to quit are needed. We examined these associations by surveying one member of dual smoker (i.e., both partners smoke) and single smoker (i.e., one partner smokes) couples who engages in WTS. We enrolled online adults ages 18-32 who engaged in WTS during the last month and were in a committed relationship of at least six months. Participants rated their harm to self and, when relevant, to partner, how much they were harming their partner due to their WTS, and partner's smoke exposure. Participants reported their motivation to quit. Of the 323 participants, 215 (67%) were in dual smoker couples. Participants in dual smoker couples reported lower own perceived risk, which correlated highly with perceived partner risk, than participants in single smoker couples; they also reported harming their partners more even though they downplayed how frequency of smoke exposure was harming the partner. Motivation to quit did not differ by couple type. Across couple types, motivation to quit increased with greater perceived harms. Smokers in dual compared to single smoker couples downplay their risks and perceived harms their smoking causes their partner. Interventions focused on harms to self and partner may be effective to increase motivation to quit and cessation in both couple types.

High on Hookah: Smoking Marijuana from a Hookah among Adults in the United States, Population Assessment of Tobacco and Health Study, 2015-2019.

Background: This study aimed to examine the trend and factors associated with smoking marijuana from a hookah device among US adults. Methods: Data were drawn from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing nationally representative, longitudinal cohort study of the US population. Adult respondents who self-reported ever smoking marijuana from a hookah at Wave 5 (2018-19, N = 34,279 US adults) were included in the multivariable analysis. Trend analysis also was conducted using National Cancer Institute JoinPoint software from 2015 to 2019. Results: In 2018-19, an estimated 23.6 million (9.7%) US adults reported ever smoking marijuana from a hookah. Trend analysis showed the increasing prevalence of using marijuana from a hookah device from Wave 3 (8.9%) to Wave 5 (9.7%; time trend p = .007). Adults aged 25-44 years old (vs. 18-24; 13%, vs. 9%), whites (vs. Black; 11% vs. 9%), and lesbian, gay, or bisexual (LGB vs. straight; 17% vs. 9%) were more likely to report ever smoking marijuana from a hookah (ps < .05). Former and current users (vs. never users) of e-cigarettes (19% and 25% vs. 5%), cigarettes (11% and 21% vs. 2%), cigars (17% and 27% vs. 3%), and pipes (21% and 33% vs. 7%) and past 30-day blunt users (vs. non-users; 39% vs. 9%) were more likely to ever smoke marijuana from a hookah (ps < .05). Pregnant women (vs. non-pregnant; 12.8% vs. 8.6%; p = 0.03) were more likely to smoke marijuana from a hookah. Conclusions: Smoking marijuana from a hookah device is prevalent among young adults in the US, especially among vulnerable populations, and has increased significantly from 2015-2019.

Association Between Sense of Coherence and Tobacco Use Among Brazilian Adolescent Students.

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13-19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p < .05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students.

Knowledge, Attitude and Practice of Shisha Smoking among Undergraduates in a Private Tertiary Institution in Nigeria: A Cross-Sectional Study.

BACKGROUND: Shisha smoking is a growing health concern in most countries and this habit of smoking tobacco is on the increase in Nigeria. It is on the rise among youths along with proliferation of clubs, bars and hotels all over the country. The increased use in Nigeria can be attributed to easy access to tobacco products. OBJECTIVE: To determine the prevalence of Shisha smoking and evaluate the knowledge, attitude and practice of Shisha smoking among university undergraduates at a private university in Nigeria. METHODS: In 2021, a cross-sectional online study was carried out among university students at Babcock University, Ilishan-Remo, Ogun State, Nigeria, using a self-administered questionnaire. RESULTS: Overall, a total of 446 students took part in the study (115 males, 321 females) with mean age of 19.7 ± 2.9. The prevalence of Shisha smoking amongst the study respondents was 4.6%. About 25.0% of those that smoked shisha stated that they have been trying to quit with none of them seeking professional help. The mean knowledge score was 6.1 ± 2.6. The knowledge of shisha was highest among females and year 6 students. A little over half of the study respondents did not know that Shisha smoking was associated with cancers (52.8%) or that Shisha contained tobacco (58.3%). On the average, the study participants had very good attitude towards Shisha smoking with an average attitude score of 3.4 ± 0.4. The best attitude score was seen in females and year 6 students. The difference was not statistically significant. (p>0.05). CONCLUSION: The habit of shisha smoking occurs among youths who may be unaware of the tobacco content and increasing evidences of possible health risks. The findings in this study may help in formulating policies which are geared towards combating this growing menace in our schools and the society at large.

CONTEXTE: La consommation de shisha est un problème de santé croissant dans la plupart des pays et cette habitude de fumer du tabac est en augmentation au Nigeria. Elle est en augmentation chez les jeunes, parallèlement à la prolifération des clubs, des bars et des hôtels dans tout le pays. L'augmentation de la consommation au Nigeria peut être attribuée à la facilité d'accès aux produits du tabac. OBJECTIF: Déterminer la prévalence de la consommation de shisha et évaluer les connaissances, l'attitude et la pratique de la consommation de shisha chez les étudiants de premier cycle d'une université privée au Nigeria. MÉTHODES: En 2021, une étude transversale en ligne a été menée auprès des étudiants de l'université Babcock, Ilishan-Remo, État d'Ogun, Nigeria, à l'aide d'un questionnaire auto-administré. RÉSULTATS: Au total, 446 étudiants ont participé à l'étude (115 hommes, 321 femmes) avec un âge moyen de 19,7±2,9. La prévalence de la consommation de shisha parmi les répondants à l'étude était de 4,6 %. Environ 25,0 % de ceux qui fumaient la shisha ont déclaré qu'ils essayaient d'arrêter, mais aucun d'entre eux n'a cherché d'aide professionnelle. Le score moyen des connaissances était de 6,1 ± 2,6. La connaissance de la shisha était la plus élevée chez les femmes et les élèves de 6e année. Un peu plus de la moitié des répondants à l'étude ne savaient pas que fumer la shisha était associé à des cancers (52,8 %) ou que la shisha contenait du tabac (58,3 %). En moyenne, les participants à l'étude avaient une très bonne attitude à l'égard de la Shisha, avec un score moyen de 3,4 ± 0,4. Le meilleur score d'attitude a été observé chez les femmes et les élèves de 6e année. La différence n'était pas statistiquement significative. (p>0.05). CONCLUSION: L'habitude de fumer la shisha est répandue chez les jeunes qui peuvent ne pas être conscients de la teneur en tabac et des preuves de plus en plus nombreuses des risques possibles pour la santé. Les résultats de cette étude peuvent aider à formuler des politiques visant à lutter contre cette menace croissante dans nos écoles et dans la société en général. Mots-clés: Shisha, pipe à eau, narguilé, connaissances, attitudes, pratiques, étudiants de premier cycle.

A qualitative analysis of Ethiopian and Eritrean Americans' initiation and continuation of hookah smoking.

Hookah smoking is emerging as a popular social practice and health behavior risk among Ethiopian and Eritrean Americans. This qualitative study was the second phase of a sequential exploratory mixed methods study and examined factors that enable the initiation and facilitate the continuation of hookah smoking among Ethiopian and Eritrean Americans. Semi-structured interviews were conducted with twenty-five Ethiopian and Eritrean American hookah smokers residing in the Washington, DC Metropolitan Area of the United States. Interview questions were guided by the Theory of Planned Behavior and addressed: (1) initiation of hookah smoking, (2) past and current patterns of hookah smoking, and (3) behavioral, control and normative beliefs toward hookah smoking. Several themes were identified under the core constructs of 'factors influencing hookah smoking initiation' and 'factors influencing hookah smoking continuation' such as curiosity, lack of health knowledge, socio-cultural acceptance, accessibility, flavor, physical dependence, physiological effects and social connections. Based on these findings, it is recommended that future prevention activities (e.g. health messages) be embedded into a comprehensive tobacco prevention approach to address individual misperceptions of harm and addiction, community social norms and environmental access around hookah smoking, which contribute to both initiation and continuation in the Ethiopian and Eritrean American populations.

Oral health and smoking in Bandare-Kong cohort study: a cross-sectional population-based study (findings from PERSIAN cohort study).

Considering the harmful effects of smoking on oral and dental health, our aim was to investigate the oral and dental health status of people in the city of Bandare-Kong, Iran, and its relationship to smoking. This cross-sectional population-based study used baseline data from the Bandare-Kong Cohort Study. A total of 4063 participants aged 35-70 years were included in this study. Using Stata17 software, negative binomial regression was employed to identify factors related to the decayed, missing, and filled teeth (DMFT) index. The association between smoking status and DMFT was assessed by the adjusted incidence rate ratio (IRR). Of the 4063 participants, 987 (24.29%) used cigarettes, hookahs, or both. The mean ± standard error (SE) DMFT index in all subjects was 11.08 ± 0.15; it was 14.17 ± 0.53 for cigarette smokers and 12.39 ± 0.37 for hookah users (p < 0.001). After adjusting for other variables, the rate of DMFT for cigarette smokers was 0.33 (IRR: 1.33; 95% confidence interval [CI]: 1.22, 1.44), which was higher than for those who did not use cigarettes. The rate of DMFT for those who used cigarettes, hookahs, or both was 0.11 (IRR: 1.11; 95% CI: 1.05, 1.18), which was also higher than for those who did not smoke. Cigarette smoking is a risk factor for oral health complaints. Although the rate of DMFT was increased in hookah smokers, it was not a predictor of dental problems. However, we suggest that hookah use be included in educational policies to control oral and dental diseases.

Impact of COVID-19 pandemic on patterns of cigarette, hookah and marijuana consumption among undergraduate students of University of Sarajevo Bosnia and Herzegovina: a repeated cross-sectional study.

Aim: The aim of the study was to assess the impact of COVID-19 pandemic on patterns of cigarette, hookah and marijuana consumption among undergraduate students of Bosnia and Herzegovina. Methods: The first part of the double cross-sectional study was conducted among undergraduate students of the University of Sarajevo from 22nd to 26th January 2020, prior to the first COVID-19 case in the country (study period 1), and the second part from March 25th to August 26th 2021, during the third wave of COVID-19 outbreak (study period 2). Results: The majority of the 1,230 respondents were women (N1 70.9%, N2 70.1%), pursuing medical sciences (N1 60.0%, N2 55.0%), in their 3rd year of study (N1 26.3%, N2 26.7%), and living in urban environment (N1 84.9%, N2 86.4%). Similar proportion of cigarette smokers (N1 38.5%, N2 39.2%), and smaller, similar portions of hookah smokers (N1 19.3%, N2 21.1%) were classified in both study periods, while the smallest portion of marijuana smokers (N2 8.0%) was classified during COVID-19. Similar number of cigarettes per day, types of cigarettes consumed and consumption frequency in the last 30 days, with the similar independent predictors of cigarette consumption (being woman and living in rural environment associated with decreased risk, and age older than 22 associated with increased risk) were identified both before and during COVID-19 pandemic. Compared to before COVID-19 pandemic, increased trends in intentions (73.6% vs. 81.2%) and attempts (51.9% vs. 75.1%) to smoking cessation among cigarette smokers, but decreased determination not to smoke in the coming year among cigarette non-smokers (N1 72.2%, N2 51.6%) and decreased awareness of smoking harmfulness among both cigarette smokers (N1 68.0%, N2 46.5%) and especially cigarette non-smokers (N1 60.9%, N2 22.9%) were seen during COVID-19 pandemic. Also, risky behavior among hookah smokers was evident during COVID-19 pandemic. Conclusions: COVID-19 pandemic seemed to positively affect intentions and attempts to smoking cessation among cigarette smokers while negatively affecting attitudes towards cigarette smoking among cigarette non-smokers.

Longitudinal associations between flavored tobacco use and tobacco product cessation in a national sample of adults.

Use of flavored tobacco has been associated with lower likelihood of short-term abstinence from tobacco. It is unknown whether longer-term associations exist, particularly for a variety of products and specific flavor categories. This study used adult survey data from the Population Assessment of Tobacco and Health (PATH) Study (2013-2018). We tested associations of past 30-day tobacco product use at wave 2 using both a 2-category any flavor versus unflavored variable and 4-category specific flavor (menthol/mint, sweet, and both menthol/mint and sweet) versus unflavored variable with past 12-month cessation from the same product two years later at wave 4. Separate models were run for each product (combustible cigarettes, cigars, hookah, e-cigarettes, and smokeless), adjusting for wave 1 sociodemographic characteristics. For all five products, past 30-day use of any flavored (versus unflavored) product at wave 2 was associated with reduced likelihood of same-product cessation at wave 4. Most specific flavor categories were associated with reduced odds of same-product cessation across all products. Any flavor use was also associated with reduced likelihood of longer-term cessation (i.e., past 24-months at both waves 3 and 4) and cessation from all five tobacco products in several analyses. Exploratory moderation results indicated that the association between e-cigarette flavor use and lower likelihood of cessation was stronger for young adults (18-24) versus older adults (25+). Current use of flavored tobacco products is associated with lower likelihood of product cessation. Flavored tobacco products warrant consideration in regulatory policy to reduce the adverse public health impact of tobacco use.

Bacterial communities of hookah tobacco products are diverse and differ across brands and flavors.

Young adults are increasingly using non-cigarette products, such as hookahs, since they are perceived as healthier alternatives to cigarette smoking. However, hookah users are exposed to not only carcinogenic compounds but also microorganisms that may play an active role in the development of both infectious and chronic diseases among users. Nevertheless, existing hookah research in this area has focused only on microorganisms that may be transferred to users through the smoking apparatus and not on bacterial communities associated with hookah tobacco. To address this knowledge gap, we conducted time-series experiments on commercially available hookah brands (Al Fakher (flavors: two apple, mint, and watermelon) and Fumari (flavors: white gummy bear, ambrosia, and mint chocolate chill)) stored under three different temperature and relative humidity conditions over 14 days. To characterize bacterial communities, the total DNA was extracted on days 0, 5, 9, and 14, PCR-amplified for the V3V4 region of the bacterial 16S rRNA gene, sequenced on the Illumina HiSeq platform, and analyzed using R. Diversity (alpha and beta) analyses revealed that the microbiotas of Fumari and Al Fakher products differed significantly and that flavor had a significant effect on the hookah microbiota. Overall, Pseudomonas, Bacillus, Sphingomonas, and Methylobacterium were the predominant bacterial taxa across all products. Additionally, we observed compositional differences between hookah brands across the 14-day incubation. These data suggest that the bacterial communities of hookah tobacco are diverse and differ across brands and flavors, which may have critical implications regarding exposures to specific bacteria among hookah users. KEY POINTS: • Commercial hookah products harbor diverse bacterial communities. • Brands and flavors impact the diversity of these communities. • Research on their viability and transmission to users' respiratory tracts is needed.