Association between alexithymia, emotional intelligence, smoking addiction, and alcohol use disorder among a sample of Lebanese adults.

BACKGROUND: Alexithymia can be associated with worse addictive traits, while emotional intelligence is associated with better addictive outcomes. In Lebanon, the prevalence of cigarette and waterpipe smoking is on the rise, although people are aware of the associated harms. Also, around 11% of Lebanese adults have experienced alcohol use disorder (AUD). This study aimed to assess the association between alexithymia, emotional intelligence, smoking (cigarette and waterpipe), and AUD among a sample of Lebanese adults. METHODS: A web-based cross-sectional study carried out between February and April 2020, during the lockdown period, enrolled 408 community-dwelling adults. The survey link was shared on social media to reach participants from all Lebanese districts/governorates. RESULTS: Taking antidepressants (Beta = 4.37) was significantly associated with more cigarette dependence, while female gender (Beta = -1.52) and having a high vs. low monthly income (Beta = 1.02) were significantly associated with less cigarette dependence. None of the variables, including alexithymia, were significantly associated with waterpipe dependence. Female gender (Beta = -0.15) and higher emotional intelligence (Beta = -0.003) were significantly associated with less AUD, whereas higher alexithymia (Beta = 0.003) was significantly associated with more AUD. CONCLUSION: This study could demonstrate a significant association between alexithymia and cigarette smoking and alexithymia and alcohol consumption. Future research is warranted to investigate the mediating effect of emotional intelligence and how these results may be used to meet the needs of alexithymic individuals with addictions.

Cultural adaptation and validation of the Arabic version of the short 12-item stroke-specific quality of life scale.

Background: Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon. Methods: A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated. Results: A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence. Conclusion: The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes.

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country.

BACKGROUND: Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts. METHODS: A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference. RESULTS: A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001). CONCLUSION: Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Knowledge, Attitude, and Practices of the General Population toward the Old-New Outbreak of Cholera in a Developing Country.

Background: In October 2022, the first case of cholera since 1993 was recorded in Lebanon. This study aimed to develop and validate a tool to explore the knowledge, attitudes, and practices (KAP) toward cholera infection and its prevention among the general population in Lebanon and identify the associated factors related to the KAP assessment to guide prevention and awareness strategies. The nation's already precarious healthcare system might become overwhelmed by the response to the cholera outbreak. Therefore, evaluating the level of cholera-related KAP among the Lebanese population is crucial since it directly affects the disease's treatment, control, and prevention. Methods: This online cross-sectional study was carried out between October and November 2022 during the cholera outbreak in Lebanon. Snowball sampling was used to recruit 448 adults living in Lebanon. Results: The suggested KAP scales had adequate structural and convergent validity and were internally consistent. The disease knowledge was inversely associated with the reluctance to receive educational information (ß = -1.58) and cigarette smoking (ß = -1.31) but positively associated with the female gender (ß = 1.74) and awareness of vaccine availability and efficacy (ß = 1.34). For attitude, healthcare professionals were less frightened than others (ß = 2.69). Better practices were related to better knowledge (ß = 0.43), while inadequate practices were associated with getting information from social media (ß = -2.47). Conclusions: This study could identify notable gaps in the knowledge, attitudes, and practices, which varied according to participant characteristics. Cholera incidence can be reduced by improved community education and training, increased access to safe water, sanitation, and hygiene amenities, and changes in behavior. These findings warrant additional actions by public health stakeholders and governmental authorities to promote better practices and curb disease transmission.

Association Between Personality Traits/Dimensions and Fear of No Mobile Phone Connectivity (nomophobia): Results of a Lebanese National Study.

Objective: To study nomophobia in a large sample of Lebanese adults and its relationship with personality traits and other sociodemographic factors that may contribute to the diagnosis such as sex, parental status, and smoking.Methods: This cross-sectional study was conducted between January and July 2019. A total of 2,260 residents randomly selected from districts in Lebanon completed a questionnaire about sociodemographic characteristic and smoking. Respondents also completed the Nomophobia Questionnaire, Personality Inventory for DSM-5, and NEO Five-Factor Inventory.Results: The results of a linear regression, taking the nomophobia score as the dependent variable, showed that higher neuroticism (B = 0.648), number of waterpipes smoked per week (B = 0.749), and disinhibition (B = 0.706) were significantly associated with higher nomophobia, whereas more agreeableness (B = -0.535) and detachment (B = -0.594) were significantly associated with lower nomophobia.Conclusions: This study assessed the variation of inherent personality traits using 2 validated personality questionnaires and their association with nomophobia. As digital use becomes more prevalent within personal and professional aspects of life, nomophobia might become an anxiety risk. Future studies should focus on preventive and treatment measures in the form of awareness campaigns.

Pharmacy Students' Mental Health and Resilience in COVID-19: An Assessment after One Year of Online Education.

COVID-19 has impacted mental health and affected education due to the shift to remote learning. The purpose of the current study was to assess the mental health of pharmacy students one year following the onset of the pandemic. A descriptive cross-sectional questionnaire was distributed to pharmacy students. The severity of depression, anxiety, and stress was assessed by the Depression Anxiety Stress Scale (DASS-21), and resilience was assessed by the Brief Resilience Scale (BRS). COVID-19-related economic, educational, and health stressors, and students' vaccine attitudes were surveyed. Descriptive, bivariate, and multivariable analysis were used, and a p-value of <0.05 was considered significant. A total of 561 students participated; 37% had mild-to-moderate depression, 37% had severe-to-extremely-severe anxiety, and 52% demonstrated normal stress levels. Severe depression, anxiety, and stress were associated with smoking and feeling isolated due to COVID-19. Around 40% of students had low resilience, associated with smoking, being in the third or fourth year of pharmacy study, and the consumption of caffeinated beverages. The mean score of satisfaction with online learning was 60.3 ± 21.3%. Only 5% of participants were vaccinated, of which 87% trusted the benefits of vaccines and their role in controlling the pandemic. One year after the onset of COVID-19, depression, anxiety, stress, and low resilience were observed among pharmacy students; the investigation of the long-term mental effects of the pandemic on university students is warranted.

Association of violent video games with alcohol use disorder and smoking dependence among male adolescents in Lebanon.

BACKGROUND: With the well-known serious effects of alcohol and nicotine dependence on adolescents' well-being, and knowing that males are more exposed to violent video gaming, this study was conducted to examine the association between exposure to violent video gaming and alcohol, cigarette, and waterpipe dependence among male Lebanese adolescents. METHODS: This was a cross-sectional observational study conducted with Lebanese male students (13-17 years old) between October and December 2019. The Video Game Questionnaire was utilized to assess the content of violence in video games. For the assessment of alcohol, cigarette, and waterpipe dependence, the Alcohol Use Disorders Identification Test scale (AUDIT), Fagerström Test for Nicotine Dependence (FTND), and Lebanese Waterpipe Dependence Scale (LWDS) were used, respectively. Log transformation was used for the three addiction scores. Four linear regressions were performed taking the AUDIT, FTND, LWDS, and violent video gaming scores as dependent variables. RESULTS: From the 388 students enroled (mean age= 15.83 ± 1.93 years), 190 (48.8%) were classified as having violent video gaming. Older age (beta=0.049) and more violent video gaming (beta=0.006) were significantly associated with more cigarette dependence. More violent video gaming (beta=0.003) was significantly associated with more waterpipe dependence. Older age (beta=-0.090) was significantly associated with lower alcohol use disorder, whereas more violent video gaming (beta=0.005) was significantly associated with more alcohol use disorder. CONCLUSION: The study supports an association between higher exposure to violent video game and higher alcohol and smoking dependence among male teenagers in Lebanon. Hence, support and guidance should be implemented to raise awareness and protect teenagers.

Smoking Behavior among Adolescents: The Lebanese Experience with Cigarette Smoking and Waterpipe Use.

(1) Background: The study aims to assess cigarette smoking and waterpipe experimentation among Lebanese adolescent school students with respect to their gender, region, age, and socioeconomic status. (2) Methods: This is a cross-sectional study, where students between 11 to 18 years of age were included from all over Lebanon. (3) Results: A total of 1133 students were interviewed. The total proportion of adolescents who ever experimented with cigarette smoking was 24.5%. Males experimented with cigarette smoking more commonly than females (31.9% vs. 19.1%; p < 0.001). Cigarette smoking experimentation was higher among students from the Beirut area (33.6%; p < 0.001) in comparison to other regions, and among those with poor health perception (29.1% vs. 19.8%; p < 0.001) compared to students with excellent health perception. The total proportion of adolescents who ever used a waterpipe was 33.9%. Waterpipes were significantly more experimented with among males than females (40.3% vs. 29.8%; p < 0.001), and among students with bad perception about their health (39.4% vs. 28.9%; p < 0.001). Adolescents who experimented with both cigarettes and waterpipes constitute 22.2% of the studied sample. (4) Conclusions: The rate of tobacco product use is alarming and constitutes a major public health issue for adolescents that urgently needs intervention. The findings raise important policy implications for the development of cigarette smoking prevention programs for youth.

Is problematic social media use associated with higher addictions (alcohol, smoking, and waterpipe) among Lebanese adults?

PURPOSE: To evaluate the correlation between problematic social media use, alcohol use disorder, and smoking addiction through both cigarettes and waterpipe, among a sample of Lebanese adults. METHODS: This cross-sectional study was carried out between January and April 2019. It enrolled 461 residents of the community randomly selected from Lebanon's districts in a proportionate rate. RESULTS: Higher problematic social media use was significantly associated with more waterpipe addiction but not cigarette dependence and alcohol use disorder.

How Does Food Addiction Relate to Obesity? Patterns of Psychological Distress, Eating Behaviors and Physical Activity in a Sample of Lebanese Adults: The MATEO Study.

Food addiction is currently not an official diagnosis (as a standalone disorder substance-related and addictive disorder) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To best of our knowledge, there is no previous research on differences between addictive-like eating behavior regarding its associations with psychological distress, eating behaviors and physical activity among individuals with obesity. The objective of the present study was to distinguish psychological and behavioral patterns of individuals with obesity concerning food addiction using a cluster analysis. We determined the profiles of the participants in terms of psychological distress, eating behaviors and physical activity and evaluated their association with food addiction. A cross-sectional study was conducted between September and November 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. A sample of 507 individuals with obesity aged between 18 and 65 years participated in the present study by filling in the online questionnaire, including the validated Arabic version of the modified version of the Yale Food Addiction Scale, the Arabic version of the Depression, Anxiety and Stress Scale, the Three-Factor Eating Questionnaire, and the short version of the International Physical Activity Questionnaire. A cluster analysis was performed using the K-mean method to identify and group participants according to their patterns/profiles. A stepwise linear regression was conducted, taking the food addiction score as the dependent variable. Higher levels of uncontrolled eating, emotional eating and stress were significantly associated with higher food addiction score. Belonging to cluster 2 (psychological well-being and cognitive restraint) (B = 14.49) or cluster 3 (moderate psychological distress and cognitive restraint) (B = 6.67) compared to cluster 1 (psychological well-being, appropriate physical activity levels and eating behaviors) was significantly associated with higher food addiction score. The present research revealed that food addiction is significantly associated with higher psychological distress and maladaptive eating behaviors. Higher levels of uncontrolled eating, emotional eating and stress as well as belonging to clusters 2 and 3 were found to be predictors of food addiction in individuals with obesity in the present study. This knowledge could be useful in regard to psychological treatment of obesity and addictive-like eating behavior.

Association between cumulative cigarette and Waterpipe smoking and symptoms of dependence in Lebanese adults.

BACKGROUND: Waterpipe and cigarette smoking dependence are becoming increasingly prevalent forms of addiction globally. This study examined whether cumulative cigarette smoking and cumulative waterpipe smoking are associated with higher dependence on both cigarettes and waterpipe. METHODS: This cross-sectional study conducted between February and April 2020, enrolled 363 participants drawn from all Lebanese districts. The mean age was 29.51 years, 64.8% were females, and 124 (34.2%) exclusive cigarette smokers, 189 (52.1%) exclusive waterpipe smokers, and 50 (13.8%) dual smokers (waterpipe and cigarette). We used the Hooked on Nicotine Checklist (HONC) as an indicator of decreased autonomy towards nicotine, in addition to the Lebanon Waterpipe Dependence Scale-11 (LWDS11) and the Lebanese Cigarette Dependence scale (LCD). A stepwise linear regression was performed taking the HONC scores due to cigarette and waterpipe smoking, LCD and LWDS-11 scores as dependent variables. RESULTS: The results showed that in the total sample, higher cumulative cigarette smoking (B = 0.005 with a confidence interval of 0.004, 0.006) was significantly associated with higher HONC cigarette scores, whereas higher cumulative waterpipe smoking (B = -0.006 with a confidence interval of - 0.009, - 0.002) was significantly associated with lower HONC cigarette scores. Moreover, higher cumulative waterpipe smoking (B = 0.012 with a confidence interval of 0.009,0.015) was significantly associated with higher HONC waterpipe scores. The results showed that, in both sexes, higher cumulative cigarette smoking was associated with higher HONC cigarette scores and lower HONC waterpipe scores. Furthermore, higher cumulative waterpipe smoking was significantly associated with higher HONC waterpipe scores in both sexes. CONCLUSION: Our study supports the fact that heavy nicotine consumption, related to both the increased frequency and smoking duration, can increase the risk of dependence. It raises the need for strategic plans to minimize and discourage the use of nicotine products in Lebanese community settings.

Factors associated with problematic internet use among a large sample of Lebanese adolescents.

BACKGROUND: International literature clearly describes factors associated with problematic internet use, including substance dependence, online gambling, social impairment, and functional difficulties. Therefore, it was imperative to assess the extent to which young adolescents in Lebanese schools are affected by problematic internet use (PIU) and the factors associated with it. This large-scale Lebanese survey aims to evaluate the relationship between PIU, depression, and substance use, including alcohol consumption and nicotine use (cigarettes and waterpipe) among adolescents in Lebanese schools. METHODS: This cross-sectional study conducted between January and May 2019 assessed internet use through the Internet Addiction Test (IAT), with 'severe internet use' being the threshold for problematic internet use. It enrolled a total of 1810 adolescents aged 14 to 17 from 16 schools from all Lebanese Mohafazat. RESULTS: The majority of the participants had an average internet use 74.8% (95% Confidence Interval (CI): 0.72-0.76), 20.7% (95% CI: 0.18-0.22) had a frequent internet use, and 4.5% (95% CI: 0.03-0.05) had a severe internet use. Higher alcohol dependence (ß = 0.456, p < 0.001), higher depression (ß = 0.079, p = 0.001), and having separated parents vs. living together (ß = 0.136, p < 0.001) were significantly associated with higher IAT scores. Higher waterpipe dependence (ß = -0.218, p < 0.001) was significantly associated with lower IAT scores. CONCLUSION: This study, the first and largest of its kind in the Middle East, showed that some psychiatric disorders, such as depression and substance use (smoking and alcohol), are associated with more problematic internet use among Lebanese adolescents. These results could serve as the first step for policymakers towards implementing early awareness campaigns to look at this problem more in-depth and come up with efficient actions to avoid it.

Adaptation of the Young Adults' Cigarette Dependence (YACD) Scale for the development and validation of the Adolescent Cigarette Dependence Scale (ACDS).

Vulnerable adolescents may lose control over cigarette use within a day or two after smoking their first cigarette, as nicotine dependence (ND) symptoms may appear before actual daily smoking and usually occur at low levels of daily smoking. Moreover, smoking can cause illnesses and promote other types of substance abuse. Therefore, it was deemed essential to adapt the Young Adults' Cigarette Dependence (YACD) Scale to develop and validate the Adolescent Cigarette Dependence Scale (ACDS) in Lebanese adolescents and evaluate whether cumulative cigarette smoking is associated with nicotine dependence and symptoms of dependence. A cross-sectional study was carried out between August and September 2020, during the partial sanitary lockdown imposed by the government to limit COVID-19, coinciding with the summer holidays for most Lebanese. The total sample consisted of 564 community-dwelling adolescents aged 13 to 18. A factor analysis was performed using a varimax rotation. The Kaiser-Meyer-Olkin (KMO) measurement of sampling adequacy and Bartlett's sphericity test were appropriate. The factors retained corresponded to Eigenvalues > 1. Cronbach's alpha value represented the internal consistency of the scale. The Hooked on Nicotine Checklist (HONC) was used to screen for dependence symptoms. All items of the YACD were extracted, except for items 4 (smoking to concentrate at work) and 18 (smoking as a habit), which yielded a three-factor solution (factor 1 = smoking patterns; factor 2 = positive and negative reinforcements; factor 3 = smoking cessation) with Eigenvalues > 1 (variance explained = 56.18%; KMO = 0.784; Bartlett's sphericity test p < 0.001; αCronbach = 0.875). The newly generated scale was termed Adolescent Cigarette Dependence Scale (ACDS) and consisted of 19 items. Higher ACDS scores (higher cigarette dependence) were significantly associated with higher HONC scores (higher symptoms of dependence) (rho = 0.647; p < 0.001). Having deceased (B = 8.54) or divorced (B = 4.26) parents and higher cumulative cigarette smoking (B = 0.29) were significantly associated with higher ACDS scores. Higher cumulative cigarette smoking (B = 0.05) was significantly associated with higher HONC scores due to cigarettes. This study could validate a new tool to evaluate nicotine dependence among Lebanese adolescents, the Adolescent Cigarette Dependence Scale (ACDS). This version adapted from the Young Adults' Cigarette Dependence (YACD) Scale is reliable and valuable and correlates well with other scales, such as the HONC. However, further studies are necessary to improve this instrument, adding new questions useful for the diagnosis and evaluation of cigarette dependence.

Relationships between inappropriate eating habits and problematic alcohol use, cigarette and waterpipe dependence among male adolescents in Lebanon.

BACKGROUND: it is important to investigate the relationship between disordered eating in male adolescents and smoking and alcohol consumption as they are risk factors to other diseases as well. For example, high levels of alcohol accompanied by the acidic damage and nutritional deficit exhibited in people with disordered eating habits - due to induced vomiting - has been shown to increase risk of esophageal cancer. Considering the very few studies done on disordered eating prevailing in males and the prevalence of smoking and drinking habits, our study aims to investigate the correlation between inappropriate eating habits and one's dependence on cigarettes, waterpipes, and alcohol all the while focusing on male adolescents. METHODS: This was a cross-sectional observational study that enrolled 389 male students (13-17 years of age) drawn from five Lebanese schools between October and December 2019. RESULTS: The MANCOVA analysis was performed taking the addiction scales as the dependent variables and the EAT-26 score as an independent variable, adjusting for the covariates (age, BMI and household crowding index). Higher EAT-26 scores (more inappropriate eating attitudes) were significantly associated with higher waterpipe dependence (B = 0.11; CI 0.06-0.17) and more problematic alcohol use (B = 0.08; CI 0.04-0.12), but not cigarette dependence. CONCLUSIONS: This study revealed an association between inappropriate eating and increased drinking and smoking the waterpipe, but not cigarettes. The manifestation of inappropriate eating habits was found to be significant among male adolescents; in the literature, this is also true for female adolescents. In Lebanon, the engagement of adolescents in alcohol drinking and waterpipe smoking is frequent as they are accessible due to the lack of law enforcement and supervision in the country. In addition, while this study found an association between inappropriate eating habits and dependency on smoking and drinking, further investigation should be done on the role of one's psychology in their exhibition of disordered eating as means to prevent the manifestation of these habits.

Association of characters and temperaments with cigarette and waterpipe dependence among a sample of Lebanese adults.

It was discovered that the relation between certain personality traits and nicotine dependence differs among ethnicities and cultures; therefore, this study was conducted to determine which temperaments and personality traits are associated with smoking dependence in order to contribute to the development of effective and targeted interventions for smoking dependence within the Lebanese population. A cross-sectional study was carried out between March and April 2020 among a sample of Lebanese adults from all Lebanese governorates. The sample included (N = 501) divided as follows: 62 (12.4%) nonsmokers, 37 (7.4%) cigarette smokers, 266 (53.1%) waterpipe smokers, and 136 (27.1%) mixed smokers. Higher cooperativeness (B = - 0.03) was significantly associated with lower waterpipe dependence. High vs. low education level (B = - 0.97), female gender compared to males (B = - 1.07), higher cooperativeness (B = - 0.01), and higher self-transcendence (B = - 0.01) were significantly associated with lower cigarette dependence, whereas higher age (B = 0.03) was significantly associated with higher cigarette dependence. A multinomial regression analysis, taking the smoking group as the dependent variable, showed that higher harm avoidance (aOR = 0.97) and novelty seeking (aOR = 0.97) were significantly associated with lower cigarette smoking. A high level of education vs. a low one (aOR = 8.85) was significantly associated with higher cigarette smoking. Higher self-transcendence was significantly associated with lower mixed smoking. Being married vs. single (aOR = 2.46) was significantly associated with higher odds of being a mixed smoker, whereas female gender compared to males (aOR = 0.41) was significantly associated with lower odds of being a mixed smoker. These results are pivotal in understanding the relationship between personality and smoking dependence.

Factors associated with problematic social media use among a sample of Lebanese adults: The mediating role of emotional intelligence.

PURPOSE: To assess the relationship of smoking (cigarettes or waterpipe), alcohol drinking, alexithymia, self-esteem, anxiety, depression, stress, social phobia, emotional intelligence, impulsivity, insomnia, physical health, and loneliness with problematic social media use (PSMU) in a sample of Lebanese citizens. METHODS: This cross-sectional study enrolled 466 participants (January-May 2019). RESULTS: Higher anxiety, alcohol use disorder, and social phobia were correlated with elevated PSMU, while older age was associated with lower PSMU. Emotional intelligence partially mediated the association between alexithymia and PSMU by 4.55%. PRACTICAL IMPLICATIONS: Since these manifestations are preventable, spreading awareness through our schools, educational programs, and even healthcare professionals would considerably reduce the pace at which young adults are transforming into anxious and distorted individuals.

Cross-sectional study of in-vehicle exposure to ultrafine particles and black carbon inside Lebanese taxicabs.

Taxi drivers' exposure to traffic-related air pollutants inside their vehicles has been reported in different countries but not yet in Lebanon. Thus, we conducted a cross-sectional study on 20 Lebanese taxi drivers to (1) assess their exposure to ultrafine particles (UFP) and black carbon (BC) inside their vehicles and (2) identify determinants of this exposure. UFP and BC were measured using Diffusion Size Classifier Miniature® and microAeth® Model AE51, respectively, for 5 hours. Data on characteristics of vehicles and trips were collected by face-to-face interviews. Associations between pollutant levels and their determinants were analyzed by multiple linear regression. The mean of UFP count (35.2 ± 17.6 x 103 particles cm-3 ) and BC (5.2 ± 1.9 µg m-3 ) concentrations in-taxis was higher in the morning measurements compared with those in the afternoon measurements. UFP count increased in-taxis by 60% for every 10 minutes spent in blocked traffic and by 84% starting from two trips with smokers compared to trips without smokers. Conversely, UFP count decreased by 30% for every 10 minutes under both air-conditioning and air recirculation mode with windows closed. BC was not affected by any of these factors. Our findings suggest easy ways to reduce UFP exposure inside vehicles for all commuters.

Validation of the AUDIT scale and factors associated with alcohol use disorder in adolescents: results of a National Lebanese Study.

BACKGROUND: This study objective was to evaluate the prevalence of alcohol use disorder (AUD) and related factors (smoking, internet addiction, social anxiety, child abuse, and bullying) among a representative sample of Lebanese adolescents, and to validate and confirm psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT). METHODS: A cross-sectional study, conducted between January and May 2019, enrolled 1810 adolescents aged between 14 and 17 from schools of all Lebanese districts. From the total number of schools, a proportionate number was selected in each district. AUD was defined as a high AUDIT score (≥8; score range 0-40). A principal component analysis technique to confirm the validity of the construct of the AUDIT scale score was done and a confirmatory analysis to assess the structure of the instrument was conducted. Spearman correlation was used for linear correlation between continuous variables. The Mann-Whitney test was used to compare the means of two groups, while the Kruskal-Wallis test was used to compare three groups or more. A stepwise linear regression was conducted, taking the AUDIT total score as the dependent variable and taking child abuse (psychological, sexual, physical and verbal), cigarette and waterpipe smoking dependence, bullying, social phobia, and internet addiction as independent variables. RESULTS: The mean AUDIT score was 6.46 ± 8.44 and high risk of AUD was found in 507 (28.0%) adolescents [95% CI 0.259-0.301]. One factor solution of the AUDIT scale was found after running the factor analysis (αCronbach = 0.978). Higher AUDIT scores were significantly associated with higher cigarette (Beta = 0.527; p < 0.001) and waterpipe (Beta = 0.299; p < 0.001) dependence, higher childhood sexual abuse (Beta = 0.656; p < 0.001) and neglect (Beta = 0.126; p < 0.001), higher bullying victimization (Beta = 0.236; p < 0.001). CONCLUSION: Alcohol use disorder among Lebanese adolescents seems to be associated with several factors, such as cigarette and waterpipe dependence, parents' divorce, higher internet addiction, bullying victimization, and childhood sexual abuse and neglect. Parents and healthcare professionals could use this data for early interventions.

Attachment style and addictions (alcohol, cigarette, waterpipe and internet) among Lebanese adolescents: a national study.

BACKGROUND: The prevalence in the Lebanese general population of cigarette and waterpipe smoking, alcohol drinking and internet use seems to be increasing lately. So far, no study was done relating the above to attachment styles in Lebanese adolescents. Consequently, the objective of our study was to assess the relationship between attachment styles (secure, preoccupied, fearful, and dismissing) and addictions (cigarettes, water pipes, alcohol, and internet) among this population. METHODS: It is a cross-sectional study that took place between January and May 2019. Two thousand questionnaires were distributed out of which 1810 (90.5%) were completed and collected back. A proportionate random sample of schools from all Lebanese Mohafazat was used as recruitment method. RESULTS: A secure attachment style was significantly associated with lower addiction to alcohol, cigarette, and waterpipe, whereas insecure attachment styles (preoccupied, dismissing and fearful) were significantly associated with higher addiction to cigarette, waterpipe, alcohol, and internet. CONCLUSION: Lebanese adolescents with insecure attachment had higher rates of addiction to cigarette, waterpipe, alcohol, and internet. They should be closely monitored in order to reduce the risk of future substance use disorder and/or behavioral addiction development.

Knowledge, attitudes, harm perception, and practice related to waterpipe smoking in Lebanon.

Waterpipe smoking (WPS) is one of the most emerging popular trends in Lebanon, with a prevalence of 36.9%, the highest among all Middle Eastern countries. Thus, the primary objective of the study was to examine the factors associated with knowledge, attitudes, and practice (KAP) related to WPS among a representative sample of waterpipe smokers. The secondary objective was to examine the effect of KAP on cumulative waterpipe dose and dependence. This cross-sectional study was carried out between May and December 2018 and enrolled a representative sample of 1550 waterpipe smokers from all Lebanese districts. The questionnaire used was specifically designed for this study. High knowledge score (Beta = 0.02, p = 0.002) were significantly associated with higher waterpipe harm perception score. In addition, high knowledge score (Beta = 0.32, p = 0.007) were significantly associated with higher attitude score toward smoking ban. Higher waterpipe harm perception score (Beta = - 1.30, p < 0.001), higher attitude (Beta = - 0.21, p < 0.001), and higher knowledge score (Beta = - 0.11, p < 0.001) were significantly associated with lower waterpipe dependence. In addition, higher waterpipe dependence (Beta = 2.02, p < 0.001) was significantly associated with higher cumulative waterpipe smoking, while higher waterpipe harm perception score (Beta = - 1.96, p = 0.009) and higher knowledge score (Beta = 0.27, p < 0.001) were significantly associated with lower cumulative waterpipe smoking. Our main finding was that better knowledge and perception of the harmful effects of waterpipe were related to a better attitude toward smoking bans and a lower waterpipe smoking. Therefore, health care providers and policymakers should join efforts to make awareness campaigns across Lebanon and develop adequate interventions to curb the use of waterpipe among the population.