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.

Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon.

OBJECTIVES: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese preschool children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]). METHODS: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits. RESULTS: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing outdoors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 and OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing outdoor × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P < 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%. CONCLUSION: PS-ARFS is suggested for screening of asthma in preschool children in an epidemiological setting and in the absence of spirometry.

Hygiene hypothesis: association between hygiene and asthma among preschool children in Lebanon.

OBJECTIVES: To validate a scale to assess the hygiene hypothesis and the association between hygiene and asthma among Lebanese preschool children aged 3-5 years. METHODS: This cross-sectional study, conducted between November 2018 and March 2019, enrolled 515 preschool children. Asthma and potential risk factors, including hygiene, were assessed using a standardized questionnaire. A specific hygiene hypothesis scale has been generated and validated for this purpose. RESULTS: The hygiene hypothesis scale items converged over a solution of nine factors that had an Eigenvalue over 1, explaining a total of 65.86% of the variance. An acceptable Cronbach's alpha value was recorded for the hygiene hypothesis scale (0.696). Variables correlated with higher odds of asthma were male gender (ORa = 0.41 for females), living near a prairie sprayed with pesticides (ORa = 3.09), having a heating system in the bedroom compared to the sitting room (ORa = 9.97), attending kindergarten (ORa = 2.80), having a mother who smokes waterpipe compared to not smoking (ORa = 3.34), having a mother with a history of asthma (ORa = 5.50), and having respiratory infections (ORa = 14.72). However, the hygiene hypothesis score was not associated with higher odds of asthma (p = 0.881). CONCLUSIONS: The current results suggested that neither home cleaning nor personal cleanliness was correlated with asthma in preschool children. Larger prospective studies that measure the intensity and duration of exposure to each toxicant are suggested to better assess the hygiene hypothesis items and their association with asthma.

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.

Cognitive function among schoolchildren in Lebanon: association with maternal alcohol drinking and smoking during pregnancy and domestic use of detergents and pesticides during childhood.

To evaluate the relation between caregiver exposure to toxics during pregnancy and childhood and the child's cognitive function in Lebanese children. This was a cross-sectional study conducted on Lebanese students in public and private schools from November 2017 to May 2018, enrolling 464 children. A first linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child as independent variables, showed that higher age (Beta = 1.65) was significantly associated with higher cognition, whereas a history of eczema in any of the parents (Beta = -7.32) was significantly associated with lower cognition in the child. A second linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child, and the exposure to toxics as independent variables, showed that maternal alcohol intake during pregnancy (Beta = -1.07) and detergent mixing (Beta = -1.48) were significantly associated with lower cognition in the child. A third linear regression, taking the Cattell total score as the dependent variable and taking sociodemographic characteristics and the family history of the child, the exposure to toxics and the diseases in the child as independent variables, showed that maternal alcohol intake during pregnancy (Beta = -1.07) and detergent mixing (Beta = -1.45) were significantly associated with lower cognition in the child, whereas a history of eczema in the child before the age of 2 years (Beta = 8.72) was significantly associated with higher cognition in the child. This study is the first to examine the association of a child's prenatal exposure and their exposure during childhood to environmental toxicants with their cognitive function in Lebanon. We consider this study to be important as it shows the possible effect of cleaning products mixing and maternal alcohol consumption on cognitive functions among children in Lebanon.

Previous, current, and cumulative dose effect of waterpipe smoking on LDL and total cholesterol.

The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region. To the best of our knowledge, no studies have assessed the impact of waterpipe smoking on lipid levels in the Lebanese population. Therefore, the objective of the study was to evaluate the correlation between waterpipe smoking and LDL-C and total cholesterol levels in exclusive Lebanese waterpipe smokers compared to non-smokers. This cross-sectional study was conducted between October 2016 and February 2017, enrolling 308 patients (156 non-smokers and 147 waterpipe smokers) from four laboratories. Current and previous WS (beta = 66.64 and beta = 71.49) were significantly associated with higher LDL scores. Current WS was significantly associated with and total cholesterol levels (beta = 34.12). Cumulative WS (number of waterpipes per week × duration in years) was significantly associated with higher LDL-C and total cholesterol levels respectively (p < 0.001 for all 3 variables). The university level of education (beta = 8.89) and current alcohol drinking (beta = 8.81) were significantly associated with higher LDL scores. Our study demonstrated an association between previous or current waterpipe smoking and lipid level. Future research are needed to detect the direct cause of the relation between waterpipe smoking and CVD. Concerned authorities should set up awareness campaigns to increase alertness on dangers of WS and dependence, and encourage these young adults to embrace health-promoting behaviors.

Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children.

BACKGROUND: The study objective was to create asthma risk factors scale (ARFS) score that would be correlated with the increased risk of asthma in Lebanese children. This scale would eventually be used both to identify children at risk and assess early diagnosis of asthma. METHODS: A case-control study (study 1) of 1276 children (976 controls and 300 cases) and a cross-sectional study (study 2) of 1000 children were conducted using a parental questionnaire. Children aged between 3 and 16 years were screened for possible enrollment. The ARFS was created by combining the following risk factors: child's exposure to pesticides, detergent mixing, alcohol, smoking and drug intake during pregnancy and breastfeeding, the actual paternal and maternal smoking status and history of asthma, and the types of food the child consumes. RESULTS: There was a significant increase in the risk assessment screening for asthma per 15 points increments of ARFS (p < 0.001 for trend). The score category 0-14.99 best-represented control individuals (88.8% controls), while a score higher than 45 represented asthmatic children best (98.4% asthmatics). The positive predictive value (disease positive/all positive by scale) came out as 94.02%, whereas the negative predictive value (disease negative/all negative by scale) was found to be 90.47%. These results were confirmed in the second study sample. CONCLUSION: The ARFS is a simple and easy-to-use tool, composed of 15 questions, for the clinician risk assessment of asthma in children, taking into account the environmental exposure, parental history of asthma and dietary habits of the child. Its value for asthma diagnosis remains to be confirmed in future prospective studies, especially in children with chronic respiratory symptoms.

The AAA Risk Factors Scale: A New Model to Screen for the Risk of Asthma, Allergic Rhinitis and Atopic Dermatitis in Children.

OBJECTIVE: To create an allergic disease risk factors scale score that would screen for the risk assessment of asthma, allergic rhinitis and atopic dermatitis (AD) in children from 3 to 17 years. METHODS: This case-control study, conducted between December 2015 and April 2016, enrolled 1,274 children. The allergic disease risk factors scale was created by combining environmental, exposure to toxics during pregnancy and breastfeeding and parental history of allergic diseases. RESULTS: Playing on carpets, male gender, child's respiratory problems or history of eczema before the  age of 2 years, and humidity significantly increased the odds of allergies in the child. Maternal waterpipe smoking, maternal history of rhinitis, history of asthma in the mother or the father, along with the maternal drug intake or alcohol consumption during pregnancy significantly increased the odds of allergies in the child. There was a significant increase in allergy diseases per category of the allergic disease risk factors scale (p < 0.001 for trend). Scores ≤2.60 best represented control individuals, while scores > 5.31 best represented children with allergic diseases. CONCLUSION: Allergic diseases seem to be linked to several risk factors in our population of school children. Many environmental factors might be incriminated in these allergic diseases.

Effect of exclusive cigarette smoking and in combination with waterpipe smoking on lipoproteins.

OBJECTIVE: A significant increase in total cholesterol and LDL-C is well shown in tobacco users, as compared to non-tobacco users. The additive effects of waterpipe and cigarette smoking on LDL levels have not been studied. The study's objective was to assess the correlation between cigarette smoking and LDL levels in Lebanese cigarette smokers and to check the interaction effect of waterpipe and cigarette smoking on LDL levels. METHODS: This cross-sectional study was conducted between October 2016 and February 2017 in 4 different laboratories, enrolling 308 patients (188 non-smokers, 105 cigarette smokers, 15 previous smokers). RESULTS: Current cigarette smoking (Beta=25.57; p<0.0001) was significantly associated with higher LDL levels and higher total cholesterol levels (Beta=53.29; p<0.0001) in exclusive cigarette smokers. Among current cigarette smokers who were current waterpipe smokers, a significant increase in LDL level was observed relative to current cigarette smokers who were not waterpipe smokers (Beta=66.64 vs Beta=37.37; p<0.0001). CONCLUSION: Among Lebanese current cigarette smokers, LDL levels increased relative to nonsmokers, consistent with findings in other populations. In addition, among Lebanese current cigarette smokers, current waterpipe smoking might increase adverse lipid profiles associated with adverse coronary effects more than cigarette smoking alone. The direct cause responsible for these observed variations in our study remains unidentified, with the hope that future research will reveal it.