Association between textual and pictorial warnings on tumbac (waterpipe tobacco) boxes and motivation to quit waterpipe smoking among Lebanese and Iraqi adolescents.

BACKGROUND: Waterpipe tobacco smoking has increased tremendously at a global level among all age groups, particularly young people. Previous studies have examined the impact of waterpipe tobacco pictorial health warnings on adults but scarce studies were done on adolescents. The aim of this study was to assess the association of textual versus pictorial warnings on tumbac boxes and the motivation to quit waterpipe smoking among adolescents located in two Eastern Mediterranean countries Lebanon and Iraq. METHODS: A cross-sectional study was conducted between May and November 2022, involving 294 adolescents waterpipe smokers from Lebanon and Iraq. The questionnaire included the Lebanese Waterpipe Dependence Smoking-11, the Depression, Anxiety and Stress Scale, the Waterpipe Harm Perception Scale, Waterpipe Knowledge Scale, Waterpipe Attitude Scale, the Fagerstrom Test for Nicotine Dependence, and the Motivation to Stop Scale. RESULTS: When adjusting the results over confounding variables, the results showed that compared to finding the warnings to stop smoking not efficacious at all, adolescents who find the warnings moderately (aOR = 2.83) and very (aOR = 6.64) efficacious had higher motivation to quit. Compared to finding the warnings not increasing their curiosity for information about how to stop waterpipe smoking at all, participants who confessed that warnings increased their curiosity a little (aOR = 2.59), moderately (aOR = 3.34) and very (aOR = 3.58) had higher motivation to quit. Compared to not considering changing the tumbac brand if the company uses pictorial warnings, adolescents who would consider changing the tumbac brand (aOR = 2.15) had higher motivation to quit. CONCLUSION: Pictorial and textual warnings on waterpipe packs were associated with higher motivation to stop waterpipe smoking. Public health education programs for this purpose seem warranted.

Irritable bowel syndrome (IBS) among Lebanese adults: unidentified IBS and associated factors.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders, but the condition is still underdiagnosed. The high of rate of unidentified IBS by patients can be related to different factors. The aim of this study is to assess the rate of unidentified IBS among Lebanese adults and investigate the role of socio-demographic factors, anxiety, depression, insomnia and eating attitudes on IBS diagnosis. METHODS: A cross-sectional study was conducted among Lebanese adults older than 18 years between June 2022 and December 2022, using a self-reporting questionnaire distributed via social media. RESULTS: A total of 425 participants was enrolled in the study with around 184 (46.8%) having a possible unidentified IBS. Higher psychological distress (aOR = 1.07) and insomnia severity (aOR = 1.08) were significantly associated with higher odds of having possible unidentified IBS whereas a higher household crowding index (aOR = 0.67) was significantly associated with lower odds of having possible IBS. The correlation of eating attitudes with cigarette smoking (aOR = 1.33; p = .025; 95% CI 1.04; 1.70) and insomnia severity with cigarette smoking (aOR = .89; p = .023; 95% CI .80; .98) were significantly associated with the presence of possible IBS. In nonsmokers, higher psychological distress (aOR = 1.07) and insomnia severity (aOR = 1.10) were significantly associated with higher odds of having possible IBS. In smokers, higher BMI (aOR = .78) was significantly associated with lower odds of having possible IBS, whereas higher eating attitudes scores (more inappropriate eating) (aOR = 1.40) were significantly associated with higher odds of having possible IBS. CONCLUSION: The study highlighted the implication of raising awareness about IBS among the Lebanese population to promote early diagnosis and minimize the rate of unidentified IBS by patients. Initiation of appropriate treatment plans, tailored symptomatic management approach, and diet programs should be highly encouraged.

Association between the bi-dimensional aspect of orthorexia and healthy behaviors among lebanese adolescents.

BACKGROUND: Recently, there has been a blooming focus on "eating healthy and clean", with the ideal of being healthy becoming a popular lifestyle trend. Previous research suggested the presence of two forms of orthorexia: Orthorexia Nervosa (OrNe) and Healthy Orthorexia (HeOr). Taking into consideration that orthorexia thoughts are led by the desire to reach an optimal physical health, the dedication to a healthy living may require healthy lifestyle habits: smoking cessation, moderate alcohol intake, and increased physical activity. The main study aim was to determine, among Lebanese adolescents, the association between healthy behaviors and the two likely forms of orthorexia (OrNe and HeOr), given that the adolescent phase is a risky period in the development of eating disorders. METHODS: A cross-sectional study, conducted between January and April 2022, enrolled 444 adolescents aged between 14 and 18 years, with an equitable random sample from all the Lebanese governorates (mean age 16.23 ± 1.15 years; 60.1% females). The Teruel Orthorexia Scale (TOS) was used to assess orthorexic eating tendencies. The Lebanese Waterpipe Dependence Scale, the Fagerström Test for Nicotine Dependence and the Alcohol Use Disorder Identification Test scales, all validated in adolescents, were used to evaluate the association between orthorexia and healthy behaviors. RESULTS: Higher TOS OrNe scores were significantly and highly correlated with the TOS HeOr scores (r = 0.68; p < 0.001). In the bivariate analysis, waterpipe smoking was weakly but significantly associated with more OrNe, whereas more physical activity was significantly and moderately associated with more HeOr. After adjusting over all sociodemographic characteristics, other behaviors and the other dimension of orthorexia, more alcohol use disorder was significantly but strongly associated with higher OrNe, whereas more physical activity remained significantly associated with higher HeOr. CONCLUSION: In light of our results, OrNe and HeOr might be considered as different entities, mainly in their associations with alcohol consumption and physical activity. This supports the hypothesis of OrNe being a new form of eating disorder, whereas HeOr possibly showing protective characteristics. Orthorexia is still a topic of controversy, especially in the probable presence of two facets that are still difficult to differentiate.