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.

COVID-19 and hookah smoking cessation among women in Southern Iran: A cross-sectional study.

Hookah smoking does not only transmit COVID-19 but also intensifies the symptoms of the disease. Thus, the present research aimed to explore the association between COVID-19 and hookah cessation among female smokers. The institutional-based cross-sectional study was conducted nine months after the onset of the COVID-19 pandemic. Face-to-face interviews were held between November 2020 and January 2021 to explore the pattern of hookah smoking among 561 female hookah smokers in Bandar Abbas in the south of Iran. The daily, weekly and monthly rates of hookah smoking showed a statistically significant decrease in the during COVID-19 era (p < .001). Thirteen percent of women managed to cease hookah smoking successfully during the pandemic. The odds ratio of hookah cessation was higher in single women (95% CI 1.09-5.23) as well as women with a high socioeconomic status (SES) (95% CI 4.28-24.01). It was also higher among women who initiated hookah smoking at an older age (95% CI 29-68) and among those with no hookah smoking family member (95% CI 301- 943). Fear of COVID-19 infection was the leading factor involved in hookah cessation or reduction. Entertainment was the leading barrier to successful hookah cessation behavior. It is believed that COVID-19 has directly and indirectly contributed to the reduced or ceased hookah smoking behavior. One of the reasons for the reduction of hookah smoking was the fear of aggravated symptoms and reasons for cessation included closure of coffee shops and removal of all hookahs from the city.

The prevalence of denture stomatitis in cigarette and hookah smokers and opium addicts: findings from Rafsanjan Cohort Study.

BACKGROUND: The aim of this study was to investigate the association of denture stomatitis prevalence with cigarette, hookah and opium consumption and also dose-response relationship between the cigarette smoking duration and odds of denture stomatitis in population of Rafsanjan cohort center. METHODS: This cross-sectional study based on data of Rafsanjan Cohort Study (RCS) with 10,000 participants. After applying inclusion and exclusion criteria, 1619 participants were included in the analysis. Data were collected by oral examination and completion of pre-designed questionnaires to assess denture hygiene, smoking behavior, opium use and some other exposure variables. Multivariable logistic regression models were fitted to investigate possible association of cigarette, hookah and opium consumption and denture stomatitis. RESULTS: Prevalence of denture stomatitis among all 1619 denture wearers was 21.6%. Cigarette smoking was associated with a higher odds of denture stomatitis, with the adjusted odds ratio (95% CI) of 2.29 (1.53-3.41). Also, dose-response increases were observed with the highest odds ratio in the 4th quartile for denture stomatitis (p-value < 0.001). Opium consumption was associated with a decreased odds of denture stomatitis (adjusted OR; 0.81, 95% CI 0.58-1.13) which was not statistically significant. Also interaction between opium consumption and cigarette smoking was not associated with higher odds of denture stomatitis (adjusted OR: 1.65, 95% CI 0.85-3.22). CONCLUSIONS: Based on the findings of the present study, while cigarette smoking had a dose-response relationship with the increased odds of denture stomatitis; this association was not found with opium consumption.

What are the intervention goals of women's hookah cessation? A systematic, evidence-based and participatory study.

This Study was designed to answer the question: what are the intervention goals of women for ceasing to smoke. The present research was part of a larger study and was a pioneering systematic research conducted between September 23, 2018 and September 26, 2019 through an intervention mapping in southern Iran among professional hookah Smoking (HS) women. In order to know more about the HS among women, the behavioral and environmental correlates of HS/cessation and the determiners or fundamental causes of these factors were extracted via a systematic review and a local qualitative study. As the results revealed, the expected outcomes of the educational program concerning hookah cessation were achieved. As the realization of these outcomes requires certain changes to the behavioral and environmental dimensions, in the next step, the intervention goals of hookah cessation were identified. As the results showed, four behavioral factors involved in the unhealthy HS behavior were individual HS, Being in the Company of hookah smokers, Visiting tempting and contaminated places and Physical and mental dependence on HS (habit), In addition, four effective environmental factors were found at different interpersonal, organizational, community and policy levels. These include, respectively: recommendation and motivation for cessation by influential figures, care providers' poor inadequate knowledge and skill, Easy acceptance of hookah in society, and the lack of effective rules. Knowledge, awareness, social norms, Motivation to comply, skill and self-efficacy, habit, were among the determining factors of hookah cessation. Employment of a systematic is based on evidence and cooperation and is guided by a assessing the needs of the target population. Such a method can suggest more purposive and relevant intervention goals so as to cease HS. The aim would be to intervene in the purposes of the above-mentioned change, as compared in predetermined interventions, and increase the chances of HS cessation among women.

Predictors of hookah smoking frequency among women in the South of Iran: A cross-sectional study.

The prevalence of hookah smoking has grown over the past decades in Iran especially in the south of the country. This study aimed to determine the behavioral and socio-demographic predictors of the hookah smoking frequency among women in southern Iran. This research was conducted on 400 women hookah smokers selected through multi-stage sampling method. Data were collected from October 2018 to September 2019 using a questionnaire guided by literature. Ordinal logistic regression analysis was run to determine the influential behavioral and socio-demographic predictors involved in the frequency of hookah smoking. Variables with a P-value of less than 0.05 in the final fitting model were associated with the outcome variable (frequency of hookah smoking per day1 = once a day, 2 = twice a day, 3 = three times a day, 4 = more than three times a day). We found that the longer duration of hookah smoking, family usage of hookah smoking, beginning to smoke hookah with peers, absence of either parent in family (single-parent families and a lack of prior intention to cease smoking), ever-married women and low socio-economic status (SES) predicted the frequency of hookah smoking. To prevent the behavior and make effective interventions to reduce hookah smoking, policy-makers should stay focused on factors other than internal motivations. Focus on the companies surrounding women smokers, quitting the habit of hookah smoking and effective interventions to decrease one's intention to smoke hookah can help reduce such unhealthy behaviors.

Stress, stressors, and substance use: Differential risk for hookah use among African American college students.

Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.

Use of social networking sites, electronic cigarettes, and waterpipes among adolescents.

OBJECTIVES: Electronic cigarettes (e-cigarettes) and waterpipes are gaining in popularity among adolescents in tandem with the increasing popularity of social networking sites (SNSs). The objective of this study was to examine the associations between the use of SNSs and e-cigarette and waterpipe use among adolescents, and to test whether these associations are independent of tobacco cigarette smoking. STUDY DESIGN: A province-wide school-based cross-sectional study. METHODS: Data were derived from the 2013 Ontario Student Drug Use and Health Survey. Our analyses included representative data from 2841 high school students across Ontario, Canada, who completed the questionnaire that included measures of lifetime use of e-cigarette and past-year use of waterpipe. RESULTS: Nearly 14.6% of students reported having smoked an e-cigarette in their lifetime and 12.2% reported having smoked a waterpipe in the past year. After adjusting for various covariates, daily use of SNSs of at least 1 h/day was associated with greater odds of e-cigarette use (odds ratios ranged from 3.31 for SNS use of 1 h/day to 3.43 for ≥3 h/day), while daily use of SNSs of at least 2 h was associated with waterpipe use (odds ratios of 3.28 for SNS use of 2 h/day and 2.83 for use of ≥3 h/day). The observed associations remained significant after further adjusting for tobacco cigarette smoking. CONCLUSIONS: The use of SNSs was positively associated with e-cigarette and waterpipe use, independent of tobacco cigarette smoking. These findings highlight the need for including SNSs in ongoing prevention and intervention efforts.

The prevalence of chronic obstructive pulmonary disease in hookah smokers.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Hookah smoking is growing worldwide and particularly in Iran. The aim of this study was to determine the prevalence of obstructive pulmonary dysfunction in hookah smokers. We conducted a population-based study in Bushehr Province, Iran. A total of 245 subjects aged 35 years or older who were taking hookah for at least 15 years and 245 healthy controls were enrolled in the study and spirometry was done. Statistical analyses were performed using SPSS for windows software version 19. The prevalence of COPD among the exposed group of hookah smoke was 10.2%, with the rate being significantly higher in the patients with older age ( p < 0.001), duration of hookah smoking ( p < 0.001), men ( p = 0.026), ≥3 hookahs/day ( p = 0.006), history of cough for ≥2 years ( p = 0.002), in patients with a history of sputum for ≥2 years ( p = 0.031), and in patients with a history of dyspnea for ≥2 years ( p = 0.001). The results of the logistic regression analysis demonstrated that older age, male gender, smoking, and occupational exposure were independent predictive factors for COPD. The results of our study suggest that hookah smoking significantly increases the risk of COPD. Given the importance of COPD in the global burden of diseases, it is necessary to carry out further studies on the relationship between hookah use and COPD.

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study.

PURPOSE: The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15-17-year-old high school students in Iran. METHOD: Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15-17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking). RESULTS: Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking. CONCLUSION: Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students' and their parents' awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents' access to WPs and tobacco in society.

Abstinence rates among college cigarette smokers enrolled in a randomized clinical trial evaluating Quit and Win contests: The impact of concurrent hookah use.

OBJECTIVE: To examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use. METHODS: Analyses were conducted on data from 1217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010-2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates. RESULTS: Participants smoked 11.5(±8.1) cigarettes per day on 28.5(±3.8) days/month, and 22% smoked hookah in the past 30days. Hookah smokers (n=270) were more likely to be male (p<0.0001), younger (p<0.0001), report more binge drinking (p<0.0001) and score higher on impulsivity (p<0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR=0.64, 95% CI=0.45-0.93, p=0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR=0.37, CI=0.14-0.99, p=0.05). CONCLUSION: College cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates.

What Online Communities Can Tell Us About Electronic Cigarettes and Hookah Use: A Study Using Text Mining and Visualization Techniques.

BACKGROUND: The rise in popularity of electronic cigarettes (e-cigarettes) and hookah over recent years has been accompanied by some confusion and uncertainty regarding the development of an appropriate regulatory response towards these emerging products. Mining online discussion content can lead to insights into people's experiences, which can in turn further our knowledge of how to address potential health implications. In this work, we take a novel approach to understanding the use and appeal of these emerging products by applying text mining techniques to compare consumer experiences across discussion forums. OBJECTIVE: This study examined content from the websites Vapor Talk, Hookah Forum, and Reddit to understand people's experiences with different tobacco products. Our investigation involves three parts. First, we identified contextual factors that inform our understanding of tobacco use behaviors, such as setting, time, social relationships, and sensory experience, and compared the forums to identify the ones where content on these factors is most common. Second, we compared how the tobacco use experience differs with combustible cigarettes and e-cigarettes. Third, we investigated differences between e-cigarette and hookah use. METHODS: In the first part of our study, we employed a lexicon-based extraction approach to estimate prevalence of contextual factors, and then we generated a heat map based on these estimates to compare the forums. In the second and third parts of the study, we employed a text mining technique called topic modeling to identify important topics and then developed a visualization, Topic Bars, to compare topic coverage across forums. RESULTS: In the first part of the study, we identified two forums, Vapor Talk Health & Safety and the Stopsmoking subreddit, where discussion concerning contextual factors was particularly common. The second part showed that the discussion in Vapor Talk Health & Safety focused on symptoms and comparisons of combustible cigarettes and e-cigarettes, and the Stopsmoking subreddit focused on psychological aspects of quitting. Last, we examined the discussion content on Vapor Talk and Hookah Forum. Prominent topics included equipment, technique, experiential elements of use, and the buying and selling of equipment. CONCLUSIONS: This study has three main contributions. Discussion forums differ in the extent to which their content may help us understand behaviors with potential health implications. Identifying dimensions of interest and using a heat map visualization to compare across forums can be helpful for identifying forums with the greatest density of health information. Additionally, our work has shown that the quitting experience can potentially be very different depending on whether or not e-cigarettes are used. Finally, e-cigarette and hookah forums are similar in that members represent a "hobbyist culture" that actively engages in information exchange. These differences have important implications for both tobacco regulation and smoking cessation intervention design.

Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon.

OBJECTIVES: Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon. STUDY DESIGN: The study design was a cross sectional survey. METHODS: 126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS. RESULTS: Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS. CONCLUSIONS: Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.

Multiple tobacco product use among adults in the United States: cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus.

OBJECTIVE: Noncigarette tobacco products are increasingly popular. Researchers need to understand multiple tobacco product use to assess the effects of these products on population health. We estimate national prevalence and examine risk factors for multiple product use. METHOD: We calculated prevalence estimates of current use patterns involving cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus using data from the 2012 RTI National Adult Tobacco Survey (N=3627), a random-digit-dial telephone survey of adults aged 18 and over. Associations between use patterns (exclusive single product and multiple products) and demographic characteristics were examined using Pearson chi-square tests and logistic regression. RESULTS: 32.1% of adults currently use 1 or more tobacco products; 14.9% use cigarettes exclusively, and 6.6% use one noncigarette product exclusively, 6.9% use cigarettes with another product (dual use), 1.3% use two noncigarette products, and 2.4% use three or more products (polytobacco use). Smokers who are young adult, male, never married, reside in the West, and made prior quit attempts were at risk for multiple product use. CONCLUSIONS: Over 10% of U.S. adults use multiple tobacco products. A better understanding of multiple product use involving combustible products, like cigars and hookah, is needed. Multiple product use may be associated with past quit attempts.

Assessing the risk of metabolic syndrome and diabetes in relation to Hookah smoking: Evidence from a cohort study in Southern Iran.

Background: Hookah smoking has pointedly increased worldwide and could have different harmful health effects. However, long term hookah smoking effects on chronic diseases has not been well studied. This study was aimed to investigate the relationship between hookah smoking with metabolic syndrome and diabetes. Methods: In this prospective study, the baseline data from 3695 participant (35-70 years old) of Bandar-e-Kong cohort study in Hormozgan province, Iran were used. In this study, data were collected through the questionnaires designed in the Kong cohort study and 25 mm of blood sample. All analyses were performed using SPSS version 27.0 and the ggplot2 package in RStudio version 2023.06.1 + 524. p < 0.05 was considered a significant difference. Results: The prevalence of hookah smoking was 17.3% in total. Also, the prevalence of metabolic syndrome, diabetes, hypertension, and dyslipidemia were 35.6, 15.2, 31.2, and 78.0%, respectively. Our results showed that there were statistically significant relationship between hookah smoking and metabolic syndrome, hypertension and diabetes (p < 0.05). In the case of dyslipidemia, hookah smoking was also associated with increase in dyslipidemia (p < 0.05). Conclusions: More evidence is needed to understand the mechanism of hookah smoking and these health effects. As well as, health education and increasing public awareness about the health effects of hookah smoking and implementation of smoking prohibition policies are highly recommended.

Decoding Waterpipe Tobacco Smoking: A Comprehensive Narrative Review Exploring Mechanics, Health Risks, Regulatory Challenges, and Public Health Imperatives.

Waterpipe tobacco smoking, commonly known as hookah or shisha, has witnessed a surge in popularity globally, particularly among young adults. However, this activity is associated with several issues related to health. This comprehensive narrative review aims to provide a valuable resource for researchers, policymakers, and public health professionals seeking to deepen their understanding of waterpipe tobacco smoking and implement evidence-based strategies to address its challenges. The present article focuses on an in-depth analysis of the health risks associated with waterpipe tobacco smoking. Based on evidence from the current scientific literature, the review explores the impact of waterpipe smoking on respiratory health, cardiovascular outcomes, and the potential links to infectious diseases. Additionally, the review discusses the emerging evidence on the long-term health consequences, highlighting the need for continued research in this area. Also, it touches on the regulatory challenges surrounding waterpipe tobacco smoking, which were critically examined, emphasizing the gaps and inconsistencies in existing policies. Finally, the review underscores the public health imperatives necessitated by the rise of waterpipe tobacco smoking. The narrative concludes by proposing a holistic approach that integrates scientific evidence, regulatory frameworks, and public health initiatives to mitigate the growing impact of waterpipe tobacco smoking on population health.

Incidental Diagnosis of Metastatic Colorectal Cancer in a Habitual Hookah Smoker: A Case Report Emphasizing Early Detection and Lifestyle Risks.

Colorectal cancer (CRC) is a major health concern and a significant contributor to global oncological mortality, influenced by genetic predisposition and lifestyle factors. Hookah smoking, prevalent in the Middle East, has been associated with an increased risk of various cancers, including CRC. This case report discusses the incidental discovery of metastatic CRC in a 42-year-old habitual hookah smoker, shedding light on the potential association between hookah use and CRC pathogenesis. Additionally, it addresses the diagnostic complexities posed by the asymptomatic nature of CRC, often identified through non-specific indicators such as abnormal liver enzymes. Furthermore, the case illustrates the crucial role of family medicine in detecting diseases, highlights the significance of multidisciplinary care in managing advanced CRC, and emphasizes the importance of public health initiatives to raise awareness about the risks of hookah smoking and promote regular health screenings in at-risk populations.

The prevalence of hookah smokers among Belarussian children and adolescents.

INTRODUCTION: The purpose of this survey was to assess the prevalence of hookah smokers among children and adolescents aged 12-16 years in Belarus. METHODS: This survey involved 3485 people, including 1737 girls and 1726 boys, and included 6 questions from the main questionnaire of the GYTS aimed at hookah consumption. The statistical processing was performed using the SUDAAN software package; a 95% confidence interval was calculated to calculate weighted prevalence estimates and standard errors. RESULTS: According to the GYTS carried out in the Republic of Belarus in 2021, hookah smoking is becoming increasingly popular. The number of adolescents who have ever smoked a hookah is 9.3%. The prevalence of regular hookah smokers is quite low (0.9%). But there are justified fears that teens who have never smoked cigarettes but have tried hookah are more likely to start smoking cigarettes and become regular cigarette smokers two years later.The frequency of hookah use naturally increases with age. The number of adolescents who have ever smoked a hookah among those aged 14, 15 and 16 years (10.7%, 11.7% and 18.2%, respectively), was higher than among students aged 12 years (5.5%) or 13 years (5.6%) (p<0.001); hookah smoking was higher among students in the 9th and 10th grades (13.0% and 14.2%, respectively), then among students in the 7th grade (5.1%) (p<0.001). CONCLUSIONS: This national survey provides the first data of prevalence of hookah smoking among children and adolescents in Belarus and allows us to conclude that the growing popularity of waterpipe tobacco smoking dictates the need for timely recommendations on waterpipe smoking policy.

Survey of the Relationship between Extroversion and Transition in Cigarette and Hookah Smoking Stages in High-School Students in Tabriz: A Longitudinal Study.

Background: Smoking is a public health problem that affects the adolescent population's health. This study aimed to investigate the relationship between extroversion (compared with introversion) and transition in cigarette and hookah smoking stages in high-school students to use the results in smoking prevention programs. Methods: A sample of 2312 students aged 15-16 years in Tabriz were included in the study. Demographic characteristics, cigarette, hookah smoking status, and Eysenck's extroversion questionnaires were completed by all students in the selected schools. Eight months later, cigarette and hookah smoking status were assessed again to determine transition in smoking stages. The marginal homogeneity (MH) test was used to compare the smoking status at the beginning and 8 months later. The generalized estimating equation (GEE) method with the ordinal link was applied to estimate the effect of extroversion on transition in smoking stages. Results: The mean (standard deviation) age of the students participating in the study was 15.5 (0.5) years. MH test results showed that, in general, transmission in the stages of both cigarette and hookah smoking in 8 months was significant in students (P-value < 0.0001). Extrovert personality had a significant positive effect on the transition from lower stages to higher cigarette and hookah smoking stages according to the GEE with ordinal link (P = 0.01). In cigarette and hookah smoking, extrovert persons transited to higher stages 1.64 and 1.55 times more than introvert persons. Conclusions: Being an extrovert person had a significant effect on the transitioning to higher stages of smoking cigarettes and hookah. In designing cognitive programs to prevent people from smoking or encourage them to quit smoking, considering this dimension of personality trait can be useful in the efficacy of the program.

Clinicopathological Profile of Non-small Cell Lung Cancer and the Changing Trends in Its Histopathology: Experience From a Tertiary Care Cancer Center in Kashmir, India.

Background The overall frequency and incidence of different cancers across the globe, including lung cancer, are marked by ethnic and geographical variations. Lung cancer is the most commonly diagnosed cancer worldwide that inflicts most of the cancer deaths. Non-small cell lung cancer (NSCLC) constitutes most lung cancer cases. The aim of this study was to find the frequency and clinicopathological characteristics of NSCLC in high incidence zone of Kashmir, an ethnically and geographically distinct area in Northern India. Material and methods The study was conducted to evaluate the clinicopathological profile of NSCLC at a tertiary care cancer center, Sher-I-Kashmir Institute of Medical Sciences (SKIMS). The patients and case records were analyzed for clinical presentation and demographic features, smoking status, radiological features, histopathological type, and stage of their disease at presentation. Results The study included 1557 NSCLC patients registered over a period of seven years, i.e., 2008-2014. Most of the patients belonged to rural areas (70%). The median age of the whole cohort was 58.0 years (ranges 22-95 years), and the male-to-female ratio was 3.7:1 (male = 1231 and female = 326). Smokers comprised 77.39% of cases, and Hookah was the most common form of smoking (65.06%). The ratio of squamous cell carcinoma and adenocarcinoma was 3.7:1 (67.5% vs. 24.9%). Stage III and IV disease accounted for 93% of cases (30.6% and 62.7%, respectively). Squamous cell carcinoma histopathology was dominant in smokers (74.3%) compared to adenocarcinoma (19%), while squamous cell carcinoma and adenocarcinoma histopathology ran parallel in nonsmokers (45.1% and 44%, respectively). Most of the patients had an Eastern Cooperative Oncology Group (ECOG) performance status between 1 and 2 (79%).  Conclusion We conclude Kashmir region is a very high-risk area for lung cancer, with NSCLC showing a high incidence. Most of our patients present in advanced stages, and the frequency of adenocarcinoma is showing an increasing trend over the years from 2008-2014.

Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation.

BACKGROUND: The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran. METHODS: In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants' characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations. RESULTS: The results showed no significant difference between women enrolled in control and intervention groups regarding participants' characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively. CONCLUSIONS: HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings. TRIAL REGISTRATION: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129.