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Recently, an increase in the incidence of all malignant neoplasms of the head and neck has been noted throughout the world. The most common type of head and neck cancer is squamous cell carcinoma, which originates from the epithelium of the oral mucosa, pharynx, and larynx. In Russia, cancer of the oral mucosa and cancer of the oropharynx are in 4th place in the structure of malignant neoplasms: more than 80 thousand new cases are registered every year. Human papillomavirus is the leading cause of increased incidence of squamous cell carcinoma of the head and neck in many regions of the world.Objective: to determine the main clinical and epidemiological features of HPV-associated head and neck cancer.Methods: a study based on a retrospective analysis of the patient's anamnestic data was carried out. Results: Demonstrated the role of smoking OR=2.07 (CI: 1.07—4.02), hookah smoking OR=3.06 (CI: 1.06—8.80), drinking strongly hot drinks OR=3.65 (CI: 1.44—9.25), the presence of a dental prosthesis OR=7.32 (CI: 2.77—19.31), heredity OR=7.38 (CI: 3.07—17.76), “Poor” dental status OR=33.54 (CI: 15.01—74.95), positive HPV status in history OR=7.31 (CI: 2.77—19.31), 5 or more sexual partners lifetime OR=4.95 (CI: 2.47—9.93) as risk factors for HPV-associated. head, and neck cancer. Conclusion: HPV prophylaxis plays an important role in reducing the incidence of associated head and neck malignancies. The results of the study convinced of the need for preventive measures in relation to the identified risk factors for the development of HPV-associated head and neck cancer.

Tobacco use is a risk factor for several diseases, disabilities and premature deaths. Shisha is specially flavoured tobacco and majority of the users perceive hookah smoking to be safer than cigarette. Shisha use has become rampant and trendy among students in tertiary institutions. This review aims to evaluate predictors of shisha consumption among students in tertiary institutions. We reviewed references of authentic databases and journals including Web of Science, PubMed, Iranian Databases, National Agency for the Campaign against Alcohol and Drug Abuse, CDC and WHO. The review focused on data documented from 2010 up to 2020.Predictors of shisha use were: shisha availability and accessibility, flavouring ,gender, awareness level, parental factors, marital status, social acceptability, peer pressure, birth order, monthly stipend, course enrolled in, internet and legal framework on hookah smoking. Most students using shisha reported to be poly drug users with marijuana, tobacco products, alcohol and khat. Most students consume shisha either singly or concurrently or simultaneously alongside other drugs. However, it is not possible to tell if shisha use preceded use of other drugs or was an aftermath. There is need to strengthen laws and policies regulating waterpipe industry. Since nearly all the reviewed literature was based on self-reported history which is prone to both social desirability bias and memory recall bias there is need to have confirmed incidence of shisha use in this sub-population.

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.

Background: Hookah smoking is increasing worldwide. It is estimated the worldwide prevalence of daily hookah smoking is 100 million. The aim of this study was to compare hookah smoking prevalence in Islamic Azad University medical students in the city of Ardabil between 2009 and 2014. Method: Of 2956 Islamic Azad University medical students, Ardabil branch, almost 25% of students {737 students (226 males vs. 511 females; 436 subjects at 2009 vs. 301 subjects at 2014)} were randomly selected to participate in this survey. An anonymous self-administered questionnaire was used after verbal informed consent according to the Review Committee of Ardabil Branch Islamic Azad University Medicine School approved protocol. A cluster sampling technique was used. The questions focused on gender, hookah smoking status, and students’ replies for the following issues: (1) Kind of hookah (2) Frequency of smoking (3) Motivation of hookah use (4) Place of smoking use (5) and Second-hand exposure to hookah. Results: Hookah use showed significant decrease in male students compared with five years ago (P

Background and objectives Clues show that a large number of toxic agents, including carcinogenic, heavy metals, other particles, and high levels of nicotine, are effectively delivered through cigarette and hookah smoking. A pilot study was carried out in Varamin city, Iran in 2016 aimed to determine status of cigarette and hookah smoking in adolescent students using, Global Youth Tobacco Survey (GYTS) questionnaire. Methods It was a cross-sectional study. At the first, of 63 Varamin city schools' using cluster sampling, 48 schools were considered as primary clusters and 4 schools were selected randomly as sample clusters and students with 7, 8 and 9 years of education were studied. The total number of registered students was 1,108 and 1,075 responded to the study questionnaire. The main tool for collecting information used in this study was the GYTS questionnaire developed by the World Health Organization, was completed by subjects. Results Totally, 479 (44.6%) students were boys and 596 (55.4%) were girls. Of 1,075 subjects the number of students at 7, 8 and 9 years education was 369 (34.3%), 362 (33.7%) and 344 (32.0%) respectively. The cigarette and hookah smoking using experience among the population was 9.2% and 25.5 respectively. Regarding the averages of the total score, although students have a relatively good attitude and specially behavioral intention (72% and 88% of the total score respectively), but only 47% of the total knowledge score by boys and 51% by girls, shows the average level of students' awareness related the undesirable effects of smoking. Conclusions Considering that one out of four students experienced cigarette and hookah smoking. Nearly half of the students are exposed to cigarette smoke at home or outdoors. The state of cigarette and hookah smoking in the country is alarming among school students.

Purpose High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances. Aim This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class. Methods Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2. Results Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study. Conclusion This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.

Introduction Hookah (also known as waterpipe) smoking is associated with acute adverse health effects such as vomiting and fainting, symptoms related to carbon monoxide poisoning, and decreased pulmonary function, however, national estimates of hookah-related acute injuries are not currently available in the scientific literature. This study provides national estimates of United States hospital emergency department visits due to hookah-related acute injuries. Methods We analyzed 2011–2019 data from the National Electronic Injury Surveillance System to calculate national estimates of emergency department visits due to hookah-related acute injuries. National Electronic Injury Surveillance System data were gathered from approximately 100 United States hospitals selected as a probability sample of approximately 5000 hospitals with emergency departments. Each case contains information abstracted from all emergency department records involving injuries associated with consumer products. All individuals admitted to emergency departments who sustained hookah-related acute injuries were included in the study. Results During 2011–2019, an estimated 1371 (95% confidence interval: 505–2283) United States hospital emergency department visits were related to hookah-related acute injuries. The most common injuries were sustained from dizziness/light-headedness and syncopal episodes (54.8%), followed by burns (41.5%). Young adults aged 18–24 years accounted for 66.8% of hookah-related acute injuries admitted to United States emergency departments. Conclusions This study provides national estimates of hospital emergency department visits due to hookah-related acute injuries. We found that hookah smoking related AIs mostly occurred among young adults. Study findings may inform public health policy and educational intervention efforts to prevent these events and complement other acute injury surveillance systems, such as the National Poison Data System.

Introduction Despite Saudi officials initiating a variety of smoking cessation programs, smoking in the country has not decreased. Thus, the objective of this study was to identify the factors associated with Saudi students' beliefs about available smoking cessation interventions. Methods A cross-sectional, pre-tested, and validated paper-based survey was administered to a cohort from a university in the Qassim region. Bivariate analyses and logistic regression were conducted to explore the factors associated with the students' beliefs regarding behavioral and pharmacotherapy interventions for smoking cessation. Results Out of 1158 surveys distributed, 958 responses were received (82.7% response rate). Students aged >23 years were more likely to believe in a behavioral intervention (marginal effect = 10.4%; 95% CI, 2.3%-18.6%). However, the respondents who indicated that they had smoked a hookah over the past 30 days were less likely to believe in either the pharmacotherapeutic (marginal effect = -7.9%; 95% CI, -15.6 to -0.3%) or the behavioral (marginal effect = -8.1%; 95% CI, -16.2% to -0.1%) interventions. Students who believed that the hookah was the same as or less harmful than cigarettes (marginal effect = -25.6%; 95% CI, -34.7% to -16.6%) and (marginal effect = -12.3%; 95% CI, -22.3% to -2.3%), respectively, were less likely to believe in pharmacotherapeutic interventions. Multiple logistic regression analyses found that hookah smokers with a willingness to quit smoking were more likely to believe in the effectiveness of cessation medications (marginal effect = 42.9%; 95% CI, 28.2%-57.6%) and behavioral interventions (marginal effect = 28.6%; 95% CI, 9.3%-48.0%). Conclusion This study found that smoking a hookah and its harmfulness were negatively associated with smoking cessation medications interventions. Regarding beliefs about behavioral interventions, while age was positively associated, hookah smoking and its harmfulness had a negative association. Willingness to quit smoking was positively associated with both medication and behavioral interventions.

COVID-19 pandemic has put the whole world in cauldron as almost each and every nation is affected by this deadly virus. Intense research is going on world over to demystify the microscopic involvements of this virus, how and whom it infects and in devising out a suitable treatment strategy in containing this pandemic. Till now there is no suitable therapeutic strategy available yet and people are advised to maintain social distancing protocols to protect themselves from contracting this disease. If we talk of symptoms, there are new things coming to fore what was initially thought out with new classes of symptoms continuously added to the already existing list and presumed to be directly aggravated on contracting COVID infection. Among various other factors that greatly increase the chances of getting infected and in aggravating the symptoms in COVID-19, poor lung health among elderly population has been found to significantly increase the chances of contracting the viral disease, exacerbating the disease condition & in poor prognosis to available treatment strategies. Hookah smoking is very common among majority of elderly population in Kashmir & cigarette smoking in younger lots could turn out devastating if the world pandemic takes an epidemic shape in Kashmir region. With high prevalence of other comorbid conditions like hypertension, type 2 diabetes, obesity and in conjunction with above nominal prevalence of cigarette and hookah smoking. Majority of both elderly and younger Kashmiri population could contract the disease and show severe symptoms owing to the factors discussed. Here, we summarize the prevalence of hookah smoking among majority of population in Kashmir and the associated lung diseases that are directly or indirectly attributed to high cigarette or hookah smoking in Kashmir and how it could act as high risk factor in COVID pandemic infection.

Hookah (waterpipe) smoking is a growing tobacco epidemic. Though perceived as a safer tobacco alternative, hookah smoke contains, in addition to tobacco combustion products, large amounts of charcoal combustion products-implicated in cardiovascular disease-from the burning charcoal used to heat the flavored tobacco. To date, little is known on the vascular effects of hookah smoking. The aim of this study was to characterize the peripheral circulatory response to acute hookah smoking in cutaneous and muscular beds. In 21 healthy young adult habitual hookah smokers who did not smoke cigarettes (age 24 ± 1 years, mean ± SE), we measured plasma nicotine, exhaled carbon monoxide, skin blood flow (laser Doppler velocimetry) and calf muscle blood flow (strain-gauge plethysmography) before and for up to 60 minutes after ad lib hookah smoking. In nine subjects, nonsmoking time-control studies were performed. Hookah smoking, which increased plasma nicotine by 5.8 ng/ml (from 0.6 ± 0.1 to 6.4 ± 1.3, p0.001) and exhaled carbon monoxide by 27 ppm (from 2.7 ± 0.2 to 29.5 ± 2.2, p0.001), decreased skin blood flow by 23% (20.1 ± 2.8 to 14.8 ± 1.9 units, p0.001) and increased skeletal muscle blood flow by 34% (2.3 ± 0.1 to 2.9 ± 0.2 units, p = 0.010). These responses required more than one hour to recover after smoking cessation. All cardiovascular parameters were unchanged in the nonsmoking time-control studies. Although perceived to be innocuous, hookah smoking produces acute cutaneous vasoconstriction with skeletal muscle vasodilation, a dissociated pattern of peripheral blood flow responses that is characteristic of nicotine and carbon monoxide. In conclusion, these findings provide objective evidence to challenge the perception that hookah smoking is a safer tobacco alternative.

Background: The purpose of this study was to determine the predictors of hookah smoking (HS) among professional HS women in Bandar Abbas, southern Iran using intervention mapping protocol. Methods:...

Non-suicidal self-injury (NSSI) among adolescents is a major health concern globally. The epidemiology and determinant of NSSI have not been studied extensively in Iran. Thus, this longitudinal study sought to investigate the prevalence, incidence and contributing factors of NSSI among adolescents in Iran. This study was conducted at high school students aged 14-18 years old in the metropolitan city of Tabriz, located in north western Iran. Data were collected from 6229 10th-grade students at two time-points, with 12 months interval in October and November 2017 and 2018. A self-administered questionnaire was used to collect information on demographic, NSSI and cigarette and hookah smoking from the study participants. The results showed that lifetime prevalence of NSSI among students was 6.2% (95% confidence interval [CI]: 5.7 to 6.9) at the first assessment. Scratching and hair pulling were the most and least common methods of self-injury, respectively. Over the one year, 206 students (3.6% CI 95%: 3.1-4.1) reported the onset of NSSI. Tobacco smoking and previous year average grade were related to the incidence of NSSI. Although gender was significantly associated with the prevalence of NSSI, the relationship between gender and incidence of NSSI was not significant. Although the prevalence of NSSI was low among adolescents, the incidence rate was considerable. Further studies are required to understand the risk factors of NSSI in Iran.

Introduction: Carbon monoxide exposure is a relatively unknown risk of smoking hookah. Dozens of cases of hookah-associated carbon monoxide toxicity have been described over the past decades, but s...

ZusammenfassungEin 27-jähriger, zuvor körperlich gesunder Mann stellte sich mit akut einsetzendem thorakalem Druckgefühl, Dyspnoe, nichtproduktivem Husten und Fieber in einer zentralen Notaufnahme vor. Stunden vor Symptombeginn habe der Patient Wasserpfeife mit speziellem, in Deutschland nicht frei verkäuflichen Tabak mit der Geschmacksrichtung Minze geraucht. Bei progredienter Oxygenierungsstörung musste der Patient noch am Aufnahmetag intubiert werden. In der Computertomografie des Thorax stellten sich bilateral diffuse, infiltrative Veränderungen dar. Die bei Aufnahme durchgeführte bronchoalveoläre Lavage erbrachte den Nachweis einer ausgeprägten Eosinophilie von 69 %. Anhand der Anamnese, der Eosinophilenzahl sowie der computertomografischen Veränderungen erfolgte die Diagnosestellung einer mit Shisha-Rauchen assoziierten akuten eosinophilen Pneumonie (AEP). Nach einer Kortisonstoßtherapie und 9 Beatmungstagen konnte der Patient auf die Normalstation verlegt werden. In der ambulanten Nachsorge zeigten sich eine normale, altersentsprechende Lungenfunktion sowie ein vollständig regredienter radiologischer Befund. Folgerung Obwohl die akute eosinophile Pneumonie (AEP) eine Rarität darstellt, ist sie eine zu berücksichtigende Differenzialdiagnose bei akut einsetzendem thorakalem Druckgefühl, Dyspnoe, nichtproduktivem Husten, Fieber und anamnestischem Wasserpfeifenkonsum. Mittels einer Kortisonstoßtherapie und Beatmung kann ein schweres ARDS bis zur vollständigen Ausheilung therapiert werden.

Background: Hookah smoking has been increasingly popular in Iran within the last two decades. The present study aims to explain the determinants of hookah smoking cessation among southern Iranian women in Bandar Abbas.Methods: The present study is a pioneering qualitative research that employed a conventional content analysis to explore factors affecting the hookah smoking cessation between 2018 and 2019. In total, 36 in-depth, semi-structured interviews were held with experienced individuals (15 women with successful cessation and 21 women with unsuccessful cessation) who 15 maximally diverged in terms of age, education, and occupation, from different geographical areas of the city. The interview process went on until the data were satiated. The required data were then analyzed qualitatively in MAXQDA.Results: Overall, six major categories were extracted. They included incentive background, need for freedom, control of external stimuli, religious norms, self-efficacy, and political factors. Conclusions: As the results showed, there were many external factors affecting the decision to quit or cut down on the rate of smoking hookahs. Catering for the required conditions and factors to strengthen the promotive ones and perceived threats, spiritual support and self-efficacy can effectively help successful cessation or reduction programs of hookah smoking.

Introduction: Smoking is an important risk factor for cardiovascular diseases. There is an increase in the prevalence of hookah smoking in both genders and among all age groups in Saudi Arabia with the misconception that hookah smoking carries less risk than cigarette smoking.Objective: Our aim in this study was to compare the outcomes of hookah versus cigarette smoking in patients presenting with myocardial infarction (MI). Methodology: In this retrospective study, we included 246 patients who presented with MI between May 2014 and October 2016. The prevalence of smoking was 56.5% in this group. The smokers were divided into two groups: hookah smokers and cigarette smokers. Propensity matching was performed to control for differences in patients' characteristics. The outcomes of in-hospital mortality, number of diseased vessels, type of intervention, and recurrence of ischemia were compared between the two groups. Results: Among the 139 smokers, 35 were hookah smokers (25%) and 104 were cigarette smokers (75%). The median number of cigarettes or cigarette equivalent per day was similar between the two groups (20). Both groups had similar outcomes in the number of diseased vessels, type of intervention, recurrence of symptoms, and mortality (hookah = 4.9% and cigarettes = 2.9%, P = 1). Conclusion: These findings support the fact that hookah smoking carries the same harmful effect as cigarette smoking on patients with MI and that the risk might be related to the number of cigarettes smoked per day rather than the type of smoking.

Introduction: Cigarette or hookah smoking, as well as alcohol consumption and abuse, are considered to be the most common etiological factors for the onset of oral cavity diseases, such as changes on the lips, tongue, stomatopyrosis, glossopyrosis, candidiasis. Aim: Research aims to determine the harmful effect of smoking the hookah as well as other harmful factors on the oral health of the student population of the Faculty of Dentistry in Sarajevo. Methods: The fourth, fifth, and sixth-year students of the Faculty of Dentistry in Sarajevo participated in this cross-sectional study. All of them are systemically healthy and consume some harmful habits: smoking cigarettes, alcohol consumption, and hookah. All students participated in the study voluntarily and they signed informed consent before the clinical examination. All the subjects gave an extensive medical history which recorded all the data on oral hygiene, harmful habits, manner and length of consumption; they were also given a clinical examination of the oral mucosa and the periodontium, as well as determining periodontal indices, and oral tests that are used for diagnostic purposes. The data is entered into work charts specially designed for these purposes. Results: The results are statistically processed in the SPSS Statistics 21.0 program and are discussed along with the results of other authors, published in relevant databases. Conclusion: The conclusion consists of important facts that originate from the results and the discussion.

Background Traditional hookah smoking has grown quickly to become a global tobacco epidemic. More recently, electronic hookahs (e-hookahs)—vaped through traditional water pipes—were introduced as healthier alternatives to combustible hookah. With combustible tobacco smoking, oxidative stress, inflammation, and vascular stiffness are key components in the development and progression of atherosclerosis. The comparable effects of hookah are unknown. Research Question What is the differential acute effect of e-hookah vaping vs combustible hookah smoking on oxidation, inflammation, and arterial stiffness? Study Design and Methods In a randomized crossover design study, among a cohort of 17 healthy young adult chronic hookah smokers, we investigated the effect of e-hookah vaping and hookah smoking on measures of conduit arterial stiffness, including carotid-femoral pulse wave velocity (PWV), augmentation index-corrected for heart rate before and after a 30-min exposure session. We assessed a panel of circulating biomarkers indicative of inflammation and oxidants and measured plasma nicotine and exhaled carbon monoxide (CO) levels before and after the sessions. Results e-Hookah vaping tended to lead to a larger acute increase in PWV than hookah smoking (mean ± SE: e-hookah, +0.74 ± 0.12 m/s; combustible hookah, +0.57 ± 0.14 m/s [P < .05 for both]), indicative of large artery stiffening. Compared with baseline, only e-hookah vaping induced an acute increase in augmentation index (e-hookah, +5.58 ± 1.54% [P = .004]; combustible hookah, +2.87 ± 2.12% [P = not significant]). These vascular changes were accompanied by elevation of the proinflammatory biomarkers high-sensitivity C-reactive protein, fibrinogen, and tumor necrosis factor α after vaping (all P < .05). No changes in biomarkers of inflammation and oxidants were observed after smoking. Compared with baseline, exhaled CO levels were higher after smoking than after vaping (+36.81 ± 6.70 parts per million vs –0.38 ± 0.22 parts per million; P < .001), whereas plasma nicotine concentrations were comparable (+6.14 ± 1.03 ng/mL vs +5.24 ± 0.96 ng/mL; P = .478). Interpretation Although advertised to be “safe,” flavored e-hookah vaping exerts injurious effects on the vasculature that are, at least in part, mediated by inflammation. Trial Registry ClinicalTrials.gov; No.: NCT03690427; URL: www.clinicaltrials.gov, Graphical Abstract

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.

Background: Optimism is known to be associated with many health behaviors. However, the associations between optimism, tobacco smoking and substance abuse in adolescents are not well documented. This study aimed to address this research gap in a large school-based population. Methods: Participants (N = 1104) were selected based on multi-stage cluster sampling method. Cigarette and hookah smoking behaviors, illicit drug use, optimism, and relevant covariates were measured using a validated questionnaire. Data were analyzed using ordinal logistic regression. Results: After adjustment, higher optimism score was a protective factor against being situated in advanced stages of cigarette smoking (odds ratio [OR] = 0.88, 95% CI: 0.84-0.91), hookah smoking (OR = 0.91, 95% CI: 0.88-0.94), and illicit drugs usage (OR = 0.90, 95% CI: 0.85-0.95). Moreover, the results showed that negative-stability and negative-globality domains of optimism were significantly higher among advanced-stage smokers and illicit drug users. Conclusion: Optimism was found to be a protective factor against tobacco smoking and substance abuse; whereas pessimism (negative-stability and negative-globality) was found to be a determinant factor. Further research is needed to investigate the effects of optimism on the transition in cigarette and hookah smoking stages.

Hookah is a single-stemmed or multistemmed instrument for vaporizing and smoking flavored tobacco, whose smoke is passed through a water basin before inhalation. The use of hookah dates back centuries and is believed to have originated in India during the reign of Akbar the Great or the Safavid dynasty of Persia. Outside its native region, hookah smoking has gained popularity throughout the world, especially among younger people. There is generally a misconception among hookah users that it is less addictive than combustible cigarette smoking and that there is little to no nicotine content in hookah, with some even believing that certain additives impart health benefits. Although studies investigating the health hazards of hookah are rather limited, the inhaled smoke contains large quantities of nicotine, tar, carbon monoxide, polyaromatic hydrocarbons, heterocyclic compounds, carboxylic compounds, and various inorganic compounds such as heavy metals, all of which are found in combustible cigarette smoking. Regular hookah use is associated with an increased risk of obstructive lung disease as well as lung cancer and malignancies of the head and neck. This narrative review summarizes the available data on the health hazards of hookah, with an emphasis on pulmonary complications. Increased knowledge and awareness of hookah smoking among healthcare providers can potentially lead to better patient education and identification of at-risk populations.

Patient: Male, 22 Final Diagnosis: Spontaneous pneumomediastinum Symptoms: Shortness of breath Medication: — Clinical Procedure: None Specialty: Surgery Objective: Rare disease Background: Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting pathology defined as the presence of free air in the mediastinum without a traumatic cause. Factors that can lead to the development of SPM include alterations in breathing patterns such as bronchial asthma, marijuana smoking, cocaine inhalation, and barotrauma occurring with Valsalva’s maneuver. Case Report: This is a case of a previously healthy 22-year-old who presented to the Emergency Department complaining of sudden shortness of breath and chest pain after smoking a hookah for the first time. Clinical and radiological findings led to the diagnosis of pneumomediastinum, which was treated conservatively. The only apparent cause of the patient’s condition was hookah smoking. Conclusions: SPM should be considered in patients who develop chest pain and shortness of breath after smoking a hookah. To the best of our knowledge, no previous cases of spontaneous pneumomediastinum associated exclusively with hookah smoking in a previously healthy patient have been reported in the English literature.

Carbon monoxide is a gas formed by partial combustion of carbon containing fuels and leads to intoxication with various non-specific clinical findings. Although hookah is a common way of tobacco consumption among people living in the Middle East, Asia and Africa, it has become popular in European countries and United States of America (USA). In our country, hookah smoking is especially common among young people and more common in cafes. In our case report, two cases with carbon monoxide (CO) poisoning findings after smoking hookah. In both cases, non-specific clinical findings were observed after hookah smoking and blood carboxyhemoglobin fraction (FCOHb) levels were higher than normal values in laboratory parameters.

Background Tobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts. Methods We analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013–2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014–2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2. Results Ever and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p Conclusions Compared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have implications for stronger efforts to increase awareness of the harmful effects of hookah as well as vaping, specifically tailored among SM communities.

In the current literature, although it has been known that hookah smoking increases the heart rate and predisposes to arrhythmia, no case report has been published regarding hookah smoking and the development of arrhythmia, including atrial fibrillation (AF). In this case report, we presented an adult patient without known cardiovascular disease who experienced AF after a heavy hookah smoking session. Following IV amiodarone infusion, normal sinus rhythm was achieved. The patient was advised to stop hookah smoking and discharged with a beta-blocker therapy and an oral anticoagulant treatment for 3 weeks. The patient’s rhythm was normal at one-month outpatient visit. This case emphasizes that hookah smoking could not be considered as a less harmful alternative to cigarette smoking because of its’ apparent side effects to the cardiovascular system.

Background The present study aimed to investigate the effects of a multi-level intervention on hookah smoking frequency and duration among Iranian adolescents and adults. Methods In this study, two comparable cities in Iran were selected to participate in an intervention program based on a social-ecological model (SEM). In each city, 133 hookah smokers in coffee houses were selected. Environmental changes in coffee houses such as serving light foods and games were conducted. A virtual group named “no hookah” was established on the Telegram application to train participants in the intervention group. Messages, pictures, and short videos were sent to the participants through that virtual network. The frequency and duration of hookah consumption were assessed in both groups at baseline and after the intervention. Results The frequency of hookah consumption decreased in 72.6% of participants in the intervention group (vs. 6.3% in the control group), and the duration of hookah consumption per session decreased in 39.5% of participants in the intervention group (vs. 5.5% in the control group). Conclusions Using multi-level interventions through a social-ecological model can reduce hookah consumption in adults.

Introduction Smoking is one of the most important causes of mortality and morbidity in the world, as it is related to the risk factor and etiology of respiratory-tract diseases. Long-term smoking causes both structural and functional damage in the respiratory airways, leading to changes in nasal mucociliary clearance (NMC). Objectives The aim of the present study was to look systematically into the current literature and carefully collect and analyze results to explore NMC in smokers. Data Synthesis Two independent reviewers conducted a literature search on some Electronic database: Pubmed, Medline, Ebsco, Springer Link, Science Direct, Scopus, and Proquest searching for articles fulfilling the inclusion and exclusion criteria. The lead author independently assessed the risk of bias of each of the included studies and discussed their assessments with the other two authors to achieve consensus. Of the 1,654 articles identified in the database search, 16 met the criteria for this review. Most of the articles (15 out of 16) showed the impairment of NMC in smokers. Conclusion The present systematic review suggests that there is an impairment of NMC in smokers. The impairment is not only observed in cigarette smoking, but also in passive smoking, bidi smoking, electronic smoking, and hookah smoking. The impairment of NMC in chronic exposure to smoking is caused by the ciliotoxic effect, hypersecretion and viscoelastic change of mucous, airway surface liquid depletion, increased oxidative stress, and deteriorations in the inflammatory and immune systems.

Dear Editor,We recently managed a previously healthy 14-year old male presenting to the emergency department with a complaint of chest pain [CP], the onset of which was the prior evening. Described...

BACKGROUND Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah's potentially detrimental effects are underestimated as a result of the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. METHODS Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients' prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. RESULTS The entire cohort included 270 patients. The mean patient age was 29.2 ± 5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (P = .326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. CONCLUSION Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.

Background: Smoking is considered as the second leading risk factor of early death and disability throughout the world. Smoking is the second leading risk factor of early death and disability in the world. The workplace is an important setting for the implementation of cigarette smoking prevention and control interventions. This study aimed to determine the prevalence of cigarette smoking and related factors by focusing on ADHD and risk-taking behaviors among a sample of Iranian workers. Methods: This cross-sectional study was conducted on 2434 male workers of Kaveh Industrial City in Saveh. Random cluster sampling was used in the selection of workers. All workers completed five sets of anonymous and validated questionnaires. ADHD was measured by Conner’s Adult ADHD Rating Scales. Data analysis was done using chi-square, independent t-test and logistic regression model in STATA 10. Also, P-value

Background The use of the hookah-smoking device is increasing at a large scale in the Eastern Mediterranean region. Hookah users are exposed to an array of chemical compounds and may suffer several chronic diseases as a result. The purpose of this study was to determine the prevalence of hookah use among male high school students in the region and to study different associated factors in order to provide local tobacco control officials with an understanding of this public health problem. Methods A convenient non-probability sampling study was conducted among students in three high schools in Al-Karkh district, Baghdad. The study period was from October 2017 till January 2019 and included 847 male students aged 15–18 years old. Using a simple random technique to select the high schools from a list of schools we chose one school from each directorate. Descriptive, chi-square test of significance, bivariate, and multivariate logistic regression analyses of data were carried out for identifying the risk factors associated with hookah smoking among these high school adolescent males. Results The overall prevalence of hookah smoking in the last 30 days among male high school students was 46.1% while in the past 6 months it was as high as 85.7%. More than two-thirds (70.6%) of the students thought that hookah smoking was more socially acceptable than cigarette smoking. Factors such as having first heard about it from friends, the media, or the presence of a hookah café near their residence were significantly associated (p > 0.05) with hookah smoking among the students. Similarly, being surrounded by friends who used hookah was also found to be significantly associated with hookah smoking, with an odds ratio of 0.18, 95% CI (0.087–0.394). Hookah smokers were less likely than non-hookah smokers to report its use as forbidden in Islam and more likely to say it is allowed in Islam. Conclusions We found an alarmingly high use of hookah smoking among male high school students in this study. Family members and peers had an important role in the prevention of hookah smoking among these students. There is a need for students to be educated about the toxicity of hookah tobacco smoking and its direct effect on their health.

Background: The outbreak of Coronavirus Disease 2019 (COVID-19) has led to a major concern for those who are more vulnerable to infections. Objectives: This study aimed to evaluate the most important risk factors for severe COVID-19 pneumonia. Methods: This retrospective study included information on clinical and epidemiological features of 105 patients with severe COVID-19 pneumonia hospitalized in Tajrish Hospital, Tehran, Iran. Initially, the medical records of the patients were investigated, and an interview was conducted based on a pre-prepared checklist to seek information about symptoms, past medical history, medication history, and behavior before hospitalization. Results: Out of 105 participants, 76 (72.5%) cases were male, and 54 (51.4%) patients were older than 54 years old. The majority of the patients (n=18; 17.1%) had both hypertension and diabetes (n=12; 11.4%). Metformin (n=36; 34.3%) was the most used medication amongst the studied patient. In addition, 24 (22.9%) patients were recreational hookah smokers, and the majority (75%) of them were under the age of 46 years old. Eventually, 19 patients were excluded from the study, of whom 11 individuals had diabetes, and 10 cases were using metformin. Conclusion: Apparently, hookah smoking played a critical role in the spread of COVID-19 in Iran and has made younger people more susceptible. In addition to older age, the immunosuppressive effects of Metformin seem to make diabetic patients with an impaired immune system more vulnerable to severe COVID-19 pneumonia. More studies on the immune system of vulnerable individuals by identifying their differences can help to protect them.

Hookah smoking has become common in the USA, especially among young adults. This study measured biomarkers of exposure to known tobacco product toxicants in a population-based sample of exclusive, established hookah users. Urinary biomarker data from 1753 adults in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study were used to compare geometric mean concentrations of biomarkers of exposure in exclusive, established past 30-day hookah users to never users of tobacco. Geometric mean ratios were calculated comparing hookah user groups with never users adjusting for age, sex, race/ethnicity, education, past 30-day marijuana use, secondhand smoke exposure and creatinine. Past 30-day hookah users (n = 98) had 10.6 times the urinary cotinine level of never tobacco users. Compared to never tobacco users, past 30-day hookah users had 2.3 times the level of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the tobacco-specific nitrosamine (TSNA) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), 1.3 times higher polycyclic aromatic hydrocarbons (PAHs) 3-hydroxyfluorene and 1-hydroxypyrene, 1.8 times higher levels of acrylonitrile, 1.3 times higher levels of acrylamide, and 1.2 times higher levels of acrolein exposure. These data indicate that hookah use is a significant source of exposure to nicotine, carcinogens, and respiratory toxicants.

BackgroundMost hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students.MethodsA cross-sectional survey of 2460 students (aged 18–25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns.ResultsAmong current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p p ConclusionsThe socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.

Background: The prevalence of hookah smoking (HS) 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 HS frequency among women in southern Iran. Method: This research was conducted on 400 female 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 HS. Variables with a P-value of less than 0.05 in the final fitting model were regarded to be associated with the outcome variable (frequency of HS per day).Results: Women' age ranged between 15 and 85 years (mean=35±13 years). We found that the lowest age of beginning to smoke hookahs (SHs) (pConclusion: To prevent the behavior and make effective interventions to reduce HS, policy-makers should stay focused on factors other than internal motivations. Encouraging the social unacceptance of hookahs, focus on those surrounding women smokers, quitting the habit of HS and effective interventions to decrease one's intention to SHs can help to reduce such unhealthy behaviors.

Background: The rise in popularity of waterpipe smoking among younger people cause increase its deleterious effects on health in recent years. The aim of this study was to estimate the pooled prevalence of water-pipe smoking in university students in Iran. Methods: We performed the literature search from 1946 to January 21, 2019, in several international and national databases such as Medline/PubMed, Web of Science, Scopus, Google Scholar, Magiran, Iranmedex, and IranPsych. To investigate the between-study heterogeneity we used the chi-squared test and I2 index. We used a random-effects model to estimate the pooled prevalence of water-pipe smoking. The potential source of heterogeneity was assessed by subgroup analysis and meta-regression. Results: According to the eligibility criteria, we included 37 relevant studies in our meta-analysis. The pooled prevalence of lifetime water-pipe smoking was 25% (95% CI: 22-29) and in male and female subgroups was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively. The pooled prevalence of water-pipe smoking in last year was 21% (95%CI: 16-25) and in last month was 8% (95%CI: 5-11). Results of meta-regression analysis showed that there was not any significant association between suspected variables and the prevalence of waterpipe smoking. Conclusion: The higher prevalence rate of water pipe smoking among university students indicates the emergency need for planning preventive program.

Objectives: Waterpipe or hookah smoking has grown considerably in popularity over the past two decades; however, consumers often have misconceptions regarding this practice. This study aimed to determine common beliefs related to waterpipe smoking among Turkmen in Iran. Methods: This qualitative study was conducted between February and June 2018 in Golestan Province, Iran, utilising data from a previously published study. A total of 26 male Turkmen waterpipe smokers of different ages, occupations and education levels underwent in-depth semi-structured interviews. A content analysis of beliefs regarding waterpipe smoking was performed. Results: Five categories of beliefs were extracted during the content analysis, including beliefs related to addiction, health-related beliefs, preferential beliefs for waterpipe versus cigarette smoking, beliefs related to the social function of waterpipe smoking and beliefs attributed to waterpipe smoking. Several misconceptions were identified, including the idea that waterpipe smoking was not addictive, prevented the use of other more dangerous drugs (i.e. cannabis and opium) and was not as harmful as cigarette smoking. Conclusion: The results of this study indicate that Turkmen in Iran hold several misconceptions regarding the use of waterpipe smoking. Educational programmes are essential to correct such misconceptions and to control the prevalence of this habit in Iran. Keywords: Water Pipe Smoking; Addictive Behaviors; Health-Related Behaviors; Qualitative Research; Tobacco Use Cessation; Iran.

PURPOSE: Smoking has been linked with osteoporosis, but further evidence is required, especially concerning the effects of different types of tobacco smoking. We sought to examine the association between smoking and bone health in a large cohort of elderly Iranians. METHODS: The data from 2377 participants aged >60 years of Bushehr Elderly Health (BEH) program were used. Regardless of the type of smoking, participants were initially classified as non-smokers, ex-smokers and current smokers. Current smokers were also categorized based on the smoking type (pure cigarette, pure hookah and both). Dual-energy X-ray absorptiometry was used to evaluate bone density as well as Trabecular Bone Score (TBS). T-score ≤ −2.5 in either of the femoral neck, total hip or spinal sites was applied to determine the osteoporosis. The association of smoking and osteoporosis was assessed using multivariable modified Poisson regression model and reported as adjusted prevalence ratios (APR). The linear regression model was used to assess the association between smoking and TBS, adjusting for potential factors. RESULTS: A total of 2377 (1225 women) were enrolled [mean age: 69.3 (±6.4) years], among which 1054 (44.3%) participants were nonsmokers. In all, 496 (20.9%) participants were current smokers. Multivariable regression analysis revealed no significant association between smoking (either current or past) and osteoporosis in women. In men, current smoking was negatively associated with osteoporosis (APR: 1.51, 95%CI: 1.16–1.96). Among current users, cigarette smoking was associated with osteoporosis (APR: 1.57, 95%CI: 1.20–2.03); however, we could not detect a significant association between current smoking of hookah and osteoporosis. In men, a significant association was also detected between current cigarette smoking and TBS (coefficient: -0.03, 95%CI: −0.01, −0.04). CONCLUSION: Current cigarette smoking is associated with both the quantity and quality of bone mass in elderly men. Although we could not detect a significant association between hookah and osteoporosis in men, considering the prevalence of hookah smoking in the middle eastern countries, further studies are needed to determine the effect of hookah smoking on bone health.

Hookah (water pipe) smoking, an old method of tobacco smoking, is regaining widespread popularity all over the world. Although the research in this field is still deficient, it has been proven for its harmful effect on human's health by increasing the risk of cardiovascular disease, infection and lung, oral and bladder cancer (Al-Numair et al., J Food Agric Environ, 5: 17, 2007; Bou Fakhreddine et al., Respir Med, 108: 1241-1253, 2014; Chaouachi, J Negat Results Biomed, 5: 17, 2006). However, no research was found to address its effect on human fertility or reproductive outcome. In this cross-sectional study, we aim to explore the effect of smoking hookah on human semen parameters among men attending In Vitro Fertilization LABs for seminal fluid analysis testing. 104 patients aged between 25 and 45, who are noncigarette smokers and have no chronic medical illness, were enrolled in the study: 50 hookah nonsmokers and 54 hookah smokers. Their semen parameters were compared. Semen volume, normal morphology and progressive motility were slightly lower in the hookah smoker (3.21 ml; 10.2%; 29.56%) versus (3.45 ml; 11.5%; 33.20%), respectively, in nonhookah smokers; however, the difference was not statistically significant. The effect of hookah smoking on semen observed in our study was not statistically significant. Further studies are needed to explore more and confirm any unfavourable effect.

Background Water-pipe smoking is the most common type of tobacco used among Iranian women. The aim of this study was to explain women’s perceptions of their intention for quitting water-pipe smoking based on the theory of planned behavior. Methods The study was a qualitative content analysis which was carried out over 4 months in 2016 in Tehran-Iran. The participants were 26 women ages 18 to 45-years-old who smoked water-pipe and were selected through snowball sampling. The study was performed in hookah cafes, parks, and homes. The data were collected through individual interviews. The interviews were open-ended questions based on the theory of planned behavior. Directed content analysis was used to analyze the data. Results Findings showed that women did not intend to quit water-pipe in that time. Main contributing factors influencing not having intention of cessation were positive attitude and false beliefs toward hookah smoking, as well as having peers and family members who smoked water-pipe or approved its use. Although most females realized the obstacles associated with hookah cessation, they believed that quitting water-pipe smoking was up to them and could control more barriers. Conclusion Social pressure, positive attitude and false beliefs towards hookah smoking, as well as external and internal obstacles diminished women ‘s intention for cessation. Therefore, it is recommended to apply the theory of planned behavior into behavior change interventions in order to increase the intention to quit water-pipe smoking.

Background Tobacco smoking is the second leading cause of death and is closely linked to fatal diseases. Hookah Smoking (HS) is a traditional way to smoke tobacco, especially in the Eastern Mediterranean region that is constantly rising around the world. This study aimed to evaluate the different levels of personal, interpersonal and social HS in Iranian urban men and determine the most important predictors of the levels through applying the socio-ecological approach (SEA). Methods This study was conducted in the coffee houses of Hashtrud and Qarah Aghaj counties in East Azerbaijan, Iran. Data collection was conducted from the entire coffee house (n = 18) from April to June 2017. Systematic sampling was employed to recruit 266 men in the coffee house. A valid and reliable instrument was used to investigate the frequency of HS and its determinants based on SEA. The SEA consists of three levels: personal (age, education, employment, income, and perceived severity and sensitivity), interpersonal (perceived reward), and social level (social support) intended to assess HS determinants. Hierarchical regression was used to determine the predictive value of SEA levels and frequency of HS. Results The mean age of daily hookah smokers (once per day and more than once per day) were (26.8) significantly lower than those (30.4) smokes weekly (once a week or more than once a week). The hierarchical logistic regression model showed that in the first step individual variables significantly predict 25.1% HS. In the second and third level interpersonal and social levels of SEA explained HS 30.1 and 30.8%, respectively. Conclusion This study found that age, income, education, and perceived reward were all important factors influencing HS among men youth. Application of SEA to determine the factors associated with HS could contribute in the development of a holistic prevention program.

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.

Background: Tobacco smoking is one of the most important public health problems that may be prevented. There is limited information about its relationship with communication skills. Findings on the relationships between self-esteem and cigarette/hookah smoking are inconsistent. The aim of this study was to investigate the relationships between cigarette and hookah smoking,self-esteem and communication skills among a representative sample of high school students. Methods: In this cross-sectional study, a sample of 1321 tenth-grade students (14-17 years) was selected through multi-stage proportionally cluster sampling in Tabriz, 2017. The participants completed a self–administered multiple choice questionnaire including questions about cigarette smoking, hookah smoking, self-esteem, and communication skills. Results: After controlling for potential confounders, the results demonstrated that higher score of self-esteem protects students against being in advanced stages of cigarette smoking (odds ratio [OR] = 0.95, 95% CI: 0.92-0.99, P=0.012). However, there was no significant association between self-esteem score and the hookah smoking. Also, there was no significant association between communication skills score and cigarette and hookah smoking. Conclusion: According to our findings, self-esteem was associated with cigarette smoking, but not with hookah smoking. Furthermore, there was no statistically significant association between communication skills score and cigarette and hookah smoking.