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Background: Associations between hookah and opium use and an increased risk of ischemic heart disease (IHD) have been suggested in a few studies, but more research is needed on the nature of these associations. We aimed to investigate the association between hookah and opium use and the prevalence of IHD in a population with relatively high prevalence of these exposures in Iran., Methods: Using baseline data from the Pars Cohort Study (PCS), a prospective study of individuals aged 40-75 years in Fars province, southern Iran, we calculated adjusted and crude odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the independent association of hookah and opium use with prevalence of IHD., Results: Of 9248 participants, 10.2% (95% CI: 9.5, 10.9) had self-reported IHD. Prevalence of ever use of hookah and opium was 48.9% (95% CI: 44.6, 53.6) and 10.2% (95% CI: 8.3, 12.5) among those with IHD, and 37.0% (95% CI: 35.7, 38.3) and 8.1% (95% CI: 7.5, 8.7) among those without IHD, respectively. Adjusted OR for the association with prevalence of IHD was 1.26 (95% CI: 1.08, 1.46) for hookah use and 1.71 (95% CI: 1.30, 2.24) for opium abuse. No dose-response association was found between hookah and prevalence of IHD., Conclusion: Hookah and opium abuse were associated with prevalent IHD in this study. Although more research is needed on these associations, particularly in prospective settings, reducing hookah and opium use could potentially reduce IHD risk., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Setting: During a period of regulatory uncertainty, a local public health unit in Ontario was notified of an exhibition for electronic nicotine delivery systems (ENDS) and novel tobacco delivery products (NTDs), specifically e-cigarettes and waterpipes, which have seen increasing use particularly among youth. Relevant statutes creating regulatory uncertainty included a new provincial Electronic Cigarettes Act (ECA) with certain sections awaiting proclamation, and a local waterpipe bylaw awaiting approval, which would have prohibited the use of these products in public spaces if they entered into force ahead of the exhibition date. Public health staff had concerns the event would normalize use of ENDS/NTDs, particularly among youth, and also planned to enforce already proclaimed ECA sections, as well as the existing Smoke-Free Ontario Act (SFOA) with regulations applicable to use of tobacco shisha in waterpipes., Intervention: Public health staff contacted event organizers and proprietors to communicate obligations under the SFOA and ECA, as well as share hypothetical implications from pending regulatory changes, including risk of charges for regulatory non-compliance if regulations came into force ahead of the planned event., Outcomes: Following discussion with health unit staff and legal consultation, the exhibition was cancelled., Implications: By directly communicating regulatory uncertainty, a public health unit was able to achieve local health goals. In this situation, public health advised exhibition proprietors of potential event disruption implicated by forthcoming regulatory changes. Subsequent cancellation of the event prevented potential adverse health impacts for at-risk groups. A similar communications approach could be used to achieve public health goals during a period of regulatory uncertainty.

Background: This study explores the differences among smokers of waterpipe tobacco in a college population to better inform campaigns to curb waterpipe use., Methods: Participants included undergraduate and graduate students attending a liberal arts university in Florida. E-mail-based, cross-sectional surveys were collected in 2 sequential years., Results: The majority of respondents (64%) reported having ever smoked a hookah, even if just 1-2 puffs. Of those who had ever smoked a hookah, 34% reported smoking a hookah within the previous 30 d. Constructs from the theory of reasoned action were all correlated with smoking behavior. The range of beliefs endorsed by smokers were more strongly associated with hookah-related attitudes compared with subjective norms. Concerns about health were stronger among never-smokers., Conclusions: Young adult college students continue to engage in waterpipe tobacco smoking at high rates. Campaigns need to focus on subsets of smokers and nonsmokers, independently., (Copyright © 2017 by Daedalus Enterprises.)

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.

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., (Copyright © 2015. Published by Elsevier Inc.)

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., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine waterpipe use and its association with demographic factors, tobacco cigarette smoking, ever use of electronic cigarettes (e-cigarettes) and alcohol use among high school students., Methods: Data were derived from the 2013 Ontario Student Drug Use and Health Survey, a school-based survey of 7th to 12th grade students. This province-wide survey was based on a stratified two-stage cluster design. Analyses were based on a subsample of 2,873 high school students and included adjustments for the complex sample design., Results: Overall, 12.5% of high school students (grades 9-12) had used a waterpipe in the previous year. Awareness of waterpipes was high - 68.4% of students reported that they were aware of waterpipes but had not used one in the past year; 19.1% had never heard of waterpipes or hookah. The percentage of high school students reporting waterpipe use in the past year was similar to reports of tobacco cigarette use (12.5% and 11% respectively). Waterpipe use was highly associated with past-year tobacco cigarette and regular alcohol use as well as ever use of e-cigarettes. In multivariate analyses, males and females had similar odds of waterpipe use, and non-White students and those in higher grades had greater odds of use after controlling for other substance use., Conclusion: These findings suggest that waterpipe use among high school students should be of some concern and suggest the need for policy measures to address potential risks associated with use.

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., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Waterpipe tobacco smoking (WTS) popularity is increasing world-wide, and health effects are emerging in the light of evidence that WTS is perceived by users as less harmful than cigarette smoking. However, there remains a paucity of available evidence from which to draw firm conclusions about its public health significance., Aims: This narrative review aims to summarize WTS literature to date to inform tobacco control specialists and health-care professionals about this phenomenon and help them to assess whether or not WTS should become a public health priority., Methods: Standard electronic databases as well as conference proceedings and personal libraries were searched in English, French and Arabic with inclusive terminology for the variety of names given to WTS., Findings: Waterpipe smoke contains significant levels of toxins, some of which are known to be carcinogenic to humans. Recent epidemiological trends have established an increasing prevalence of WTS in the Middle East and the United States, particularly among adolescents. It is used commonly across multiple ethnicities and both genders with less of a social gradient than cigarette smoking. Attitudes and beliefs have been researched widely and several reasons for believing it is less harmful than cigarette smoking include water filtration and social acceptability. A wide range of diseases have been associated with WTS, but research in this area is relatively underdeveloped and a better evidence base is needed. Worryingly, the waterpipe industry, including waterpipe cafes, operates in an almost completely unregulated market and employs deceptive marketing techniques to attract new users., Conclusions: Waterpipe tobacco smoking (WTS) appears to be on the increase, especially among younger users, and therefore represents a potential public health concern. While legislators should consider enforcing and extending existing tobacco laws to a growing WTS industry, further research is required to fill gaps in the literature and provide evidence-based interventions for tobacco control specialists and health-care professionals., (© 2013 Society for the Study of Addiction.)

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. [ABSTRACT FROM AUTHOR]

Introduction: The research regarding the effect of hookah smoking on health is still deficient, even though it has been proven to jeopardize human health by raising the hazard of different types of cancers, infections, and cardiovascular disease. We aimed to study the effect of dual tobacco smoking (hookah and cigarettes) on semen parameters of infertile men. Methods: In this cross-sectional study, we studied the effect of different types of smoking patterns on human semen parameters among men who visited IVF laboratories to do a seminal fluid analysis (SFA). A total number of 761 participants were included, divided into the following: 108 dual smokers, 219 hookah smokers, 222 cigarette smokers, and 212 non-smokers. To analyze the effect of dual smoking on normal morphology, an interaction term between the cigarette index and hookah index was used. Results: Multivariable regression analysis after adjustment for age, BMI, education level, children, chronic diseases, varicocele, testicular surgery history, infertility duration, and cause revealed no significant difference in the sperm concentration and the percentage of progressive motility between non-smokers, cigarette smokers, or hookah smokers. However, there was a significant difference in the log of normal morphology percentage between the three groups. Cigarette and hookah smoking were significantly associated with having lower percentages of normal morphology. There was a significant difference in the log-normal morphology %, where light and heavy dual smokers had the least exponential beta of log-normal morphology %, 0.43 (95% CI: 0.33–0.55) and 0.36 (95% CI: 0.24–0.53), respectively. Conclusions: Dual tobacco smoking can adversely affect sperm morphology. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This research explored factors associated with knowledge, attitude and practice of hookah smoking cessation during the Covid-19 pandemic. The participants were 650 women over 15. The data were collected by face-to-face interviews and structured questionnaires in multi-stage sampling. The results showed 63.5%, 56.3%, and 34.8% of the participants had a good knowledge, positive attitude, and a good practice. The age below 20 (AOR=1.134), college education (AOR=13.227), good economic status (AOR=2.153), holding a job (AOR=1.299), initiation age of hookah use>30years (AOR=3.956) were significantly associated with good knowledge. College education (AOR=1.215), and the initiation age of >30years (AOR= 1.350) were significantly associated with positive attitude. Besides, the initiation age of >30years, (AOR=2.513), history of HS< 5 years (AOR=1.884), no history of HS in family (AOR=1.678), the mere use of fruit tobacco, (AOR=2.131), good knowledge (AOR=9.264) and positive attitude (AOR=2.641) were significantly correlated with a good practice Based on the results, besides knowledge and attitude, a set of influential internal and external factors should be considered to eliminate HS habit during the pandemic. COVID-19: Coronavirus Disease-2019, HS: hookah smoking, HSC: hookah smoking cessation, TU: tobacco use, SES: socio-economic-status [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study assesses the long‐term effectiveness of a lifestyle intervention on cigarette, passive, and hookah smoking in adolescent boys and girls. METHODS: One thousand one hundred and fifty‐nine adolescent participants of Tehran Lipid and Glucose Study (TLGS) (2001‐2004) were followed for 12 years. Participants in the intervention area received lifestyle interventions in family, schools, and community settings, with the largest part implemented in schools. After excluding those with missing baseline parental data (n = 66), complete parental data of 1093 adolescents was used for cluster analysis. Families were classified as low‐ and high‐risk. Two hundred and ninety‐six individuals who did not complete intervention/follow‐ups were excluded, GEE was performed on 797 adolescents (369 boys, 192 intervention) to assess the intervention effect on tobacco‐related habits. RESULTS: Adolescents' mean baseline age was 15.21 ± 1.95. Those living in high‐risk families were more at risk of cigarette, passive, and hookah smoking. Intervention decreased odds of cigarette and passive smoking by 38% and 57%, respectively. Intervention did not reduce hookah smoking in adolescents. After sex‐specific analysis, the intervention reduced current cigarette smoking by 40% only in boys and passive smoking in both sexes. CONCLUSIONS: Targeting lifestyle behaviors in school‐aged adolescents and their families reduces cigarette smoking in boys and protects both sexes from secondhand smoke. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Introduction: The epidemic tobacco use is a public health concern worldwide. This study aimed to evaluate the prevalence of tobacco use and its socioeconomic determinants in the city of Shiraz, Iran. Methods: In total, 5873 adults aged 20 and older were included in this study from the city of Shiraz, Iran, from June to October 2015. The sampling was conducted using the stratified random sampling method. Active cigarette, hookah, and second‐hand smokers were labeled as tobacco users in this study. Past smokers and non‐smokers were labeled as non‐tobacco users. The participants' socioeconomic status (SES) was determined based on their self‐reported level of education, occupation, income, and residence. Results: In this study, 35.4% of the participants were tobacco users. The prevalence of active cigarette, active hookah, dual‐users, and secondhand smokers was 13.3%, 8.3%, 0.4%, and 13.4%, respectively. The prevalence of tobacco use was highest among individuals with primary education level (40.9%), manual jobs (46.4%), lowest income level (38.1%), and those living in the suburban areas (36.4%). In multivariate analysis, the most socioeconomic factors related to tobacco usage were lack of academic education, manual job, and low‐income level. Conclusions: Tobacco control efforts should be more focused on vulnerable groups of cigarette and hookah users in the southwest of Iran. Moreover, SES and reduction of health‐related disparities and inequality should be considered a crucial concern in this regard. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore the clinical relationship between the varicocele-associated male infertility with hookah smoking practice in the Saudi community in the al Jouf region. Materials and Methods: A total of 192 patients were categorized into two groups; varicocele with (Varicocele-Associated Hooka (VH) group; n = 100) and without smoking (NHV group; n = 92). Laboratory investigations such as hormonal (follicle-stimulating hormone, and luteinizing hormone [LH]), semen analysis were performed. Ultrasonography-based varicocele screening was performed. Data were analyzed with SPSS version 21.0. P < 0.05 was considered statistically significant. Results: Increased prevalence of varicocele Grade 2 (57%) and Grade 3 (52.5%) in HV groups. In contrast, Grade 1 was increased in NHV group (55.6%). A significant (P = 0.05) decrease in testosterone levels in the HV group (2.83 ± 0.21) as compared to NHV group (2.33 ± 0.07) observed. Decreased levels of sperm count (21.96 ± 6.31) and sperm morphology (14.09 ± 0.45) were observed in HV groups as compared to NHV group (22.5 ± 5.49, 14.51 ± 5.02, respectively). HV groups showed the increased diameter of the testicular vein (3.52 ± 0.71) as compared to NHV group (3.42 ± 0.72). Chronic smoking revealed a statistically significant effect on testosterone (P = 0.015) and LH levels (P < 0.041) in the HV group. In addition, hookah smoking sessions per week affect sperm motility (P = 0.02) in the HV group. A significant correlation was observed in sperm count (r = 0.24, P < 0.016) and motility (r = 0.25, P = 0.010) in HV group. Conclusion: Chronic hookah smoking significantly affects the reproductive hormonal and semen parameters in varicocele patients as compared to people with varicocele without smoking. This implies that hookah has an adverse effect on male reproductive and infertility. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Smoking is an independent risk factor for atherosclerosis & coronary heart disease (CHD). dyslipidemia has been shown to be a significant coronary heart disease risk factor. This study is a case-control, conducted between June to November 2016, and aimed to find out the effect of cigarette smoking and hookah consumption on lipid profiles among the adult population. A total of 200 adults out of them 50 subjects were a non-smoker (controls group) and the other 150 were smokers (cases group), aged between 20-55 years and collected from Rafah Governorate. Personal & demographic data and clinical data situation of the study population were taken by interview questionnaire. Biochemical evaluations were carried out. Collected data were analyzed using SPSS-18. The findings showed that there was a significant difference between the mean ± SD of lipid profile in the controls group and the mean ± SD of lipid profile in seven cases sup-group (P < 0.05). Further, there was a statistically significant relationship between the mean ± SD of lipid profiles levels and years of cigarettes smoking among cigarettes smokers group (p=0.000). In contrast, among hookah smokers group, a statistical significance relation between the mean ± SD of TC level and years of hookah smoking is reported (p=0.010). Cigarette and hookah smokers had appeared with high progressing towards the emergence atherosclerosis and coronary risk factors; because, mostly, they were having high serum TC, TGs, LDL-C, and low serum HDL-C levels as compared to nonsmokers, and these findings agree with most of the previous studies. [ABSTRACT FROM AUTHOR]

Smoking tobacco is the second most common cause of death worldwide and is among the leading serious risk factors for disease. Among the forms of tobacco smoking, the two most common can be specified: cigarette smoking and smoking through a hookah. Cigarette use is related to approximately 450,000 premature death cases in the US each year. Compared to the extensive knowledge regarding the damages caused by smoking cigarettes, scientific data on the damages of hookah smoking has accumulated only in recent years. The sources for finding articles were "Pubmed" and "Google scholar", using the search terms 'Water pipe tobacco', 'Hookah'and 'Nargileh', including results in English only. Hookah smoking has been linked to various types of cancer, respiratory diseases, coronary heart diseases, lung diseases, infertility problems, dental problems, etc. Nevertheless, Hookah smoking is on the rise, and is now the second most popular form of smoking in the United States. Due to this growing popularity, it seems that the health implications are pushed aside, in light of the following reasons -- exposure to flavored hookah, social nature of hookah smoking, the internet and the mass media, the unharmful perception of smoking hookah. There is an urgent need for developing policies targeted towards hookah smoking on multiple levels, including - raising public awareness through health education guidance and educational programs; legislation regarding public smoking prohibitions, warning labels, taxing regulations and production standards; effective and uncompromising enforcement. [ABSTRACT FROM AUTHOR]

Introduction: Hookah smoking is becoming increasingly popular among the youth. Evidence shows that exposure to marketing of the unhealthy products through social media platforms may impact adolescent health behaviors. The aim of the study was to perform a content analysis of online portals selling hookah products.Materials and Methods: A content analysis of online retail market was conducted on Google India using three keywords hookah, hookah products, and shisha. Retail websites popular in India that were selling hookah products were randomly selected and explored. A total of 15 themes were developed and used to describe various promotional strategies for hookah products.Results: In all, 41 (19.2%) products claimed to be tobacco/nicotine-free and only 14 products (6.5%) displayed age/health-specific warnings. About 86% of products were available at discounted rates; glamorizing words for describing products in form of superior, premium, and legendary were found on 189 (88.3%) products. Phrases such as "ultimate way to celebrate," "perfect excuse to chill with your friends," and "now enjoy the world of smoking without any doubt of harm" are commonly used to promote hookah products.Conclusion: Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among the youth. Most products are being sold without any warnings and there is no means to control the selling of the products to minors. There is a need to raise the issue of hookah products in the same tune as done for other forms of tobacco. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Transtheoretical model (TTM) has been recognized as a common theoretical model in researches in terms of addictive behaviors. The aim of this study was to examine the psychometric properties of the Persian brief version of the TTM for hookah tobacco smoking cessation in a sample of Iranian rural adults who were in the preparation stage for hookah cessation. Methods: This was a validation study on Iranian rural adult hookah smokers by the TTM instrument. First, to translate the questionnaire items from English to Persian, backward-forward procedure was used. Face and content validity of the instrument items were assessed. Confirmatory factor analysis (CFA) was performed to determine the construct validity of the instrument. For this aim, 300 participants completed the instrument. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were calculated to examine the internal consistency and reliability of the subscales of the instrument. Findings: The content validity index (CVI) and content validity ratio (CVR) of the items were ≥ 0.80 and ≥ 0.60, respectively. Based on CFA, the data fitted the TTM model. root mean square error of approximation (RMSEA), the goodness of fit index (GFI), adjusted GFI, and comparative fit index (CFI) were 0.037, 0.960, 0.910, and 0.950, respectively. At this stage, 6 items were deleted. The ICC and Cronbach's alpha of the subscales ranged between 0.60-0.74 and 0.71-0.86, respectively. The final instrument with 29 items was confirmed. Conclusion: The findings suggest that translating Persian brief version of the TTM instrument was a reliable and valid tool to identify the determinants of hookah smoking cessation among Iranian rural adults. [ABSTRACT FROM AUTHOR]

Purpose: Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS.Approach: A systematic synthesis of content and legal interactions among federal, state, and local TCP documents.Setting: Pennsylvania, which represents a politically and demographically diverse microcosm of the United States.Participants: No human subjects.Method: Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs.Results: Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs.Conclusion: Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform. [ABSTRACT FROM AUTHOR]

In the summer of 2009, the FDA obtained authority to regulate the manufacturing, distribution, and marketing of cigarettes and smokeless tobacco products. The Family Smoking Prevention and Tobacco Control Act was passed to reduce the trend of new users forming an addiction to tobacco before they were of the age to have an understanding of the toxic and even deadly consequences. However, non-conventional tobacco products, such as hookah tobacco, e-cigarettes, and other modified tobacco or tobacco-free alternatives are currently not regulated. On April 24th, 2014, the FDA announced they were planning on extending the agency's tobacco authority to cover additional tobacco products. Yet, not much is known about the hazards of these tobacco and potentially reduced exposure products (PREPs). Steam Stones are one alterative tobacco product where no quantitative information is available. These small pebble-like rocks contain no tobacco or nicotine and are coated in a viscous flavored fluid formulation consisting of glycerin, and are placed in a hookah head as an alternative to hookah tobacco. A total metal analysis with ICP–MS/MS was performed on the two originally marketed brands, Mya and Shiazo. The coatings of the stones underwent an initial hot water extraction for the purposes of determining the stones' metal composition for 26 metal targets. The toxic metals detected in both the Mya and Shiazo stones included trace levels of Cr, Ni, Cu, As, and Pb. This led to analyzing the toxic metals a smoker could potentially be exposed to during a 30 minute smoking session using both brands of steam stones and two different types of traditional smoldering charcoal. It was found that a smoker could inhale statistically similar quantities of Cr (between 12.2 ± 9.91 ng per smoking session to 1130 ± 776 ng per smoking session) and As (between 191 ± 30.1 ng per smoking session to 246 ± 101 ng per smoking session) when smoking one of four hookah head scenarios (scenario 1: Mya stones and Coco Nara charcoal, scenario 2: Mya stones and Fantasia charcoal, scenario 3: Shiazo stones and Coco Nara charcoal, and scenario 4: Shiazo stones and Fantasia charcoal). Although steam stones are marketed as free of nicotine, tar, carcinogens, and carbon monoxide, the use of traditional smoldering charcoal still exposes a user to these toxicants, including unacceptable amounts of harmful metals, such as Cr and As, despite the use of an alternative tobacco product. Notably, the use of electronic charcoal decreased the amount of toxic metals present in the smoke. Therefore, the smoke still contained relatively high levels of toxic metals, likely due to the use of traditional charcoal, which was previously quantified by ICP–MS/MS in our earlier paper [40]. [ABSTRACT FROM AUTHOR]

Background: Given the increasing evidence of its negative health effects, including contributions to both infectious and chronic diseases, waterpipe tobacco smoking raises public health concerns beyond even those presented by traditional smoking. Methods: Identification of Clean Indoor Air Acts (CIAAs) from each of the 50 United States and District of Columbia were retrieved and examined for inclusion of regulatory measures where waterpipe tobacco smoking is concerned. Several instances of exemption to current CIAAs policies were identified. The cumulative policy lens is presented in this study. Results: States vary in their inclusion of explicit wording regarding CIAAs to the point where waterpipe tobacco smoking, unlike traditional smoking products, is excluded from some legislation, thereby limiting authorities' ability to carry out enforcement. Conclusion: Consistent, comprehensive, and unambiguous legislative language is necessary to prevent establishments where waterpipe tobacco smoking occurs from skirting legislation and other forms of regulatory control. Stricter laws are needed due to the increasing negative health impact on both the smoker and the bystander. Actions at both the federal and state levels may be needed to control health risks, particularly among youth and young adult populations. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine predictors of refraining from hookah smoking among high-school students in Bandar Abbas, southern Iran based on Prototype/Willingness model. Methods: This cross- sectional with analytic approach was performed on 240 high-school students selected by a cluster random sampling. The data of demographic and Prototype-Willingness Model constructs were acquired via a self-administrated questionnaire. Data were analyzed by mean, frequency, correlation, liner and logistic regression statistical tests. Results: Statistically significant determinants of the intention to refrain from hookah smoking were subjective norms, willingness, and attitude. Regression model indicated that the three items together explained 46.9% of the nonsmoking hookah intention variance. Attitude and subjective norms predicted 36.0% of the non-smoking hookah intention variance. There was a significant relationship between the participants' negative prototype about the hookah smokers and the willingness to avoid from hookah smoking (P=0.002). Also willingness predicted non-smoking hookah better than the intention (P<0.001). Conclusion: Deigning intervention to increase negative prototype about the hookah smokers and reducing situations and conditions which facilitate hookah smoking, such as easy access to tobacco products in the cafés, beaches can be useful results among adolescents to hookah smoking prevention. [ABSTRACT FROM AUTHOR]

Hookah smoking is growing in popularity among college-age students in the United States. Community-based, semistructured, in-depth interviews were conducted with 20 college-age individuals who had used a hookah to smoke tobacco. A structured analysis of responses was conducted and framed in terms of the health belief model's four main constructs. Although hookah smokers were aware of the potential severity of tobacco-related illnesses, they did not express a perceived susceptibility to those illnesses. To the extent that cues to action exist with respect to hookah smoking, they generally serve to promote a risky behavior that is perceived to be largely social in nature. [ABSTRACT FROM PUBLISHER]

This study was aimed at assessing the various factors associated with shisha smoking such as attitudes, practice and addiction among the adult population aged 15 - 44 years in Lahore city. A cross-sectional survey was held in Shisha bars, tobacco shops and Shisha cafes along with some major undergraduate colleges and Universities of Lahore in summer of 2013. All adults aged between 15 and 44 years of age who consumed Shisha were included in the sample. All other age groups and people not smoking were excluded. The data for this study were collected with the participants using an approved self- administered questionnaire. Data analysis was done using the IBM SPSS version 20. The final sample size was 300 (male 194 and female 106). The largest group was of young adults aged 21-25 years. Out of all the participants, 65% of the sample was smoking shisha for over a year. It was noteworthy that encouragement for shisha smoking was brought on more by friends (61%) as compared to colleagues (9%) and the money spent on such activities was utilized from their own pocket money (70.3%). It was also observed that 42.3% of the sample recognized water-pipe/shisha as being a stress reliever and 68.7% admitted it to be a status symbol. Hence, 77.7% of the sample smoked shisha in the company of friends with 11.3% claiming to be completely addicted to it. In addition, 72.3% of the participants of this study refused to quit water-pipe/shisha smoking. Significance was found in Pearson's correlation between gender and duration, expenditure and frequency of consumption, addiction and duration, status symbol and stress reliever, company and status symbol and addiction with duration and wanting to quit (p < 0.05). A high significance was observed in age with duration, expenditures, company, stress reliever and status symbol (p < 0.01). Frequency of consumption with addiction, and stress reliever (p < 0.01); stress reliever with age (p < 0.01); addiction with stress reliever and status symbol (p < 0.01); wanting to quit with gender and duration (p < 0.01); and lastly expenditures with encouragement, addiction, status symbol and stress reliever (p < 0.01) were also observed in 2-tailed significance of Pearson's correlation. This study concludes that shisha smoking is responsible for a lot of ill-effects in the oral cavity apart from the body itself. This habit should be minimized and the misconceptions related to it should be made clear to all young population to avoid further harm to their health. [ABSTRACT FROM AUTHOR]