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      Waterpipe smoking: Results from a population-based study in Qatar

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          Abstract

          INTRODUCTION

          Waterpipe smoking is common in the Eastern Mediterranean Region and is becoming more prevalent in Qatar. To better plan waterpipe smoking control strategies we aimed to: 1) determine the prevalence of waterpipe smoking and explore its patterns in Qatar; 2) describe the knowledge, attitudes, and practices related to smoking behaviors; 3) recognize locations of waterpipe smoking and symptoms experienced during waterpipe sessions; and 4) evaluate the frequency of waterpipe smoking and the initiation age.

          METHODS

          We analyzed the data of a 7921 population-based survey of adults aged ≥18 years (nationals and expatriates), conducted in Qatar between March and December 2019. Out of 7105 surveys collected, 6904 were complete and included in the analysis.

          RESULTS

          Of the 6904, 570 (8.3%; 95% CI: 7.7–9.0) were waterpipe tobacco smokers, 425 (10.6%) males and 145 (5.1%) females. The highest prevalence of waterpipe smoking was reported among people aged 18–24 years (10.6%). Of the 575 waterpipe smokers, 56.3% (n=324) were exclusive waterpipe smokers. Use of other tobacco products among waterpipe smokers was higher among Qataris (52.3%) than expatriates (37.7%). Waterpipe cafés were the most common location for waterpipe smoking, however, females preferred restaurants; 83.3% reported that waterpipe smoking is harmful, while 39.3% considered that it is less harmful than cigarette smoking.

          CONCLUSIONS

          Waterpipe smoking prevalence is considerably high in Qatar, the second form of tobacco used. The formulation of new policies and enforcement of regulatory restrictions on waterpipe smoking are essential to reduce its uptake. Expansion in tobacco cessation services for women and poly-tobacco users is needed.

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          Most cited references51

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          The global epidemiology of waterpipe smoking

          Objectives In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally. Data sources Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used. Study selection The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking. Data extraction Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review. Data synthesis Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns. Conclusions Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.
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            Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure.

            Waterpipe (hookah, shisha) tobacco smoking has spread worldwide. Many waterpipe smokers believe that, relative to cigarettes, waterpipes are associated with lower smoke toxicant levels and fewer health risks. For physicians to address these beliefs credibly, waterpipe use and cigarette smoking must be compared directly. The purpose of this study is to provide the first controlled, direct laboratory comparison of the toxicant exposure associated with waterpipe tobacco and cigarette smoking. Participants (N=31; M=21.4 years, SD=2.3) reporting monthly waterpipe use (M=5.2 uses/month, SD=4.0) and weekly cigarette smoking (M=9.9 cigarettes/day, SD=6.4) completed a crossover study in which they each smoked a waterpipe for a maximum of 45 minutes, or a single cigarette. Outcome measures included expired-air carbon monoxide (CO) 5 minutes after session's end, and blood carboxyhemoglobin (COHb), plasma nicotine, heart rate, and puff topography. Data were collected in 2008-2009 and analyzed in 2009. On average, CO increased by 23.9 ppm for waterpipe use (SD=19.8) and 2.7 ppm for cigarette smoking (SD=1.8), while peak waterpipe COHb levels (M=3.9%, SD=2.5) were three times those observed for cigarette smoking (M=1.3%, SD=0.5; p's<0.001). Peak nicotine levels did not differ (waterpipe M=10.2 ng/mL, SD=7.0; cigarette M=10.6 ng/mL, SD=7.7). Significant heart rate increases relative to pre-smoking were observed at 5, 10, 15, 20, 25, and 35 minutes during the cigarette session and at 5-minute intervals during the waterpipe session (p's<0.001). Mean total puff volume was 48.6 L for waterpipe use as compared to 1.0 L for cigarette smoking (p<0.001). Relative to cigarette smoking, waterpipe use is associated with greater CO, similar nicotine, and dramatically more smoke exposure. Physicians should consider advising their patients that waterpipe tobacco smoking exposes them to some of the same toxicants as cigarette smoking and therefore the two tobacco-smoking methods likely share some of the same health risks.
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              Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review

              Background In spite of the negative health effects of waterpipe tobacco smoking, its use is becoming more common. The objective of this study is to systematically review the medical literature for motives, beliefs and attitudes towards waterpipe tobacco smoking. Methods We electronically searched MEDLINE, EMBASE, and the ISI the Web of Science in January 2012. We included both quantitative and qualitative studies. We selected studies and abstracted data using standard systematic review methodology. We synthesized data qualitatively. Results We included 58 papers reporting on 56 studies. The main motives for waterpipe tobacco smoking were socializing, relaxation, pleasure and entertainment. Peer pressure, fashion, and curiosity were additional motives for university and school students while expression of cultural identity was an additional motive for people in the Middle East and for people of Middle Eastern descent in Western countries. Awareness of the potential health hazards of waterpipe smoking was common across settings. Most but not all studies found that the majority of people perceived waterpipe smoking as less harmful than cigarette smoking. Waterpipe smoking was generally socially acceptable and more acceptable than cigarette smoking in general. In Middle Eastern societies, it was particularly more acceptable for women’s use compared to cigarette use. A majority perceived waterpipe smoking as less addictive than cigarette smoking. While users were confident in their ability to quit waterpipe smoking at any time, willingness to quit varied across settings. Conclusions Socializing, relaxation, pleasure and entertainment were the main motives for waterpipe use. While waterpipe users were aware of the health hazards of waterpipe smoking, they perceived it as less harmful, less addictive and more socially acceptable than cigarette smoking and were confident about their ability to quit.
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                Author and article information

                Journal
                Tob Induc Dis
                Tob Induc Dis
                TID
                Tobacco Induced Diseases
                European Publishing on behalf of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID)
                2070-7266
                1617-9625
                24 June 2022
                2022
                : 20
                : 61
                Affiliations
                [1 ]Tobacco Control Center, WHO Collaborating Center for Treating Tobacco Dependence, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
                [2 ]Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare, Milan, Italy
                [3 ]Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
                Author notes
                CORRESPONDENCE TO Silva Kouyoumjian. Tobacco Control Center, WHO Collaborating Center for Treating Tobacco Dependence, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. E-mail: SKouyoumjian@ 123456hamad.qa
                Article
                61
                10.18332/tid/149907
                9227603
                35836909
                e6071cff-4536-496a-bb50-180dfa35b0cc
                © 2022 AlMulla A. et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License.

                History
                : 02 February 2022
                : 06 April 2022
                : 09 May 2022
                Categories
                Research Paper

                Respiratory medicine
                tobacco,smoking,waterpipe,prevalence,qatar
                Respiratory medicine
                tobacco, smoking, waterpipe, prevalence, qatar

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