ArticlePDF Available

Abstract and Figures

Objectives: To investigate the use of unconventional substances and materials in water pipe among cafe water pipe smokers. Methods: This was a questionnaire-based survey among subjects attending coffee shops in the region of Al Madinah, Saudi Arabia between February and March 2013. Results: We invited 110 subjects, only 90 consented to participate in the study. A percentage of 1.1% used fluids other than water in the water pipe tank, 18.9% added other soft drinks to the tank, and 7.8% added flowers, spices or drugs to the tobacco mix placed in the head of the water pipe. A proportion of participants used fruits to replace the water pipe head (12.2%), or to replace water pipe tank (4.4%). Higher number of children the smokers had and cafe smoking were all significantly associated with unconventional practices. Conclusions: A substantial percentage of sample of water pipe smokers in Al Madinah, Saudi Arabia use unusual materials and/or substances in the water pipe and this is probably encouraged by cafe smoking.
Content may be subject to copyright.
890 Saudi Med J 2014; Vol. 35 (8)
Unconventional materials and substances
used in water pipe (narghile) by smokers
in central western region, Saudi Arabia
Ashraf S. Baboor, BDS,
Ahmad A. Alnazzawi, MSc, PhD,
Osama A. Abu-Hammad, MSc, PhD,
Najla S. Dar-Odeh, BDS, FDS RCS.
Objectives: To investigate the use of unconventional
substances and materials in water pipe among café
water pipe smokers.
Methods: is was a questionnaire-based survey
among subjects attending coffee shops in the region
of Al Madinah, Saudi Arabia between February and
March 2013.
Results: We invited 110 subjects, only 90 consented
to participate in the study. A percentage of 1.1%
used fluids other than water in the water pipe tank,
18.9% added other soft drinks to the tank, and 7.8%
added flowers, spices or drugs to the tobacco mix
placed in the head of the water pipe. A proportion
of participants used fruits to replace the water pipe
head (12.2%), or to replace water pipe tank (4.4%).
Higher number of children the smokers had and
café smoking were all significantly associated with
unconventional practices.
Conclusion: A substantial percentage of sample of
water pipe smokers in Al Madinah, Saudi Arabia use
unusual materials and/or substances in the water pipe
and this is probably encouraged by café smoking.
Water pipe smoking is now considered an epidemic
that is affecting all continents.1-7 Recent reports
have indicated a high prevalence of water pipe smoking
among Saudi adolescents,8 and university students.9
Besides the documented health hazards of conventional
water pipe smoking,10 reports have emerged to indicate
that there are other unconventional methods of water
pipe smoking. ese methods may employ certain
materials other than Muassel, the conventional mix,
such as cannabis,11 psychoactive drug,12 marijuana or
hashish.3 A recent study conducted in neighboring
Jordan found that approximately 6% of a sample of
water pipe smokers mix alcohol with the tank water,
and approximately 2% mix other substances with
Muassel such as cannabis, antihistamine drugs, and
paracetamol.7 Former studies have found an association
between water pipe smoking and an increased risk of
being involved in road accidents, and this was attributed
to the use of cannabis in water pipe.13 Other aspects
of water pipe smoking that have received little or no
attention is the unconventional use of fruits to replace
certain components of the water pipe instrument itself
like the head or water tank. is practice increases
the appeal of the habit particularly among females,14
but may pose certain health hazards that are yet to be
investigated. e aim of this study was to investigate
the prevalence and pattern of unconventional materials
and substances incorporated in water pipe in a sample
of water pipe smokers in AlMadinah AlMonawara,
Saudi Arabia.
Methods. e study was based on a cross sectional
survey whereby a questionnaire was designed to explore
the pattern of unconventional practices in the water
pipe set. e questionnaire included personal questions,
questions on smoking history including unconventional
practices, and finally questions on health perceptions
and awareness. Before distributing the questionnaire, it
was validated for clarity and it was further tested for
reliability. Subjects included in this study were regular
male patrons at coffee shops that serve water pipe in
Almadinah Almonawara, Saudi Arabia. To make sure
that only participants who fit these inclusion criteria
are included in this study, we conveniently recruited
participants during their smoking sessions at the coffee
shops. Recruitment and data collection took place
during February and March 2013. We explained to
the participants the nature of the study and after their
acceptance (informed consent form) to participate in
the study, they completed the questionnaires privately.
e study was approved by the ethical committee of
the College of Dentistry, Taibah University.
Statistical analysis. Statistical analysis was performed
using the Statistical Package for Social Sciences for
Windows version 17.0 (SPSS Inc., Chicago, IL, USA).
Frequency distribution were obtained and chi-square
test was used to assess the statistical differences between
frequencies. Statistical significance was set at a p-value
of 0.05, with a confidence interval of 95%.
Results. One hundred and ten subjects were invited
to participate in this study. Only 90 subjects agreed to
participate giving a response rate of 81%. e subjects
were all males and had an age range of 19-52 years
(mean=31.4, median=31, SD=8.54). Personal and
social characteristics of the study sample are shown in
Table 1. Although all subjects were water pipe smokers,
98% of them responded that they are smokers when
891 Saudi Med J 2014; Vol. 35 (8)
asked if they believe that they were smokers. Table 2
shows characteristics of water pipe smoking in our
In total, 23.3% of the study group used unusual
methods and/or materials in water pipe; 12.2% used
fruits as the water pipe head (pineapple, apples, pears,
orange), while 4.4% used fruits to replace water pipe
tank (watermelon, cantaloupe). Only 1.1% used fluids
other than water in the water pipe tank (blueberry
juice), 38.9% of the subjects added ice to water pipe
tank, 18.9% added soft drinks to the tank (rose water,
mint, lemon, orange juice, apple juice and fizzy drinks),
and 7.8% added flowers, spices or drugs to Jarak, the
type of tobacco mix placed in the head of the water
pipe in the region of Saudi Arabia, (roses, banana
peels, euphoric substances, cardamoms, carnations,
paracetamol). When the number of participants who
practice unconventional water pipe smoking was cross-
tabulated with social characteristics, only the higher
number of children that married people have, and the
occupation of employee were significantly associated
with unconventional practices with P values of p=0.005
and p=0.013. Also, when number of participants who
practice unconventional water pipe smoking was cross-
tabulated with characteristics of water pipe smoking,
the only significant association was with coffee shops
as the place of smoking (p=0.017). Health awareness
perceptions were as follows: 42% used disposable tips
when smoking the water pipe outside their homes,
100% believed water pipe was harmful, 95% wished
to quit water pipe smoking, and 23.3% tried to quit.
Also, 1.1% of the subjects visit the physician routinely
while 4.4% visit the dentist routinely. Cross-tabulation
in association with unconventional practices did not
show a significant association with the desire to quit
water pipe (p=0.231), routine visits to the dentist
(p=0.569), and oral hygiene practice (p=0.363). Table 3
shows perceived health hazards of water pipe and reason
for difficulty to quit the habit.
Discussion. is study was a survey similar to
a previous study.7 Although both Jordan and Saudi
Arabia are predominated by the Arab Muslim culture,
Unconventional substances and materials in water pipe ... Baboor et al
Table 3 - Perceived health hazards of water pipe smoking and reasons for
difficulty in quitting the habit.
Perceived health hazards of water
pipe smoking
n (%)
Chest problems 75 (83.3)
Cancer 32 (35.5)
General health problems 5 (5.6)
Reasons for not being able to quit
It became a habit 32 (35.6)
To lift the mood 32 (35.6)
To break the routine 18 (20.0)
To spend time with friends 4 (4.4)
Addiction 4 (4.4)
Table 1 - Social characteristics of participants, and the number of
participants from each category that do unconventional
practices. P value resulting from cross tabulation between social
characteristics and unconventional practices is displayed.
Characteristics n (%) Participants
tabulation with
Marital status
Number of children
for married subjects
No children
1 child
2 children
3 children
4 children
5 children
11 have children
Table 2 - Characteristics of water pipe smoking in our sample. P value in
association with unconventional practices is shown. Introducer
is the person(s) introducing the smoker to water pipe smoking.
Companion is the person(s) with whom water pipe smoking
session is spent.
Characteristics n (%) Participants with
tabulation with
Frequency per week
1-3 times
4-7 times
14-21 times
24 (26.7)
55 (61.1)
11 (12.2)
Age of onset (years)
8 (8.8)
82 (91.2)
11 (12.2)
79 (87.8)
17 (18.9)
73 (81.1)
Favorable place for
Coffee shop
79 (87.8)
11 (12.2)
892 Saudi Med J 2014; Vol. 35 (8)
it is known that the community of Al Madinah Al
Monawara is more conservative than that of Amman.
e city is considered one of the 3 most sacred places
for Muslims around the globe. e holy Muslim city is
geographically divided into 2 main areas; the Haram
itself and the area outside the Haram, where it is allowed
to smoke and to provide the service of water pipe in
coffee shops. Another characteristic of this community
is the unavailability of water pipe to females in coffee
shops. is explains why our sample was purely made
of males. is limitation should be avoided in future
studies to include females regardless the place where
they smoke a water pipe. e sample was a convenient
sample of 90 participants which was another limitation
of the study.
e use of unconventional smoking methods was
practiced by a substantial proportion of water pipe
smokers (23.3%), mostly represented by adding soft
drinks to the tank (18.1%), while the least popular
practice was mixing Jarak (tobacco mix) with other
substances in the form of flowers, spices, and drugs
(7.8%). Materials added to tank, or used to replace
head and tank seem to be innocuous. However, they
may be associated with unknown health risks. Unlike
other studies,7 alcohol was not used by this sample
which reflects a number of trends such as the religious
nature of people in Al Madina and also the fact that
alcohol consumption is prohibited in Saudi Arabia.
However, this did not deter subjects who mixed
euphoric substances with Jarak (n=2), or the man who
added paracetamol to it. Unconventional practices were
not significantly associated with marital status. On the
other hand, they were associated with a higher number
of children that married men had. Moreover, employees
followed by retired people were significantly associated
with this practice. Whether these 2 observations are
age-related or not, this needs further exploration.
Statistical analysis for the association of nationality with
unconventional practices was not performed because
of the relatively small number of non-Saudi’s (n=4)
participating in the study.
Smoking water pipe once or more daily is considered
heavy smoking.15 Most of the sample were heavy
smokers (73.3%), smoking water pipe 4-7 times a
week (61.1%), while a substantial proportion (12.2%)
smoked 14-21 times a week. e frequency of water pipe
smoking was not significantly associated with the use of
unconventional practices, indicating that other factors
make water pipe appealing to the heavy smokers, apart
from unconventional practices. It may also indicate
that the use of unconventional practices does not lead
to heavy smoking. ese factors were explained by the
answers to the question:” why do you think that quitting
is difficult?” with comparable proportions describing it
as a habit, and as a “mood modifier”. Four of the sample
(4.4%) even admitted to being addicted to the habit.
Neither companions nor introducers, were significantly
associated with unconventional practices, although it
was mostly friends who introduced to the habit or later
became the companions. It was the favorable place for
smoking, cafés, which was significantly associated with
unconventional practices. is is reasonably explained
by the length of time and amount of expertise needed
to prepare the water pipe setting incorporating fruits, or
fluids other than water in the tank (Figure 1). Recently,
in neighboring Jordan there are active campaigns to
ban café water pipe. But one cannot be optimistic
yet regarding cutting the popularity of water pipe.
Other existing methods for expert preparation of
unconventional water pipe are still operative, like home
delivery, or the “take- away” water pipe. ese methods
should be addressed efficiently if the practice of water
pipe is to be counteracted.
Only 2% of water pipe smokers perceived that they
were non-smokers, and 95% wished to quit the habit.
Furthermore, the whole sample believed that the habit
is harmful to health. However, they had poor knowledge
on health hazards of the waterpipe, and actual practices
of this sample show that they need more education in
this regards. ey did not even recognize the dangers
of sharing the water pipe like infections similar to
cold, herpes, and tuberculosis.16 is observation
was evident in that less than half of the sample used
disposable tips when smoking away from home.
Moreover, negligible proportions visit the dentist and
physician routinely. is has significant consequences
taking into consideration that the population of water
Figure 1 - Fruits such as melons, cantaloupe, and apples are sometimes
used to replace the water tank or the head of the water pipe.
Unconventional substances and materials in water pipe ... Baboor et al
893 Saudi Med J 2014; Vol. 35 (8)
pipe smokers are prone to various health problems.
Perceived health hazards of water pipe were very general
and excluded other important documented hazards. It
is worth mentioning that similar studies in neighboring
countries reported less awareness regarding the health
perceptions and desire to quit water pipe.1,14
In conclusion, unconventional risky practices seem
to be associated with café water pipe smoking.
Received 13th February 2014 . Accepted 27th May 2014.
From the College of Dentistry, Taibah University, Al Madinah Al Monawara,
Kingdom of Saudi Arabia. Address correspondence and reprints request to:
Dr. Najla S. Dar-Odeh, College of Dentistry, Taibah University, Al Madinah
Al Monawara, PO Box 344, Al Monawara 30001, Kingdom of Saudi Arabia.
1. Dar-Odeh NS, Bakri FG, Al-Omiri MK, Al-Mashni HM,
Eimar HA, Khraisat AS, et al. Narghile (water pipe) smoking
among university students in Jordan: prevalence, pattern and
beliefs. Harm Reduct J 2010; 7: 10.
2. Jamil H, Templin T, Fakhouri M, Rice VH, Khouri R, Fakhouri
H. Comparison of personal characteristics, tobacco use, and
health states in Chaldean, Arab American, and non-Middle
Eastern White adults. J Immigr Minor Health 2009; 11:
3. Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an
emerging health risk behavior. Pediatrics 2005; 116: e113-e119.
4. Poyrazoğlu S, Sarli S, Gencer Z, Günay O. Waterpipe (narghile)
smoking among medical and non-medical university students
in Turkey. Ups J Med Sci 2010; 115: 210-216.
5. Slama K, David-Tchouda S, Plassart JM. [Tobacco consumption
among young adults in the two French departments of Savoie in
2008]. Rev Epidemiol Sante Publique 2009; 57: 299-304.
6. Tamim H, Akkary G, El-Zein A, El-Roueiheb Z, El-Chemaly S.
Exposure of pre-school children to passive cigarette and narghile
smoke in Beirut. Eur J Public Health 2006; 16: 509-512.
7. Dar-Odeh NA, Beyari MM, Al-Abdalla M, Al-Shayab MH,
Abdulrazzaq WS, Jarar S, et al. e use of unconventional
substances and tools in narghile (waterpipe) smoking; a pilot
study in Jordan. British Journal of Medicine and Medical
Research 2013; 3: 2042-2052.
8. Al Moamary MS, Al Ghobain MO, Al Shehri SN, Gasmelseed
AY, Al-Hajjaj MS. Predicting tobacco use among high school
students by using the global youth tobacco survey in Riyadh,
Saudi Arabia. Ann orac Med 2012; 7: 122-129.
9. Mandil A, BinSaeed A, Ahmad S, Al-Dabbagh R, Alsaadi M,
Khan M. Smoking among university students: a gender analysis.
J Infect Public Health 2010; 3: 179-187.
10. Dar-Odeh NS, Abu-Hammad OA. Narghile smoking and its
adverse health consequences: a literature review. Br Dent J
2009; 206: 571-573.
11. Gatrad R, Gatrad A, Sheikh A. Hookah smoking. BMJ 2007;
335: 20.
12. Hu X, Primack BA, Barnett TE, Cook RL. College students and
use of K2: an emerging drug of abuse in young persons. Subst
Abuse Treat Prev Policy 2011; 6: 16.
13. Elias W, Assy N, Elias I, Toledo T, Yassin M, Bowirrat A.
e detrimental danger of Water-Pipe (Hookah) transcends
the hazardous consequences of general health to the driving
behavior. J Transl Med 2012; 10: 126.
14. Dar-Odeh NS, Abu-Hammad OA. e changing trends in
tobacco smoking for young Arab women; narghile, an old habit
with a liberal attitude. Harm Reduct J 2011; 8: 24.
15. Chaaya M, Jabbour S, El-Roueiheb Z, Chemaitelly H.
Knowledge, attitudes, and practices of argileh (water pipe or
hubble-bubble) and cigarette smoking among pregnant women
in Lebanon. Addict Behav 2004; 29: 1821-1831.
16. Jukema JB, Bagnasco DE, Jukema RA. Waterpipe smoking:
not necessarily less hazardous than cigarette smoking : Possible
consequences for (cardiovascular) disease. Neth Heart J Mar
2014; 22: 91-99.
Unconventional substances and materials in water pipe ... Baboor et al
Do you have any comments or questions?
Agree or disagree with published articles?
e correspondence section within the journal is a forum to comment on any of the articles
published in the journal. Correspondence will not be sent for peer review, and will only
be edited for the use of appropriate language. All correspondence should be submitted and
published within 6 months from the date of the original publication.
Please submit your correspondence through the journal website (, and don’t
forget to clearly state the title of the original publication, and your contact details.
... One anaesthesiology resident stated that he used combination of chlorpheniramine and orphenadrine/ paracetamol for their mind-altering effect [46] d. Miscellaneous (n = 4) 37 Purging with paracetamol: report of four cases. ...
... Narghile, Hoookah). [46,47] In a cross-sectional survey that was conducted in Jordan, almost half of participating community pharmacists (n = 138) reported mixing medications (one of which was paracetamol) with alcohol or other drinks. [48] Another study in Jordan reported the use of paracetamol in combination with other medicines for their mind-altering effects. ...
... [47] This practice has also been reported in other countries in the region. [46] Miscellaneous uses Four studies reported the suspected abuse of paracetamol by general public for different reasons. Tiller and Treasure (1992) described four cases of young females (18-22 years old) with eating disorders inducing vomiting using paracetamol after eating binges. ...
Objectives To describe and map what is known about unconventional uses of paracetamol through a scoping review of published literature by adopting adopted a PRISMA systematic approach methodology. Key findings Four themes for unconventional uses of paracetamol emerged: (a) use of paracetamol in sleep (a-1) positive effect of paracetamol on sleep (n = 9) or (a-2) neutral or negative effect of paracetamol on sleep (n = 9); (b) use of paracetamol in sport (n = 13); (c) mixing paracetamol with drinks, waterpipe and illicit drugs (n = 5); and (d) miscellaneous uses (n = 4). Forty records were reviewed and charted. Available literature supports concern around the potential of harmful or non-medical use of paracetamol, especially among patients with a history of substance use, parents of young children or athletes. Summary Paracetamol (acetaminophen) is one of the most popular and widely used drugs for the treatment of pain and fever. It is considered remarkably safe if used within instructions. However, there is growing evidence that paracetamol, is sometimes used outside approved indications or abused (i.e. used for non-medical reasons). This review highlights the need for enhanced pharmacovigilance and surveillance of non-medical paracetamol use and raising general public awareness of its potential dangers especially in higher than recommended doses.
... The details of selected articles are categorised: a. Articles related to general population [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] b. Articles related to studies in schoolchildren [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] c. ...
... The articles [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] show smoking prevalence, smoking types, desire to quit, male and female difference in smoking and oral hygiene. ...
... [19] Waterpipe smoking was also found among general population. [12,18,22] Waterpipe smokers used unusual materials or substances. They used different fluids other than water like soft drinks in the water pipe tank, and tobacco mixed with different spices or drugs. ...
Full-text available
Smoking, as recreational activity, is being practiced by over 1 billion people globally. The main objective of the present study was to explore smoking prevalence, its effects and people attitude in the Kingdom of Saudi Arabia (KSA) by literature review. PubMed was used for systematic search. Search was made with key words ‘Smoking AND Saudi Arabia’ and a total of 790 articles were found. When limits were applied with English language and studies on human, 502 articles were left. All abstracts of these articles were reviewed with the application of inclusion criteria of studies in the KSA and Saudi Arabia population and 75 articles were left. Then, these articles were categorised according to content, attitudes, cross-sectional studies, factors or diseases, its effects and associations to risk factors, original articles, prospective and retrospective studies, studies about smoking, surveys, studies showed different prevalences of smoking among schoolchildren, medical colleges, university students, health professionals and other population. Tobacco smoking was a major and modifiable risk factor for cardiac diseases and other diseases in Saudi Arabian population. Majority of smokers were found motivated to quit smoking, needed guidance and treatment. Second-hand smoke (SHS) affects newborns and children's health. Waterpipe smoking and SHS were potential threats for population's health in SA. It was concluded that in the KSA, smoking is a forthcoming alarming threat for different tobacco-related diseases. Now, it can be controlled in minimal time with lesser efforts by strategic planning, designing tobacco control programmes according to sex, age groups and education levels. Keywords: Diseases, Saudi Arabia, smoking, tobacco
... Waterpipe smoking has been a traditional type of smoking in wide areas of Asia and Africa. A new trend has been witnessed lately in waterpipe smoking showing a high popularity among adolescents and youth, increased popularity among youth in Europe and North America particularly university students, and inclination of females of all age groups to smoke waterpipe in societies that discourage women smoking cigarettes [7]. ...
... Carbohydrate-rich diet in general, increases adherence of Candida to epithelial cells and hence increasing the risk of infection [24]. It is also known that waterpipe smoking utilizes materials that may be rich in sugar like the tobacco mix and the cooling liquid [7]. This, combined with the fact that sugar consumption encourages oral Candida carriage [25], suggest that more research needs to be conducted on that area. ...
Full-text available
Background Tobacco smoking and diet have been both linked to increased oral Candida carriage. The aim of this study is to investigate the distribution of Candida species in the oral cavity of young individuals smoking cigarettes and waterpipe who have various dietary habits. Methods Participants were recruited from university students during December 2013, and were divided into three groups; a control non-smoking, a cigarette smoking, and a waterpipe smoking groups. The study sample completed a pre-structured questionnaire on smoking, and dietary habits. Oral swab samples were collected from all participants to determine oral Candida carriage and the colonizing Candida species. Data were statistically analyzed to determine the significance of association between Candida carriage on one hand and smoking status, and dietary habits on the other hand. Findings A total of 238 students participated in the study and among those only 30 (12.8%) students had oral Candida carriage. Candida albicans was the most common species to be recovered (56.7%), followed by Candida dubliniensis (23.3%). The association between smoking, and perceived dietary habits on one hand and oral Candida carriage on the other was not statistically significant. Conclusions Smoking, and perceived dietary habits seem to have no association with oral Candida carriage among a young cohort of university smokers. It is recommended that similar studies are conducted on older age groups to investigate if age has any influence.
... ments namely the electronic cigarettes and waterpipe, about the possibility of salivary virus transmission[16]. Steroids: Mucormycosis (black fungus) is triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients. ...
... Though tobacco smoking (including passive smoking) is widely considered as one of three leading risk factors in the global disease burden [14], the number of people smoking in the Middle East in general, and in Medina in particular, is increasing [15][16][17][18]. Smoking is undoubtedly associated with poor oral health, along with behaviors such as frequent snacking and infrequent tooth brushing [14,19]. ...
Full-text available
The aim of this observational study is to investigate the oral health status and practices in the multicultural community of Medina, Saudi Arabia. A cross-sectional questionnaire was distributed that asked about oral health, dental and periodontal conditions, personal attitudes toward dental care, and smoking habits. Cross tabulation with chi-squared testing was carried out to investigate the association of toothbrush usage and smoking with several variables. Four-hundred and sixty subjects enrolled in the study. The majority of the respondents were students and Saudi males. More than 75% of the participants had neither a family dentist nor dental insurance; 7% were smokers, 84% used a toothbrush, 17% used dental floss and 34% used miswak (a teeth cleaning twig made from the Salvadora persica tree). Some of the individuals complained of tooth sensitivity, halitosis and bleeding gums. The main reason for dental visits was pain, with 23% of the participants having never visited a dentist. Tooth brushing was significantly associated with gender, nationality, occupation, education, marital status, having kids and dental insurance (p ≤ 0.05). Tobacco consumption was significantly associated with age, occupation, education level, marital status, having children, having bleeding gingivae and halitosis. Effective dental education programs are needed to improve dental knowledge and awareness in the Medina community.
... However, it is established now that there is a proportion of asymptomatic patients who may transmit infection, and the presence of the virus in saliva means that even non-aerosol producing dental procedures can be a source of infection. Another important aspect of this finding is that dentists who are engaged in tobacco cessation efforts should disseminate awareness among their smoker patients of the possibility of salivary virus transmission via social sharing of tobacco smoking instruments namely the electronic cigarettes and waterpipe [46]. ...
Full-text available
COVID-19 was declared a pandemic by the World Health Organization, with a high fatality rate that may reach 8%. The disease is caused by SARS-CoV-2 which is one of the coronaviruses. Realizing the severity of outcomes associated with this disease and its high rate of transmission, dentists were instructed by regulatory authorities, such as the American Dental Association, to stop providing treatment to dental patients except those who have emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus, and also to preserve the much-needed supplies of personal protective equipment (PPE). Dentists at all times should competently follow cross-infection control protocols, but particularly during this critical time, they should do their best to decide on the emergency cases that are indicated for dental treatment. Dentists should also be updated on how this pandemic is related to their profession in order to be well oriented and prepared. This overview will address several issues concerned with the COVID-19 pandemic that directly relate to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.
... Studies (9,10,(20)(21)) that investigated nargile con- sumption represent the basis for this study and they were found searching for the key words such as: hoo- kah, water pipe, smoking, high school, risk factors at PubMed MEDLINE. On the basis of the above mention- ed studies, a questionnaire was prepared for this rese- arch. ...
Full-text available
S U M M A R Y In recent years, the prevalence of hookah smoking has increased worldwide, particularly in young people, which may have potentially serious consequences for their health. The aim of this study was to examine the factors associated with the consumption of hookah by high school students. The present study was conducted in the city of Novi Pazar, and students aged 17-19 years attending the following high schools were included: Medical School, Grammar School, Economic-Commerce School and Catering School. The study was designed as a case-control study. The cases were students who consumed nargile, while the control group consisted of students who had never smoked nargile. A special questionnaire was constructed for the purpose of this research, which was used to evaluate the opinions of adolescents on the consumption of nargile. Our research included a total of 270 seniors in high schools in Novi Pazar. The average age of the students was 18 years. The most important factors that may contribute to start using nargile were: previous consumption of nargile by older family members, divorced parents, and active smoking of cigarettes by other family members. Most students emphasized that hookah smoking is socially unacceptable form of behavior. Also, hookah smoker were neither more attractive nor popular. Nargile consumption is more common by adolescents whose parents are divorced, as well as by adolescents whose family members are smoking nargile or tobacco. The most common reason for nargile consumption among adolescents is a desire for relaxation.
... One phenomenon raised by participants in this study, which has been noticed in the past few years in Jordan and other countries, is adding medications to the water-pipe or the so-called Narghile (Baboor et al., 2014). In a crosssectional survey of 61 cafes in Jordan, almost 10% of respondents reported adding antihistamines, paracetamol of cannabis to the tobacco or tank water of the Narghile (Dar-Odeh et al., 2013). ...
Background: The problem of prescription and nonprescription drug abuse and misuse is well known worldwide. It has been 8 years since this problem has been investigated in Jordan. Objectives: This study aims to investigate the abuse/misuse of drugs sold with or without a prescription in community pharmacies in Jordan in 2014 and to document any changes that may have aroused in the past 8 years. Methods: A cross-sectional survey using a structured questionnaire based on one used previously in 2006 was sent to a stratified random sample of 320 community pharmacies. Data were managed and analyzed in SPSS. Results: A total of 290 questionnaires were completed (response rate = 92.4%). The pharmacists named 727 nonprescription and 372 prescription drugs as being suspected of abuse, each classified into 6 categories. New products have appeared on the list such as: ophthalmic drops (n = 39, 13.4%) and the anti-epileptic; Lyrica (pregabalin; n = 19, 6.5%). Other drugs previously on the 2008 list like misoprostol have retracted in 2014 (from 7.1% to 1.3%). Conclusion: Patterns of suspected prescription and nonprescription drug abuse/misuse have slightly changed in Jordan over time, with new drugs emerging and previous ones disappearing from the list.
... Our estimates are similar to a study among 90 waterpipe users in Saudi Arabia, where 18.9% mixed the apparatus water with soft drinks, and 7.8% added flowers, spices, or drugs to the tobacco. [41] A qualitative analysis with local governments in London highlighted that several waterpipe-serving premises openly advertise 'alcoholic waterpipes', usually at premium prices. [30] Public health implications While waterpipe tobacco smoking appears to be a prevalent but infrequent activity, longitudinal studies indicate that it may serve as a gateway for future cigarette use among adolescents in the US [42] and Jordan. ...
Full-text available
Introduction: Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking. Methods: We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly. Results: f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking. Conclusions: While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
Full-text available
Cigarette smoking has declined over the last years in modern countries. On the contrary, waterpipe smoking has increased, especially among young people visiting waterpipe bars. Unfortunately, most waterpipe smokers seem to know little about the possible cardiovascular and other health consequences of waterpipe smoking. To describe by narrative literature review the known adverse consequences for the human body caused by smoking the waterpipe compared with the consequences of smoking normal cigarettes. Also, to get a picture of public awareness of these consequences as deducted from the literature and a small new survey in the Netherlands. Tobacco smoking is associated with serious adverse (cardiovascular) health effects, and there is no evidence that these effects are less serious if a waterpipe is used. The increasing use together with the limited amount of awareness and attention for the possible health consequences of smoking the waterpipe is worrisome. Especially considering the increasing acceptance and use of the waterpipe among the youth. Therefore we recommend more systematic research into the possible health hazards of waterpipe smoking. In the meantime education campaigns and materials are needed to raise public awareness on the possible health risks of waterpipe use.
Full-text available
Aims: Narghile smoking may be associated with a number of unconventional practices that need to be thoroughly investigated for their potential health problems. We investigated the prevalence and pattern of unconventional practices related to narghile smoking including the use of medications, fruits, and alcohol, among a sample of café patrons. Place and Duration of Study: A few cafés at Amman, Jordan during July 2011. Methodology: This was a cross-sectional survey whereby a pre-prepared questionnaire was distributed to a sample of café patrons. Questionnaire included demographic information, history of tobacco use, pattern of narghile smoking including unconventional practices and lastly health awareness and attitudes towards cessation. Results: Out of 96 café patrons, 61 (63.5%) agreed to participate with 42 males and 19 females. Age range was 16-64 years (mean=27.5±9.2). About 47.5% used fruits as the narghile head and 16.4% used fruits as water tank. Equal proportions (9.5%) of the sample added either milk/soft drinks to tank or added drugs to tobacco mix or the liquid contents of the tank. Conclusion: Narghile smoking may be associated with unconventional practices like the use of psychoactive drugs and alcohol. Further research is needed to explore the reasons behind this trend, and the associated potential health hazards.
Full-text available
To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA). A cross-sectional study was conducted among high school students (grades 10-12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010. The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1-2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). "Ever smoked" status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28-3.63), parent smoking (OR = 1.70, CI: 1.25-2.30) or other member of the household smoking (OR = 2.11, CI: 1.59-2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56-12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09-15.48). Several predictors of cigarette smoking among high school students were identified.
Full-text available
Objective: To determine whether the consumption of tobacco used in Water-Pipe by drivers increases the risk of a motor vehicle collision as a consequence of hypoxia. Design: Analytical case-control study. Data sources: Seventy exclusive Water-Pipe smokers (Experimental Group--EG)--mean age ± SD: 29.47 ± 10.45 years; mean number of weekly WPS, (6.9 ± 3.7); mean duration of WPS (WPS) is (7.5 ± 2.1 years)--and thirty non-smoker (Control Group--CG; mean age ± SD: 36.33 ± 13.92 years) were recruited during 2011 from two Arab villages located in the Galilee, northern Israel. Methods: We performed a case-control study exclusively among Water-Pipe smokers with an appropriate non smokers control group. Demographic questionnaire, Pulse Oxymeter for blood oxygenation measure and a driver simulator for measuring various participants driving behaviors were utilized. Statistical analysis for analyzing the different variables, Pearson's x2 analysis for the comparison of categorical variables, continuous variable is compared using Student's t-test and for testing the correlation between the different variables and bivariate correlation analysis were applied. Results: In the (EG) following WPS, we observed increase in the pulse rate--from 80 to 95 (t = 11.84, p < 0.05) and decrease in saturation level from 97.9 to 97.32, the decrease is statistically significant (t = 3.01, p < 0.05) versus no change in (CG). An increased number of accidents among EG (OR is 1.333 with CI of 1.008-1.776), while in CG, an insignificantly decrease (t = 3.08, p < 0.05). In EG an increase in centerline crossings (OR is 1.306 with CI of 1.016-1.679), also the total time not being within the lane was increased and the estimated (OR: 1.329; CI: 1.025-1.722). WPS increases the number of accidents by 33% and Hypoxia can cause driving behavioral turbulences. Conclusion: The results show that WPS has a significant impact on driving behavior and on the risk of being involved in road accidents and causing driving to become riskier and less careful and stable. To the best of our knowledge, this is the first time such relationships have been tested. After WPS the total number of traffic accidents and driving violations increase. The results show a significant increase in the pulse rate immediately after WPS with a decrease in the saturation rate (the level of blood oxygenation); these changes continue half an hour after WPS.
Full-text available
Narghile smoking by young females is becoming more acceptable than cigarettes in the conservative societies of Arab countries. Lack of social constraints on narghile smoking has resulted in an increased prevalence of narghile smoking among young Arab females and an earlier age of onset of this habit when compared to cigarette smoking. Documented health hazards of narghile smoking including pulmonary, cardiovascular and neoplastic ailments are consequently expected to affect this vulnerable sector of the population together with their offspring. In this commentary, we shed some light on the changing trend of tobacco use among young Arabic women as shown by an increasing number of studies investigating habits of tobacco use in young people.
Full-text available
K2 or "spice" has emerged as a popular legal alternative to marijuana among adolescents and young adults. However, no data has been published assessing prevalence of and associations with ever K2 use in any population. This study's aims were to examine prevalence of ever K2 use among a sample of college students, to determine characteristics of persons who use K2, and to access the association between K2 and other drug use. Ever use of K2 was reported by 69 (8%) of the sample of 852 college students. Response rate was 36%. Bivariate and multivariate analyses assessed whether sociodemographic characteristics and other drug use were associated with ever use of K2. Ever use of K2 was reported by 69 (8%) of the sample. Among these 69 individuals, 61 (88%) had used a cigarette and 25 (36%) had used a hookah to smoke K2. In multivariate analyses, K2 use was more common in males (vs. females, adjusted Odds Ratio (aOR)=2.0, 95% Confidence Interval (CI)=1.2-3.5, p=0.01) and 1st or 2nd year college students (vs. 3rd year or above, aOR=2.4, 95% CI=1.2-5.0, p=0.02). Ever use of K2 in this sample was higher than ever use of many other drugs of abuse that are commonly monitored in adolescents and young adults. Although DEA had banned five synthetic cannabinoids recently, clinicians and public health officials concerned with substance abuse in youth should be aware of and monitor the use of this drug in college students over time.
Full-text available
The main objectives of this paper were to estimate the consumption patterns of tobacco use among King Saud University (KSU) undergraduate students; and investigate different risk factors which may contribute to tobacco use among female students. A representative sample (n=7550) of the total KSU undergraduate student population of 69,498 (males and females) was selected, stratified according to college and gender. A modified version of the WHO/CDC Global Youth Tobacco Survey (GYTS) questionnaire was used for data collection. Overall smoking prevalence among KSU students was estimated at 14.5%, prevalence among male students (32.7%), and females (5.9%). Independent risk factors for smoking among males were found to be: age, father's smoking habits, and "friends' smoking habits"; while among females were: sister's smoking habits and "friends' smoking habits." The findings of this study re-emphasize the significance of peer pressure on smoking among university students of both sexes; influence of family members, usually of same sex. We need to foster gender-sensitive tobacco prevention intervention programs, to prevent youngsters of both sexes from taking up such habit. We also need to raise awareness of girls and young women, of the consequences of smoking in general, water-pipe in specific, on their own health, that of their spouses, families, and off-springs, many of whom could develop chronic respiratory disorders, as passive smokers in the beginning/potential smokers themselves, later on. All such efforts should be backed and supported by strong governmental commitment, to ensure success of their implementation accordingly.
Full-text available
This investigation was performed in order to determine the prevalence rate of waterpipe smoking in students of Erciyes University and the effects of some socio-demographic factors. A total of 645 students who study the first three grades of the medical faculty and the engineering faculty of Erciyes University were enrolled in the study. A questionnaire including 48 questions was applied. Chi-square test and logistic regression method were performed for the statistical analyses. The total prevalence rate of waterpipe smoking was found to be 32.7%. The prevalence rate of waterpipe smoking was 28.6% in the medical and 37.5% in the non-medical students. It was determined that 41.6% of the males and 20.2% of the females currently smoke waterpipe. Gender, cigarette smoking, and the presence of waterpipe smokers among family members and friends have significant effects on the prevalence of waterpipe smoking. Residence and economical status of the family and with whom the students live have no significant effect on the prevalence rate. Approximately one-third of the students currently smoke waterpipe. Smoking of both cigarette and waterpipe was frequently found. The measures against all tobacco products should be combined.
Full-text available
Narghile is becoming the favorite form of tobacco use by youth globally. This problem has received more attention in recent years. The aim of this study was to investigate the prevalence and pattern of narghile use among students in three public Jordanian universities; to assess their beliefs about narghile's adverse health consequences; and to evaluate their awareness of oral health and oral hygiene. The study was a cross-sectional survey of university students. A self-administered, anonymous questionnaire was distributed randomly to university students in three public Jordanian universities during December, 2008. The questionnaire was designed to ask specific questions that are related to smoking in general, and to narghile smoking in specific. There were also questions about oral health awareness and oral hygiene practices. 36.8% of the surveyed sample indicated they were smokers comprising 61.9% of the male students and 10.7% of the female students in the study sample. Cigarettes and narghile were the preferred smoking methods among male students (42%). On the other hand, female students preferred narghile only (53%). Parental smoking status but not their educational level was associated with the students smoking status. Smokers had also significantly poor dental attendance and poor oral hygiene habits. This study confirmed the spreading narghile epidemic among young people in Jordan like the neighboring countries of the Eastern Mediterranean region. Alarming signs were the poor oral health awareness among students particularly smokers.
Background: As a result of tobacco control measures in France, smoking among adolescents is decreasing. However, this decrease is associated with changes in the way youth are consuming tobacco and turning towards new tobacco products: cheaper forms of tobacco such as rolling or chewing tobacco, or fashionable forms such as narghile. The aim of this study is to describe in young adults: (1) prevalence of tobacco use and main risk factors of daily smoking, (2) the entry mode for tobacco use and (3) prevalence and main risk factors related to "chewing tobacco" used as snuff. Methods: A descriptive transversal study was undertaken in five private and public high schools in the French Alps region in 2008. Anonymous questionnaires were given out to the students of 12th grade (last year of general secondary education) and BTS (professional training). Smoking prevalence and other forms of tobacco consumption were described, as well as the entry mode in tobacco use. Finally, we used logistic models to identify the main determinants of smoking cigarettes and using chewing tobacco. Results: This study included 920 students: 22.3% (95% IC: 19.6-25.0) were daily smokers and 65.9% (95% IC: 62.8-69.0) had tried tobacco. Approximately 40% had experimented with rolling tobacco, cannabis or narghile. We found the usual determinants of daily smoking: an environment conducive to smoking, and not belonging to a sports club. Around 11% (95% IC: 9.2-13.2) had tried chewing tobacco. Risk factors associated with chewing tobacco were: having a smoking friend (adjusted OR: 3.07; 95% IC: 1.95-4.83), studying in a private school (adjusted OR: 2.57; 95% IC: 1.52-4.31), or being male (adjusted OR: 1.79; 95% IC: 1.15-2.79). Conclusion: As found in national studies, cigarette smoking is declining among young adults, but the use of other tobacco products (narghile, chewing tobacco) is emerging. The relatively high consumption rate and the risk factors of chewing tobacco need to be examined in depth in order to organize prevention programs for young adults.