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Tobacco and waterpipe use among university students, Saudi Arabia: impact of tobacco sales ban

Authors:
  • Department of Medical Laboratory Sciences, Faculty of Pharmacy, Jadara University, P.O. Box 733, Irbid 21110, Jordan

Abstract

Tobacco and waterpipe use among university students, Saudi Arabia: impact of tobacco sales ban Background: Waterpipe smoking is a method of tobacco consumption that continues to spread globally. In 2002, a ban of tobacco sales was adopted in the Saudi Arabian cites of Mecca and Medina. Aims: This study aimed to examine prevalence of waterpipe and cigarette smoking among students of Taibah University, the biggest university in Medina city where tobacco sales ban is implemented. Methods: A structured questionnaire was used to achieve the aims of the study. Results: The study showed that prevalence of current and ever waterpipe use was 24.2% and 36.04%, respectively, while for current and ever use of cigarette smoking it was 31.9% and 42.7%, respectively. This prevalence is similar to that reported by studies conducted in other Saudi cities where tobacco sales are allowed. Multivariate analysis showed that waterpipe use was higher among senior students, those with monthly household income between 5000‐ 9000SR, those with pocket money spending of more than 500SR/month, and if number of individuals living at the household is 5 or more. On the other hand, current cigarette smoking was higher in those of more than 22 years, among male students, in those with pocket money spending of more than 500 SR/month and those who lived away from their parents. Conclusions: Collectively, waterpipe and cigarette smoking, despite ban on tobacco sales, are still common among Taibah University students in Medina/Saudi‐Arabia.
Tobaccoandwaterpipeuseamonguniversitystudents,SaudiArabia:impactoftobaccosales
ban
HaythamDaradka1,OmarF.Khabour2,3,KaremH.Alzoubi4,RimaNakkash5andThomas
Eissenberg6
1DepartmentofBiology,TaibahUniversity,Medina,SaudiArabia.2DepartmentofClinical
LaboratorySciences,TaibahUniversity,Medina,SaudiArabia.3DepartmentofMedical
LaboratorySciences,JordanUniversityofScienceandTechnology,Irbid,Jordan.4Department
ofClinicalPharmacy,JordanUniversityofScienceandTechnology,Irbid,Jordan.5Department
ofHealthPromotionandCommunityHealth,AmericanUniversityofBeirut,Beirut,Lebanon.
6DepartmentofPsychology,VirginiaCommonwealthUniversity,Richmond,UnitedStatesof
America.(Correspondenceto:HaythamDaradka:hmdaradka@yahoo.com).
ABSTRACT
Background:Waterpipesmokingisamethodoftobaccoconsumptionthatcontinuestospread
globally.In2002,abanoftobaccosaleswasadoptedintheSaudiArabiancitesofMeccaand
Medina.
Aims:Thisstudyaimedtoexamineprevalenceofwaterpipeandcigarettesmokingamong
studentsofTaibahUniversity,thebiggestuniversityinMedinacitywheretobaccosalesbanis
implemented.
Methods:Astructuredquestionnairewasusedtoachievetheaimsofthestudy.
Results:Thestudyshowedthatprevalenceofcurrentandeverwaterpipeusewas24.2%and
36.04%,respectively,whileforcurrentandeveruseofcigarettesmokingitwas31.9%and
42.7%,respectively.Thisprevalenceissimilartothatreportedbystudiesconductedinother
Saudicitieswheretobaccosalesareallowed.Multivariateanalysisshowedthatwaterpipeuse
washigheramongseniorstudents,thosewithmonthlyhouseholdincomebetween5000
9000SR,thosewithpocketmoneyspendingofmorethan500SR/month,andifnumberof
individualslivingatthehouseholdis5ormore.Ontheotherhand,currentcigarettesmoking
washigherinthoseofmorethan22years,amongmalestudents,inthosewithpocketmoney
spendingofmorethan500SR/monthandthosewholivedawayfromtheirparents.
Conclusions:Collectively,waterpipeandcigarettesmoking,despitebanontobaccosales,are
stillcommonamongTaibahUniversitystudentsinMedina/SaudiArabia.
Keywords:shisha,tobacco,smoking,hookah,Taibah
https://doi.org/10.26719/emhj.18.021
Received:09/05/17;accepted:01/10/17
Copyright©WorldHealthOrganization(WHO)2018.Somerightsreserved.Thisworkis
availableundertheCCBYNCSA3.0IGOlicense(https://creativecommons.org/licenses/bync
sa/3.0/igo).
Introduction
Globally,approximately6milliondeathseachyearareattributedtotobaccosmoking(1).In
additiontocigarettesmoking,waterpipetobaccosmokinghasbecomemorepopular(2)
particularlyamonghighschoolanduniversitystudents(3).Thisgrowthinpopularityisdue,in
part,tothemisperceptionthatthewaterpipe‘filters’thesmoke,renderingitlessharmfulthan
othertypesoftobaccosmoking(4).Infact,waterpipetobaccosmokecontainscarcinogenssuch
aspolycyclicaromatichydrocarbonsthatcauselungtumours,toxicaldehydecompoundsthat
causelunginflammation,highlevelsofcarbonmonoxidethatcontributetocardiovascular
disease,andnicotinethatcausesaddiction(58).Animalstudieshaveshownthatwaterpipe
smokeexposureleadstolunginflammation,oxidativestress,impairedpregnancyoutcomes,
renalfunctions,chromosomalstructure,andcognitiveandmentalability(914).Thus,thistype
ofsmokinghasthepotentialtocausecancer,lungdisease,cardiopulmonarydisease,
dependence,andotherdisorders.(9,1518).Forthesereasons,waterpipetobaccosmokingis
nowseenasapublichealththreatrequiringeffectivepolicyintervention(19,20).
Onepotentialinterventionistobantobaccosales,andthisapproachwasadoptedintheSaudi
ArabiancitesofMeccaandMedinain2002(21).Thisisatotalbanthatthroughoutthewhole
cityincludingTaibahUniversity(wherethecurrentstudywasconducted),andallformsof
tobaccoincludingcigarettes,cigars,Jurak,andwaterpipetobacco(waterpipecafésarealso
banned,asisthesaleofparaphernaliausedinwaterpipetobaccosmoking).Traderswho
violatethebanarecompelledtopayafinebetweenSR5000toSR10000(SR1=US$0.37),and
theirstorescouldbeclosediftheyarecitedforathirdviolation(22).Tobaccoconsumptionis
commoninSaudiArabia,wherestudiesindicatethat,amonghighschoolchildren,the
prevalenceofalltypesoftobaccosmokingwas30.3%inboysand8.5%ingirls,where
waterpipesmokingrepresented53.9%(bothgenders)ofcurrenttobaccousers(23).Similar
prevalencewasreportedamongcollege(24)andmedicalanddentalstudents(2529).
Thepurposeofthisstudyistoexaminetheprevalenceanddemographicandenvironmental
factorsassociatedwithcigaretteandwaterpipetobaccosmokingamongstudentsofTaibah
University,thebiggestuniversityinMedinacity.TaibahUniversityisagovernmentuniversityin
SaudiArabiathathasmorethan69000studentsandoffersbothundergraduateandgraduate
programmesinmostfieldsincludingbasicsciences,medicalsciences,engineeringand
humanities.Asof2014,thecityofMedinahasapopulationofapproximately1.5million(30).
Thesizeofthecityisapproximately589squarekilometreslocatedinthewesternpartofSaudi
Arabia.
Methods
Subjects
StudentsfromTaibahUniversity,Medina,SaudiArabiawererecruitedtoparticipateinthe
study.Tobeeligibletoparticipate,subjectshadtobeatleast18yearsoldandenrolledas
studentsinTaibahUniversity.ThestudywasconductedbetweenFebruaryandApril2015.The
studyprocedureswereapprovedbytheresearchandethicalcommitteesofTaibahUniversity.
Recruitment
Participationwasvoluntaryandparticipantswereselectedrandomlyusingatwostagecluster
samplingstrategyaspreviouslydescribed(31).Inbrief,TaibahUniversity’smaincampus
regionswereidentifiedinboththemaleandthefemalebranches.Theregionswereallocated
numbersandthreeregionsfromeachbranchwererandomlyselectedusingfishbowldrawing
method.Recruitmentwasfacilitatedbygenderspecificstafffromeachregionoccurredduring
theworkingdaysofagivenweekfrom10:00to15:00.Duringsamplingtime,everyfourth
studenttoentertheselectedregionwasinvitedtobepartofthestudy.Approximately1700
(1200malesand500females)studentswereinvitedtoparticipateinthestudy.Ofthose,793
malestudents(66%)and274femalestudents(35%)completedtheanonymoussurvey.
Theinstrumentandmeasures
Thesurveyinstrument(inArabic)wasconstructedbasedonthatusedpreviouslyinJordan(32).
TheinstrumentwasmodifiedtoaccommodatedifferencesinspokenArabicbetweenJordan
andSaudiArabia.Tomakesurethattheinstrumentwassuitableforthepopulation,itwaspilot
testedintheuniversitywith50studentsandwasmodifiedaccordingtotheircomments.
Amongthemeasureswascigarettesand/orwaterpipesmoking,wherestudentswereaskedto
reportiftheyhavesmokedtobaccousingwaterpipeand/orcigarette,evenapuff,inthepast
30days(currentusers)andever.Demographicmeasuressuchasstudentspecialty,age,
universitylevel,sex,paternaleducation,monthlyhouseholdincome,andpocketmoneyspent
werealsoobtained.Forstudentspecialty,participantswereaskedtoselectfrom:basic
sciences,medicalsciences,engineeringandhumanities.Forpaternaleducation,weasked
participantstoselectfrom:didnotcompletehighschool,completedhighschool,and
completedcollegeorhigherdegrees.Formonthlyhouseholdincome,weaskedthestudentto
selectfromthefollowings:SR0–5000,SR5001–9000,andSR9001ormore.Thesurveyalso
containeditemsaskingwhetherparticipantslivedinacity(vs.village)andwhetherornotthey
livedwithparents.
DataAnalysis
TheSPSSsoftware(Version21)wasusedforstatisticalanalysis.Chisquarestatisticaltestwas
usedtodeterminesignificantdifferencesinprevalenceofcigaretteandwaterpipetobaccouse
acrosssociodemographicvariables.Themultivariablelogisticregressionmethodwasusedto
determinetheindependentassociationbetweendifferentvariables.P<0.05wasconsidered
significant.
Results
Ofthe1700invitedparticipants,1067returnedthequestionnaire(62.8%).Ofthefinalsample,
74.3%weremale.Theagerangewas18–29withthemajoritybetween21and25years(63%),
46%oftheparticipantswerefromcollegeofbasicsciencesfollowedbyhumanities(19%).The
samplewasevenlydistributedacrossdifferentuniversityyears.Themajorityofparticipants
livedinthecity(92.4%)andwiththeirparents(89.6%),and41%reportedmonthlyhousehold
incomeoflessthanSR5000.ApproximatelyhalfofparticipantsspentmorethanSR1000per
monthfrompocketmoney.
Theprevalenceofcurrentandeverwaterpipeusewas24.2%and36.04%respectively,whilefor
currentandeveruseofcigarettesmokingitwas31.9%and42.7%respectively.Inbivariate
analyses(Table1),waterpipetobaccousewasassociatedwithuniversitylevel(P<0.001),age
(P<0.01),monthlyhouseholdincome(P<0.001),numberofotherslivinginthehome(P<
0.001)andlivingawayfromparents(P<0.01).However,currentcigaretteusewasassociated
withuniversitylevelandspecialty(P<0.01),age(P<0.001),gender(P<0.005),monthly
householdincome(P<0.001),pocketmoneyspentmonthly(P<0.001)andlivingawayfrom
parents(P<0.01).
Table1:DemographicandenvironmentalassociationswithwaterpipetobaccoandcigarettesmokingamongTaibah
Universitystudents
WaterpipetobaccoCigarettes
CurrentuseEveruseCurrentuseEveruse
Participantcharacteristic
N(Column
%*)
Row%PRow%PRow%PRow%P
College 
Basicsciences451(46.4)25.60.25233.10.16729.30.06237.00.011
Medicalsciences164(16.9)33.143.140.547.0
Engineering170(17.5)22.040.033.147.6
Humanities186(19.2)25.033.329.934.9
Year 
1st114(12.0)17.4<0.00124.1<0.00131.00.01239.5<0.001
2nd138(14.5)29.536.834.141.3
3rd223(23.5)32.045.437.245.7
4th193(20.3)28.534.930.536.8
5th223(24.6)18.122.425.028.8
6th48(5.1)57.987.248.972.9
Age 
>21185(17.5)23.60.00533.90.17323.00.00233.50.002
22163(15.5)28.735.531.939.3
23196(18.6)38.446.841.348.0
24175(16.6)25.732.637.039.4
25128(12.1)29.638.929.938.3
26ormore208(19.7)18.434.438.552.4
Sex 
Malestudents793(74.3)25.50.10034.80.01036.80.00544.00.153
Femalestudents274(25.7)31.544.727.339.1
Paternaleducation 
Didnotcompletehigh
school238(23.2)25.70.20832.4<0.00136.40.19745.40.001
Completedhighschool346(33.7)24.530.129.633.5
Completedcollegeor
higher442(43.1)30.747.133.945.7
(e.g.,MA,PhD)  
Monthlyhousehold
income 
SR0–5000424(40.7)22.3<0.00126.6<0.00131.5<0.00136.6<0.001
SR5001–9000 374(35.9)20.036.928.239.8
SR9001ormore 245(23.5)43.553.046.556.3
Numberofotherslivingat
home 
0–4420(39.3)18.0<0.00126.7<0.00134.10.80640.70.548
5–6315(29.5)32.242.433.243.2
7ormore334(31.2)33.545.635.644.6
Pocketmoneyspent
monthly 
SR0–500274(26.0)11.8<0.00115.7<0.00117.5<0.00121.9<0.001
SR501–1000 256(24.3)26.442.531.546.9
SR1001–2000277(26.3)37.246.351.857.0
SR2001ormore 247(23.4)32.343.836.944.1
Urbanity 
City982(92.4)26.20.18535.80.02733.50.17541.60.116
Village81(7.6)34.650.941.050.6
Livingarrangement 
Withparents951(89.6)24.2<0.00133.3<0.00132.1<0.00140.1<0.001
Other110(10.4)50.771.450.962.7
*Valuesmaynotaddupto100duetorounding.
Computedusingchisquareanalysescomparingproportionofusersineachsociodemographiccategory.
SR1=US$0.37.
Inmultivariateanalysis(Table2),oddsofwaterpipeusewasreportedtobeloweramong
engineeringstudentsandtobehigheramong6thyearstudents,thosewithmonthlyhousehold
incomefromSR5000–9000,thosewithpocketmoneyspendingofmorethanSR500per
month,andthosewithnumberofindividualslivingathomeof≥5.However,oddsofcurrent
cigarettesmokingwasreportedtobehigherinstudents≥22yearsofage,andamongmale
students,inthosewithpocketmoneyspending>SR500permonthandthosewholivedaway
fromparents.
Table2:Multivariableanalysescomparingassociationsamongcurrentwaterpipeandcigarettesmokers*
AOR(95%CI)forwaterpipe
tobaccosmoking
AOR(95%CI)forcigarette
smoking
ParticipantcharacteristicCurrentuseEveruseCurrentuseEveruse
College  
Basicsciences1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
Medicalsciences0.57(0.28
1.14)
0.61(0.31
1.19)
1.16(0.70
1.94)
0.89(0.54
1.45)
Engineering0.39(0.19
0.81)
0.40(0.20
0.80)
0.63(0.37
1.09)
0.66(0.40
1.09)
Humanities0.67(0.29
1.11)
0.57(0.30
1.07)
0.76(0.46
1.27)
0.67(0.41
1.08)
Year  
1st1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
2nd1.23(0.44
3.42)
0.97(0.38
2.48)
0.40(0.19
0.84)
0.45(0.23
0.89)
3rd1.32(0.46
3.75)
1.08(0.43
2.70)
0.43(0.20
0.91)
0.52(0.26
1.03)
4th1.55(0.50
4.79)
0.62(0.23
1.71)
0.24(0.11
0.54)
0.25(0.12
0.54)
5th0.71(0.23
2.25)
0.44(0.16
1.21)
0.25(0.11
0.58)
0.24(0.11
0.54)
6th8.88(1.78
44.26)
29.98(5.47
64.23)
0.64(0.17
2.33)
4.05(1.11
14.76)
Age  
18–211.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
221.39(0.55
3.48)
1.27(0.54
3.01)
2.19(1.08
4.45)
1.80(0.95
3.41)
231.66(0.62
4.48)
2.31(0.92
5.79)
3.67(1.73
7.78)
3.34(1.68
6.61)
241.61(0.57
4.56)
2.45(0.92
6.53)
4.46(2.01
9.87)
4.06(1.96
8.43)
251.56(0.53
4.61)
2.73(1.00
7.50)
2.93(1.26
6.82)
3.09(1.42
6.72)
26ormore0.84(0.27
2.62)
1.83(0.65
5.15)
1.89(0.78
4.57)
3.13(1.42
6.93)
Sex  
Malestudents1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
Femalestudents1.09(0.54
2.19)
0.88(0.45
1.70)
0.38(0.22
0.67)
0.75(0.50
1.13)
PaternalEducation  
Didnotcomplete
highschool
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
Completedhigh
school
0.95(0.48
1.86)
0.75(0.40
1.44)
0.98(0.60
1.61)
0.66(0.41
1.05)
Completedcollegeor
higher(e.g.,MA,PhD)
0.51(0.25
1.06)
0.75(0.38
1.50)
0.61(0.36
1.03)
0.56(0.34
0.91)
Monthlyhousehold
income  
05000SR‡1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
50019000SR0.40(0.20
0.81)
0.73(0.38
1.39)
0.77(0.46
1.29)
0.82(0.51
1.33)
9001ormoreSR1.83(0.87
3.84)
1.95(0.96
3.98)
2.12(1.20
3.75)
2.30(1.34
3.96)
Numberofothersliving
inthehome  
0–41.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
5–62.53(1.44
4.44)
2.84(1.67
4.81)
1.02(0.68
1.55)
1.14(0.77
1.69)
7ormore3.49(1.98
6.14)
4.46(2.62
7.59)
1.27(0.84
1.92)
1.38(0.94
2.04)
Pocketmoneyspent
monthly  
SR0–5001.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
SR501–1000 2.44(1.10
5.40)
4.76(2.27
10.02)
2.08(1.17
3.70)
3.29(1.93
5.61)
SR1001–200010.40(4.87
22.18)
9.23(4.44
19.16)
5.01(2.82
8.90)
4.73(2.74
8.17)
SR2001ormore 4.69(1.99
11.05)
3.73(1.64
8.47)
2.41(1.25
4.65)
2.12(1.14
3.94)
Urbanity  
City1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
Village1.42(0.48
4.23)
1.15(0.39
3.37)
1.11(0.51
2.44)
1.27(0.59
2.72)
LivingArrangement  
Withparents1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
1.0
[Reference]
Other2.85(1.17
6.93)
3.40(1.38
8.36)
2.11(1.08
4.11)
1.82(1.05
3.48)
*Valuesmaynotaddupto100duetorounding.
Mulvariableanalysescontrolledforallvariablesinthetableandwereadjustedforclusteringofindividuals
withininstitutions.
SR1=US$0.37.
Discussion
Theresultsofthisstudyshowedthattobaccouseiscommonamonguniversitystudentsin
Medina,SaudiArabia,wheresaleoftobaccoproductsisbanned.Thenumberofcurrent
waterpipesmokersdidnotdifferrelativetothatofcigarettesmokers.Inaddition,asdescribed
below,theprevalenceoftobaccouseamongstudentsofTaibahUniversityissimilartothat
reportedinotheruniversitiesinthecountry,indicatingtheineffectivenessofbanningtobacco
productsinthecityinreducingtobaccouseamongstudents.
SeveralreportshaveexaminedtheprevalenceoftobaccouseinSaudiArabia.Asurveythat
involved10735individualsaged≥15years(5253menand5482women)fromSaudiArabia,
whichwasperformedduring2013,showedthatcurrentcigarettesmokingwas12.2%while
dailywaterpipesmokingwasreportedby4.3%ofthepopulation(7.3%ofmenand1.3%of
women)(33).AstudythatwasconductedondentalstudentsatKingSaudUniversityinRiyadh
showedthatthecurrentprevalenceofallformsoftobaccosmokerswas27.6%inmale
studentsand2.4%infemalestudents(26).Thestudyalsoshowedthatmostsmokersused
waterpipeonly(51.5%),followedbybothwaterpipeandcigarettes(25%),orcigarettesonly
(23.5%).AnotherstudybyKouraetal.(34)conductedwithcollegefemalestudentsinDammam
areashowedthatcurrentsmokingwas8.6%amongwhich43.2%werewaterpipesmokers.In
addition,waterpipesmokingwasreportedtoreach37%amonghealthcareuniversitystudents
inSaudiArabia(35)and36%amongdentalpractitionersinMedinaarea(36).
AmongsecondaryschoolchildreninRiyadhcurrentsmokingwasreportedby28.6%ofthe
students(24).SimilarnumberswerereportedamongschoolchildrenatRiyadhandAlHassa
regionsofSaudiArabia(23).ApreviousstudyinanotherSaudicitybeforetheMedinacityban
reportedaprevalenceforcurrenttobaccosmokingof25.3%(37).Inthecurrentstudy,
waterpipeusewas24.2%andforcigarettesmoking31.9%.Thus,evenwhensellingtobacco
productsisprohibitedinMedinacity,prevalenceofcigaretteandwaterpipetobaccosmokingis
notlower(evenhigherinseveralinstances)relativetoratesreportedinotherSaudiregions.
Importantly,accordingtothelaw,thebanisrestrictedtosellingtobaccoproducts;however,no
finesareimposedonindividualswhosmokeinsidethecity.AnassessmentdoneinMecca2008
showedthatonly75%ofstorescompliedwiththenosaleban(38),whilenosuchevaluation
wascarriedoutinMedina.Inadditionwaterpipeandcigarettesmokersmaybringtheir
productswiththemandmayalsosmuggletheminforothers.
InBhutan,wherealsoasimilarexperienceofbanningtobaccosaleswasimposedin2004,63%
ofthosesurveyedaspartofinternationaltobaccocontrol(ITC)studyreportedpurchasingtheir
cigarettesfromBhutanwithsalestakingplaceinaconcealedmanner,alackofproper
enforcementandavailabilityofsmuggledproducts(39).However,inBhutanotherstringent
tobaccocontrolmeasuressuchasbansonsmokinginallindoorareasaswellasoutdoorpublic
places,bansonadvertisingandpromotions,andincreasedtaxationoncigarettesimportedfor
personalusewereinplace.Infact,therateofcurrenttobaccouseinBhutanin2014according
toaSTEPwisesurveywas25%(40).Todate,inlinewiththeimplementationoftheWHO
FrameworkConventionofTobaccoControl(FCTC),whichisaninternationalbindingpublic
healthtreatyontobaccocontrol,morecomprehensivetobaccocontrolpolicieshavebeen
evaluatedgloballyandhaverepeatedlyshowntobesuccessfulindecreasingsmokingrates.
Thesepoliciesincludedbansonsmokingindoorswithpenaltiesforviolation,banson
promotionandadvertising,aswellaslargerpictorialwarningsonalltobaccoproducts.Morein
depthevaluationsoftobaccosalesbans,suchasthatoftheMeccaandMedinaandBhutan
experiences,areneededtobuildevidenceandfurthershedlightontheeffectivenessofthis
policyindecreasingtobaccoconsumptionasastandalonepolicy,independentofother
tobaccocontrolpolicies.
Thecurrentfindingsshowedthatwaterpipeandcigarettetobaccousewasassociatedwith
universitylevel,age,monthlyhouseholdincome,numberofotherslivinginthehomeandliving
awayfromparents.However,genderisassociatedonlywithcigarettesmokingbutnotwith
waterpipeuse,indicatingsocialacceptanceofwaterpipeuseamongfemalesintheregion(41).
GenderandagewerefoundtobeassociatedwithsmokingamongSaudismokers(33).Having
smokerfriendsandbeingmalearethehighestriskfactorsfortobaccouseamongdental
studentsatKingSaudUniversityinRiyadh(26).Asforfemalesmokingbehaviour,havinga
familymembersmokeristhemainfactorassociatedwithsmokingamongfemalestudentsin
Dammamcity(34).AreportbyAminetal.2010(23)showedthatgender,ageandhaving
relativesandfriendsassmokersareamongthemajorfactorsassociatedwithwaterpipe
smoking.Inothercountriesintheregion,gender,income,livingawayfromparentsandhaving
relatives/friendsassmokersareamongriskfactorsofwaterpipe/cigarettesmoking
(3,31,32,4244).Thus,riskfactorsfortobaccousearesharedamonguniversitystudentsin
TaibahUniversityandotherlocalandregionaluniversities.
Conclusion
Collectively,resultsofthecurrentstudyindicatethatwaterpipeandcigarettessmokingare
commonamongstudentatTaibahUniversityinMedina,SaudiArabia,irrespectiveoftheban
ontobaccoproductsalesinthatarea.However,thementionedresultscertainlyadvocate
implementationmorecomprehensivetobaccocontrolmeasuressuchassmokefree
environments,increasedtaxationoftobaccoproducts,bansofadvertisement,promotionand
sponsorshipaswellaslargerpictorialhealthwarningsinlinewithFCTCaswellasWHO
MPOWERmeasures.FuturestudiesthatcompareprevalenceoftobaccouseinMedinaand
MeccatotheprevalenceoftobaccouseinotherSaudicities(wheretobaccosalesarenot
banned)arerecommendedtoshedlightontheeffectivenessofsuchbans.
Funding:None.
Competinginterests:Nonedeclared.
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... 5 Different fragrant materials are used to improve tobacco taste in waterpipe. 6 The prevalence of waterpipe use varies greatly between different regions; it is 4.4% among Karbala University students in Iraq, 7 8.9% in Iran, 8 12.6% in Jordan, 9 18.0% in the United States (US), 10 24.2% in Saudi Arabia, 11 24.4% in Palestine, 12 and 28.0% in Kurdistan Region of Iraq. 13 The main determinants for waterpipe use have been identified as its affordability, availability, and media influence. ...
... We found that 27.0% of male and 7.6% of female students were current waterpipe users. The findings of this study show a lower prevalence of waterpipe use than the results of similar studies conducted among university students in Jordan (36.6% of men and 88.6% of women), 9 Saudi Arabia (66.0% of men and 35.0% of women), 11 The Kurdistan Region of Iraq (49.0% of men and 10.0% of women), 13 and Britain (26.5% of men and 16.6% of women). 24 Addict Health, Autumn 2020; Vol 12,No 4 http://ahj.kmu.ac.ir, 06 October However, the rate of waterpipe use found in this study is higher than researches conducted among university students in the US (6.4% of men and 5.9% of women) 25 and Syria (25.5% of men and 4.9% of women). ...
... The fact that men use waterpipe more than women has also been indicated in other studies. 7,[10][11][12][13]27 While this difference could be true, it should also be noted that in some regions, women underreport the use of tobacco, due to cultural constraints. 13 Moreover, in societies like Afghanistan, less number of female university students are gathering together to study or socialize than their male counterparts. ...
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Background: Waterpipe tobacco smoking (WTS) is an ancient type of smoking that has become a global phenomenon. This study aimed to identify the prevalence of waterpipe smoking and its relation to socio-demographic characteristics in Herat University students in western Afghanistan. Methods: In this cross-sectional study, a structured self-administered questionnaire containing 53 items in 3 subscales was distributed between July and December 2018, to examine the use of waterpipe among Herat University students. Data were evaluated in SPSS. Chi-square test was used to observe differences between categorical variables. All important variables were separately evaluated for men and women in logistic regression models. A P-value less than 0.05 was considered statistically significant. Findings: The prevalence of ever waterpipe use in male and female students was 54.1% and 81.8%, respectively. Parents' higher education and family economic status were associated with higher rates of ever waterpipe use in both sexes. On the other hand, marital status and parents' employment were not associated with waterpipe use. Ever waterpipe use was associated with having smoking friends or family members in both sexes. Male and female waterpipe users believed that cigarette smoke had more nicotine than waterpipe. While more male waterpipe users believed that cigarette was more addictive than waterpipe, more female users believed otherwise. Conclusion: The prevalence of ever waterpipe use is higher in male students at Herat University. Having a smoking friend and family member positively influences waterpipe use among both sexes. Most users believed that waterpipe smoking was less hazardous than cigarette smoking.
... Age was not significantly associated with waterpipe smoking, which could be explained by the lower variability of age among smoking participants in our sample. Although a study supported similar findings (Azab et al., 2010), another study showed a significant relationship (Daradka et al., 2019). No significant difference in waterpipe smoking was observed between males and females in the current study, similar to the findings of a study conducted in Saudi Arabia (Daradka et al., 2019), as this could be due to the social acceptance of waterpipe smoking among women (Akl et al., 2013). ...
... Although a study supported similar findings (Azab et al., 2010), another study showed a significant relationship (Daradka et al., 2019). No significant difference in waterpipe smoking was observed between males and females in the current study, similar to the findings of a study conducted in Saudi Arabia (Daradka et al., 2019), as this could be due to the social acceptance of waterpipe smoking among women (Akl et al., 2013). In contrast to our findings, other studies have shown significant gender differences in WTS among students (Khabour et al., 2012). ...
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... Among smokers in our study, the majority of students used smoke waterpipe (53.5%), cigarette (25.6%), and both waterpipe and cigarette (9.3%), as shown in Table 2. These results are comparable to a previous study conducted among Taibah University students in Medina, Saudi Arabia [28]. Based on gender specificity, the Jazan male and female medical students who smoke using waterpipe or cigarette were 76.5% and 88.9%, respectively. ...
... Based on gender specificity, the Jazan male and female medical students who smoke using waterpipe or cigarette were 76.5% and 88.9%, respectively. In Medina, the authors found that 62.3% of males used waterpipes or cigarettes, while 58.8% of females did so [28]. These results indicate that the majority of young smokers prefer cigarettes and waterpipes as tobacco smoking tools. ...
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Tobacco smoking has a significant role in health deterioration worldwide; it can lead to many dangerous diseases. Tobacco smoking among medical students is common worldwide, but the prevalence and determinants vary from one community to another. Data from medical students in Saudi Arabia is limited. This study was conducted to estimate the prevalence and determinants of smoking among medical students at the College of Medicine, Jazan University, Saudi Arabia. A cross-sectional study using a self-administered electronic survey was conducted to estimate tobacco smoking's prevalence and characteristics among medical students at Jazan University. The survey includes information on the gender, academic year, academic performance, type of tobacco smoking, and age of onset of the participants' tobacco smoking. Other data, like the prevalence of passive smoking and social factors, were considered, too. The sample size was 354, 51.7% males and 48.3% females, students with a response rate of 38.02%. The prevalence of smoking among medical students was 12.4%, while passive smoking prevalence was 39.9% of all medical students. The research shows that 18.6% of male and 5.9% of female medical students were active smokers. Regarding the type of tobacco, we found that 47% of male smokers used waterpipe, while the percentage among female smokers using waterpipe reached 77.8%. The age of onset of smoking for 34.9% of the smokers was between 18 and 21 years old. The prevalence of smoking is inversely proportional to the GPA. Additionally, 71.1% of the smokers did not have a smoker friend, and only 13.3% of the smokers were motivated to quit. University age is critical for smoking habits, and the smoking cessation rate was low. More campaigns should be done in universities to increase smoking cessation awareness, and smoking cessation clinics should be activated at universities.
... Another study in eastern region finds that 22.8 percent of university students had smoked shisha within the past 30 days and that shisha use is more prevalent than either cigarette use or e-cigarette use (Alshayban and Joseph 2019). A study of students at Taibah university in medina reports that current shisha use is 24.2 percent despite a citywide ban on the sale of tobacco products (Daradka et al. 2019). Nationally, it has been reported that 4.3 percent of Saudis age 15 years and older smoke shisha every day (moradi-lakeh et al. 2015). ...
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... Another study in eastern region finds that 22.8 percent of university students had smoked shisha within the past 30 days and that shisha use is more prevalent than either cigarette use or e-cigarette use (Alshayban and Joseph 2019). A study of students at Taibah university in medina reports that current shisha use is 24.2 percent despite a citywide ban on the sale of tobacco products (Daradka et al. 2019). Nationally, it has been reported that 4.3 percent of Saudis age 15 years and older smoke shisha every day (moradi-lakeh et al. 2015). ...
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This cross-sectional study was designed to investigate the prevalence, knowledge, attitude, and predictors of waterpipe (WP) smoking among intermediate and secondary school adolescents in the Kingdom of Saudi Arabia (KSA). A self-administered anonymous questionnaire was used to collect data on demography, WP smoking status and patterns, the Arabic version of the Global Youth Tobacco Survey tool, and instruments to assess knowledge and attitude towards WP smoking. The Patient Health Questionnaire (PHQ-9) was also used. Descriptive and inferential statistical techniques were used. Modeling of WP smoking behavior was conducted using logistic regression. A total of 639 male students participated in this study. The prevalence of current WP and cigarette smokers were 17.7% and 14.6%, respectively. Out of the total population, 47.8% of students have the misconception that WP smoking is less harmful than cigarettes. A significant association ( P < 0.05) of some demographic factors (age, school stage, residence, and parents’ educational level) on WP smoking status was observed. Pleasure, socializing, and happiness represented the primary motives for initiating WP smoking. The majority of students had misconceptions about WP’s health effects. More than 50% believed that smoking WP could ease anxiety, cause less harm, and has less addictive properties compared to cigarettes. Modeling suggested that the most significant predictors of WP smoking were cigarette smoking, depression, and the attitude index. Current findings warrant further research and official health programs to promote educational initiatives regarding WP smoking.
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The use of tobacco products is a modifiable risk factor for non-communicable diseases. The aim of the study was to determine the prevalence of waterpipe tobacco product use and associated risk factors amongst University of Limpopo students aged 17–43 years. This cross-sectional study comprises 916 (415 males and 501 females) University of Limpopo students aged 17–43 years. The questionnaire was validated for the University of Limpopo student population before it was used. Logistic regression was used to determine the associated risk factors for waterpipe tobacco product use among the University of Limpopo students. Staying on campus (OR 2.54 95%CI 1.87 3.44) or off-campus (0.39 95%CI 0.29 0.54) was significantly (p<0.05) associated with using waterpipe tobacco products even after adjusting for age and gender and receiving a bursary (on Campus OR=3.8095%CI 2.59 5.57) off-campus (0.26 95%CI 0.18 0.39). Our results demonstrate that waterpipe smoking was more prevalent among university male students than female students. Liking the taste and difficulties to refuse were significantly (p<0.05) associated with the use of waterpipe amongst University students. Future research should investigate the association of waterpipe use with risk factors for non-communicable diseases over time.
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Rationale and objectives: Little are known about nicotine dependence (ND), perceived stress, and willingness to quit smoking at different treatment stages in patient with affective disorders (AD). This study aimed to evaluate the association between ND and perceived stress among patients with AD presenting with psychiatric treatment at different clinical stages (first visit or follow-up), and in different nicotine type users (cigarette and waterpipe smokers). We also aimed to evaluate the willingness to quit smoking and its association with barriers to quitting. Methods: This cross-sectional mixed-method study collected quantitative and qualitative data from patients (n = 57) presenting for treatment with AD and ND at different sites in Saudi Arabia. Quantitative validated scales were used to assess the 70 of depression symptoms, anxiety symptoms, perceived stress, and ND. Qualitative questions assessed barriers to quit smoking. We used a linear regression modeling to estimate the association between ND and perceived stress as well as to estimate the association between barrier to quit and willingness to quit. Results: ND had a statistically significant association with perceived stress (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.20-3.63). Participants in the follow-up group had a higher ND score than those in the first-visit group. One of the most commonly reported barriers to quitting was using nicotine as a stress management (33.3%), which predicted positive willingness to quit (OR: 2.23; 95% CI: 1.48-3.37; P < .01). Boredom was reported as a barrier in the waterpipe group more than cigarette group. Conclusion: ND has a significant association with perceived stress regardless of treatment status in patients with AD, indicating the need to evaluate smoking cessation during the early stages of treatment for patients with AD and ND. It will be critical for clinicians to offer patients with AD alternative coping mechanisms to manage stress and boredom.
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Background: Although the number of cigarettes smoked has been declining due to major public health initiatives, shisha tobacco smoking is gaining popularity around the world, particularly among youth and university students. Methods: A cross-sectional study was conducted among 464 university students in Eastern Province of Saudi Arabia using a structured questionnaire (i) to assess the prevalence of shisha smoking; (ii) to evaluate risk-perception, knowledge and normative belief about shisha smoking, and to compare these among users and non-users of shisha. Results: The study reported a high prevalence (22.8%) of the current use of shisha among the university students with a narrow gender gap and found that STS is getting more popular than other forms of tobacco. A quarter of participants had low risk perception and 30.2% had low knowledge of shisha smoking harm. Importantly, more than two-fifth of them were current users of shisha. Low risk-perception about shisha and social acceptability were significantly contributed to the high prevalence of shisha smoking among the youth. Conclusion: It is important to provide exposure to education related to shisha hazards and increase the awareness of students and the public about the health effects of shisha smoking.
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Objectives: The objective of this study was to assess tobacco use, secondhand smoke exposure, knowledge of health risks, and smoking predictors among dental students attending King Abdulaziz University, Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted and 420 dental students were invited to participate. Binary logistic regression analyses assessed the predictors of smoking. Results: A total of 336 dental students completed the questionnaires with 25% reporting current or previous tobacco use and 96% reporting secondhand smoke exposure. Nearly half of all smokers initiated smoking during the dental program. The logistic regression results revealed that being a male (OR = 7.1, p < .0001; 95%CI = 3.7-13.4) and having a smoker in the family (OR = 2.6, p = .005; 95%CI = 1.3-5.0) increased the likelihood of smoking. In contrast, knowledge of health risks decreased the likelihood of smoking (OR = 0.90, p = .014; 95%CI = 0.82-0.98). Conclusions: Despite possessing knowledge about the health risks of smoking, high numbers of dental students continue to smoke and were exposed to secondhand smoke. Sex and family influence were the main pro-smoking risk factors, whereas increased knowledge of health risks was a protective factor. Tobacco control programs to reduce and/or prevent tobacco use among future dentists are needed.
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Introduction: Although waterpipe smoking is common in Gulf counties, its prevalence in Saudi Arabia is uncertain. The purposes of this study were (a) to assess the prevalence of waterpipe smoking among healthcare university students in Saudi Arabia and (b) to determine their attitudes and practices of waterpipe smoking. Materials and methods: A cross-sectional survey was conducted among university students of three different health sciences colleges, namely medical, dental, and pharmacy, of a public university, through random cluster sampling. The questionnaire was designed to ask specific questions related to smoking in general and to waterpipe smoking specifically. The study was approved by the institutional research & ethics committees. Results: A total of 535 participants were included in the study. More than one-third of the participants that reported having ever smoked a waterpipe (n= 198, 37%), and the majority of these were current smokers (62.1%, n= 123); dental students were the most common (45.5%, n= 90). Curiosity and pleasure-seeking were the main factors associated with starting waterpipe smoking. About one-sixth (14.9%, n= 80) of the participants failed to identify a single harmful effect, while a vast majority of participants considered waterpipe smoking to be less unhealthy than cigarette smoking. Conclusion: Waterpipe smoking is very popular among Saudi university students, and knowledge among university students about the dangers of waterpipe smoking is alarmingly low.
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BACKGROUND Waterpipe tobacco smoking prevalence, practice, and the associated health perceptions among dental practitioners have not been previously reported. This study aims to determine the prevalence of waterpipe smoking among dental practitioners and to evaluate their awareness of health hazards of waterpipe smoking, particularly the adverse effects on oral health. METHODS This was a cross-sectional questionnaire-based survey among dental practitioners. Surveyed dental practitioners practiced dentistry in the holy city of Al-Madinah Al-Munawarah, a city in the Central-Western Region of Saudi Arabia, and the study was conducted during March 2015. The questionnaire consisted of questions on demographic data, history and practices of tobacco use, and perceptions toward the health hazards of smoking. Dentists were approached at their work places and invited to participate. Descriptive statistics were used to describe the sample’s demographic and smoking characteristics, while cross-tabulation and chi-square test were used to determine the statistical significance of association between the groups (P ≤ 0.05). RESULTS One hundred dental practitioners participated in the survey, with 55 males and 45 females. Twenty-six percent indicated that they were waterpipe smokers. Male gender and cigarette smoking were the only factors to be significantly associated with waterpipe smoking (P = 0.008 and P = 0.000, respectively). Most participants stated that waterpipe smoking is harmful to health, and the most commonly reported health hazard was respiratory disease, which was reported by 81% of participants. CONCLUSIONS Prevalence of waterpipe smoking among dental practitioners is comparable to adult populations but lower than younger populations of university students. Health awareness of dental practitioners regarding waterpipe smoking was judged to be insufficient.
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Background Despite a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004, two nationwide surveys conducted in 2012 and 2013 reported high tobacco use in Bhutan. National Health Survey 2012 reported that 4 % of the population aged 15–75 years used smoked tobacco and about 48 % used smokeless tobacco. Similarly, Global Youth Tobacco Survey (GYTS) of Bhutan reported tobacco use prevalence of 30.3 % in 2013. However, factors associated with this high tobacco use were not systematically studied. Hence, we assessed the prevalence of tobacco use and its associated sociodemographic, behavioral, and environmental factors. Methods This cross-sectional analytical study used secondary data collected in a nationally representative Non-communicable Disease Risk Factors Surveillance STEPS Survey 2014 conducted among Bhutanese adults (18–69 years). The survey included a total of 2820 adults; selected using multistage stratified cluster sampling. Weighted analysis was done to calculate the prevalence of tobacco use. Unadjusted and adjusted prevalence ratios were calculated using log binomial regression. ResultsThe prevalence of current overall tobacco use was 24.8 % (95 % CI: 21.4–28.3) and that of smoked, smokeless, and dual forms (smoked and smokeless forms) were 7.4 % (95 % CI: 5.8–9.0), 19.7 % (95 % CI: 16.5–22.9), and 2.3 % (95 % CI: 1.8–2.9), respectively. Significantly higher prevalence of tobacco use in all forms was found among males, younger age groups, and alcohol users. The prevalence of smoked form was higher in urban areas compared to rural areas (11 % vs 6 %; aPR 1.8, 95 % CI: 1.5–2.0). Among individuals who reported having a non-communicable disease, the prevalence of smoked tobacco use was significantly lower than those who did not have disease (3.5 % vs. 8.3 %; aPR 0.5, 95 % CI: 0.3–0.9). Exposure to health warnings was protective for current tobacco use and smokeless tobacco use, while exposure to tobacco warnings through the media was helpful among smokers and overall tobacco users. Conclusions Despite a comprehensive ban on tobacco, tobacco use was high in Bhutan, especially the smokeless form. Males, younger age groups, and alcohol users should be targeted with behavioral interventions along the stricter implementation of tobacco control measures.
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Introduction: In recent years, waterpipe tobacco smoking has been increasing in popularity all over the world. In this study, we explored effects of waterpipe smoking on pregnancy outcomes in rats. Methods: Animals were exposed to waterpipe tobacco smoking using a whole body exposure system two hours per day during pregnancy. A control group was exposed to fresh air only. Results: The results showed significant association between exposure to waterpipe smoke during pregnancy and low birth weight (P < 0.01) and neonatal death (P < 0.01). In addition, the rate of growth of offspring of the waterpipe group was significantly lower than that of control group as measured by body weight gain during the first 3 months of life (P < 0.001). No effect was found for waterpipe smoking on mean number of progeny and male to female ratio among offspring. Conclusion: waterpipe smoking is associated with adverse effects on pregnancy outcomes.
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Behavioral aspects play a major role in the prevention of oral diseases. Moreover, not many people are aware of the relationship of smoking with potential oral diseases. Therefore, the aims of this study were to analyze oral hygiene behavior, smoking habits, and perceived oral health problems among a sample of university students in Al-Kharj, Saudi Arabia. A self-administered questionnaire about oral hygiene behavior, smoking, and perceived oral health problems was developed. The questionnaires were mainly distributed in Medical, Dental, and Pharmacy colleges of the university. Questionnaires completed at other colleges were included under the term "other colleges." Overall, 380 questionnaires were returned. Majority of the students (92.4%) reported cleaning their teeth. Most of the students reported cleaning teeth once daily (48.7%). Just over a half (55.8%) reported having a dental check-up in the last 6 months, and a significantly higher number of dental students reported having a dental check-up (P < 0.05). Regarding smoking, the majority (63.4%) reported to have never smoked while 17.3% reported that they were smoking frequently. About 17.6% perceived oral health problems, including a significant proportion of those who reported frequent smoking. Oral hygiene behavior exhibited by the university students sample was similar. Majority cleaned their teeth, although only once. Smoking habit was not exhibited by the vast majority of students. Frequent smokers perceived oral health problems more than other students.
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Waterpipe tobacco usage is spreading rapidly worldwide, with reports of more youth being waterpipe users compared to adults. In many areas of the world, waterpipe usage surpasses cigarette smoking. Waterpipes and cigarettes are both mechanisms for inhalation of tobacco smoke and therefore have serious health consequences. However, because of the many differences between the two products, prevention and control strategies that have proven effective for cigarettes may not transfer readily to waterpipe. This report highlights the differences between waterpipes and cigarettes in toxicant exposure and physiologic effects, patterns of use, social norms, the extent of evidence, and the policy environment. There is little evidence to date around effective interventions for waterpipe prevention and control. The current state of evidence for intervention to curb or control waterpipe is at ground zero and critically needs attention from both scientists and policy makers. National and global efforts aimed at cigarette prevention have succeeded, particularly in developed countries. We suggest the time has come to harness what we know works for cigarette prevention and control and adapt it to tackle the growing epidemic of waterpipe tobacco use.
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Waterpipe tobacco smoking carries adverse health consequences due to high level of chemical toxicants. This study investigated the anthropometric measurements of singleton newborns of Jordanian women with no known chronic diseases who smoked waterpipe during pregnancy, and the difference in these measurements in newborns of pregnant women who smoked waterpipe, cigarettes, both types, and none during pregnancy. The study also investigated the pattern of different types of tobacco smoking as a function of pregnancy trimester. A descriptive, comparative, retrospective, cross-sectional design was used. Two hundred and eight-five women (74 waterpipe, 84 cigarettes, 26 dual, 101 none) and their newborns were recruited from three hospitals. A questionnaire was used while interviewing mothers to assess tobacco smoking pattern. The results showed that compared with non-smokers, mean birth weight was 0.47 kg (95%CI = −0.70 to −0.35) lower for waterpipe-only smokers, 0.23 kg (95%CI = −0.41 to −0.8) lower for cigarette-only users, and 0.59 kg (95%CI = −0.81 to −0.31) lower for dual users. Compared to non-smokers, mean newborn length was 2.7 cm (95%CI = −3.80 to −1.42) lower for dual smokers, 2.2 cm (95%CI = −3.28 to −1.58) lower for waterpipe smokers, and 1.2 cm (95%CI = −2.01 to −0.45) lower for cigarette smokers. Compared with non-smokers, mean newborn head circumference was 1.9 cm (95%CI = −2.72 to −1.65) lower for waterpipe smokers, 1.7 cm (95%CI = −2.65 to −1.16) lower for dual smokers, and 0.8 cm (95%CI= −1.34 to −0.36) lower for cigarette smokers. From these results, we may conclude that waterpipe tobacco smoking during pregnancy can contribute to a reduction in newborn's anthropometric measurements. Increasing awareness of waterpipe tobacco smoking adverse effects and developing cessation interventions in pregnancy is needed.
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Context: Waterpipe smoking (WPS) has been known for over 400 years. It has been spread widely especially between youth because of the addition of pleasant flavor and because it was misconsidered to be less harmful than cigarette. Objective: In this study, we investigated the effect of waterpipe smoking on renal oxidative and functional parameters and compared that at acute and chronic exposure time in mice. Materials and methods: Mice were divided into three groups, namely acute, chronic and fresh air control. Acute group was exposed to waterpipe smoke for one hour daily for six days using whole-body exposure system, while chronic group was exposed to waterpipe smoke for one hour daily for 30 days using whole-body exposure system. Result: Exposure to waterpipe smoke has shown significant changes on the mice kidney functional parameters such as creatinine and blood urea nitrogen. Both exposures (acute and chronic) has shown a significant reduction in superoxide dismutase (SOD) activity (p < 0.05), whereas the activity of other antioxidant enzymes (catalase and GPx) reduced only with chronic exposure to waterpipe smoke (p < 0.05). Additionally, the level of thiobarbituric acid reactive substances (TBARS) in mice kidney homogenates has shown a significant elevation following chronic exposure to waterpipe smoke (p < 0.05). Discussion and conclusion: In conclusion, chronic waterpipe smoke affects the kidney parameter and antioxidant markers, therefore affecting its functionality of detoxifying and removal of poisonous material from the body.
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To assess smoking behavior, knowledge of smoking harm, and attitudes toward campus smoking policy at an Egyptian university, an online survey of students, staff, and faculty was conducted (N = 992). The smoking prevalence of 38% among men was in line with Egypt's national average, but the smoking prevalence among women of 20% was much higher than the national average. Smoking status influenced beliefs about smoking harm and attitudes toward smoking policy, with nonsmokers having stronger beliefs about the harm of smoking and showing stronger support for smoking regulations than smokers. Smokers were more knowledgeable about smoking policy than were nonsmokers and differed slightly in their preferences for smoking policy enforcement strategies. These findings contribute to our understanding of how to tailor college smoking policy and programs to an Egyptian context.