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Effect of Educational Intervention Based on Theory of Planned Behavior on Reducing Smoking and Hookah Use Among High School Male Students
Background Using smoking and hookah has increased among high school students in recent years. Therefore, the present study aimed to determine the effect of educational intervention based on the theory of planned behaviour (TPB) on reducing smoking and hookah use among high school students. Methods This experimental study was conducted on 300 high school male students in Fasa City, Fars Province, Iran, in 2021–2022. Subjects were selected using a simple sampling method and were randomly divided into intervention (n = 150) and control (n = 150) groups. The educational intervention for the experimental group included 7 sessions of 45–55 min using small group discussion, question and answer, practical demonstrations, video clips, PowerPoint, and booklets. Before the intervention and 3 months after the educational intervention, both experimental and control groups completed the questionnaire. Data were analyzed using SPSS 22 software through Chi‐square, independent t‐test, paired t‐test, and McNemar test. Results The mean age of the experimental and control groups was 17.89 + 1.46 and 17.1 + 1.58 years. The results showed that before the educational intervention, there was no significant difference between the experimental and control groups in terms of awareness, attitude, subjective norms, perceived behavioral control, and behavioral intention; however, 4 months after the educational intervention, there was a significant increase in the experimental group. Also, before the educational intervention, there was no significant difference between the two groups in terms of current smoking and hookah use; however, 4 months after the intervention, there was a significant difference between the two groups. Conclusion Implementing the TPB‐directed instructional sessions resulted in reducing smoking and hookah use among high school students. This experimental study was conducted on 300 high school male students. The educational intervention for the experimental group included 7 sessions. There was no significant difference between the experimental and control groups in terms of awareness, attitude, subjective norms, perceived behavioral control, and behavioral intention; however, 4 months after the educational intervention, there was a significant increase in the experimental group. Implementing the TPB‐directed instructional sessions resulted in reducing smoking and hookah use among high school students.
Journal Article
Flavored Versus Nonflavored Waterpipe Tobacco: A Comparison of Toxicant Exposure, Puff Topography, Subjective Experiences, and Harm Perceptions
Flavored waterpipe (WP) tobacco is the main type of tobacco used by young WP smokers, and a major factor attracting youth to smoke. However, evidence regarding the effect of limiting flavor on WP smokers' experience continues to be lacking. This study aims at evaluating the effect of flavor restriction on WP smokers' toxicant exposure, smoking topography, subjective experiences and harm perception.
Thirty-two WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavor vs non-flavored tobacco) in a crossover design pilot study. Plasma nicotine concentration and exhaled carbon monoxide (eCO) were measured before and after each smoking session. Puff topography was recorded throughout the smoking session. Participants completed survey questionnaires assessing subjective smoking experiences and harm perception.
Significant differences were observed in plasma nicotine concentration between the two WP tobacco conditions, with a higher increase in plasma nicotine concentration following the flavored tobacco session. There were no significant differences between the two WP tobacco conditions for eCO and smoking topography measures. Compared with the non-flavored WP tobacco, we documented enhanced subjective smoking measures of satisfaction, calmness, taste, puff liking and enjoyment following the preferred flavored WP tobacco session. Cigarette harm perception was significantly higher among participants after smoking their preferred flavor compared with non-flavored WP tobacco.
Limiting tobacco flavor has a substantial effect on WP smokers' nicotine exposure, subjective experience and harm perception. Therefore, eliminating or restricting WP flavors could be an essential element of comprehensive tobacco control policies to reduce the appeal of WP tobacco products for youth.
This study highlights the important role of flavor in shaping WP smokers' experiences and exposures and the potential impact that regulating flavored WP tobacco may have on curbing WP use among youth in the US. Such regulations may reduce the appeal and the interest in WP smoking initiation and continued use.
Journal Article
The effects of hookah/waterpipe smoking on general health and the cardiovascular system
Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but “appealing” flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.
Journal Article
Characteristics of Hookah Tobacco Smoking Sessions and Correlates of Use Frequency Among US Adults
Abstract
Introduction
Hookah tobacco smoking has increased in the United States. However, information on hookah use frequency and other characteristics of hookah use is limited.
Methods
Investigators analyzed data from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US youth and adults. Our analysis draws on baseline data from adult (ages ≥18 years) ever (N = 10 624) and past year (n = 3947) hookah users. Bivariate and regression analyses were conducted to identify associations between demographics, use characteristics, and hookah use frequency.
Results
Overall, 16.4% of adults reported ever smoking tobacco from a hookah. Of those, 31.9% reported smoking hookah within the past year. Among 3947 past-year hookah tobacco smokers, 10.7% were daily/weekly users, 13.7% were monthly users, 42.1% smoked every couple of months, and 33.5% smoked about once a year. Among daily/weekly hookah users, 66% were young adults (ages 18–24 years). When comparing daily/weekly hookah users to those who smoked every couple of months, more frequent hookah use was associated with younger age, male gender, a greater number of times the hookah is refilled during a session, fewer people sharing, and hookah ownership.
Conclusion
Although there were few demographic differences between daily/weekly users and less frequent hookah tobacco smokers, some notable differences in use behaviors exist among use frequency groups. Unlike other tobacco products, hookah is often smoked communally, over an extended time period. A detailed understanding of hookah user characteristics and experiences could inform hookah-specific measures, messaging, and regulations.
Implications
To our knowledge, this is one of the first studies to characterize hookah use frequency, session length, and other hookah use experiences using a nationally representative sample of US adult hookah smokers. Understanding characteristics of hookah tobacco smokers, their use experiences, and patterns of hookah use frequency would be useful in assessing risks for hookah tobacco dependence at the population level. Additionally, identifying variation in use behaviors of hookah tobacco smokers could be used to inform the development of strategies to reduce and prevent hookah tobacco use, such as tobacco regulations or public education efforts, particularly among young adults.
Journal Article
Correlates of susceptibility to waterpipe tobacco smoking in young adults
Many US young adults are susceptible to waterpipe (i.e., hookah) tobacco smoking (WTS) initiation, but research on factors associated with WTS susceptibility is limited. We examined sociodemographic, other tobacco and substance use, and attitudes and perceptions correlates of WTS susceptibility among young adults.
Baseline data from a randomized trial testing WTS risk messages was collected in US young adults aged 18 to 30 years who never used waterpipe tobacco but were susceptible to WTS (n = 294). Extent of susceptibility to WTS was defined using the average score of a valid scale with higher scores indicating higher susceptibility. Correlates were sociodemographics, other tobacco and substance use, and attitudes and perceptions. Multiple linear regression models identified correlates of greater WTS susceptibility.
Participants averaged 25 (SD 3.2) years of age, 60% were male, 22% were Black non-Hispanic, 47% completed some college education, and 66% were employed. Our models consistently showed that more positive attitudes toward WTS (β = -0.08, p<0.01), lower perceived addictiveness relative to cigarettes (β = -0.09, p = 0.04), and greater perceived social acceptability of WTS (β = 0.05, p<0.01) were positively correlated with WTS susceptibility. Additionally, young adults who smoked cigarillos (β = 0.53, p<0.01), used cannabis (β = 0.14, p = 0.02), and Black non-Hispanic versus White non-Hispanic young adults (β = 0.18, p = 0.03) also had higher WTS susceptibility.
Findings suggest that WTS prevention efforts require multicomponent interventions including targeting subpopulations at greater risk based on race/ethnicity and other tobacco and substance use. These interventions should consider attitudes and social acceptability of WTS as modifiable targets to maximize public health benefits.
Journal Article
Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers’ and non-smokers’ responses
BackgroundAlthough Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS.MethodsWe conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis.ResultsParticipants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users.ConclusionsOur exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.
Journal Article
Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk
Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Hookah (ie, waterpipe) smoking is a centuries-old revived yet understudied global epidemic of tobacco use. Because of the traditional set-up of a hookah-pipe, in addition to inhaling tobacco-combustion products, smokers are also exposed to large amounts of charcoal combustion products from the burning charcoal briquettes used to heat the hookah flavored tobacco. Despite being heavily advertised and actively glamorized in the mass media as a healthier tobacco alternative, the toxicological constituents of hookah smoke-including nicotine, carbon monoxide, particulates, oxidants, heavy metals, phenols and flavorants-indicate the potential to cause adverse cardiovascular events.
Herein, we review evidence on hookah smoke toxicological constituents, cardiovascular effects and potential mechanisms by which hookah smoke aerosol could cause cardiovascular disease.
The evidence reviewed here indicates that contrary to the widespread popular belief that hookah is a healthier tobacco alternative, the constituents of hookah smoke aerosol contains similar chemicals compared to cigarette smoke, many of which are known to be harmful to cardiovascular health and mediated by similar pathophysiologic processes. Because the burning charcoal briquettes are a unique source of toxicant emissions specific to hookah smoking, some constituents differ in their quantities from cigarettes with some of their cardiovascular effects unknown.
To date, much more is known about the constituents and their toxicology than about the effects of hookah smoking on human cardiovascular health. Further research on long-term consequences of hookah use is needed.
This review provides an overview on the potential impact of hookah smoking on cardiovascular health. Readers will gain an insight into evidence on its toxicological constituents, human health effects, and pathophysiological mechanisms by which hookah smoking might cause cardiovascular disease. The review also highlights current research gaps regarding the cardiovascular consequences of hookah smoking, specifically the long-term consequences in the United States and Europe among flavored-hookah tobacco users.
Journal Article
The Effects of Pictorial Health Warning Label on Waterpipe (Low- and High-Frequency) Smokers’ Experiences, Toxicant Exposures, and Puffing Behavior
BackgroundPictorial health warning label (PHWL) is an effective risk communication measure among cigarette smokers. However, there is a lack of knowledge regarding the effect of PHWL on low- and high-frequency waterpipe (WP) smokers. This study examined the effects of PHWL on puffing behavior, subjective experiences, and toxicant exposures among low- and high-frequency WP smokers in the United States (US).MethodsSixty current (past-month) WP smokers (low-frequency; n = 30 and high-frequency; n = 30) completed two 45-min ad libitum WP smoking sessions in a cross-over design study (WP with no-PHWL vs. WP with PHWL). We compared the mean differences of puff topography, expired carbon monoxide (eCO), plasma nicotine concentration, and subjective experiences between the two smoking groups.ResultsMean age of low-frequency smokers was 21.5 years and high-frequency smokers was 21.3 years. Compared to high-frequency, low-frequency smokers had significant reduction in average total smoking time [mean difference (SD) = −7.6 (10.2) min vs. −2.6 (6.7) min, p = 0.03] and number of puffs [mean difference (SD) = −33.37 (70.7) vs. −0.70 (29.2), p = 0.02] following exposure to PHWL compared to no-PHWL condition. Post-session subjective experiences were lower among high-frequency smokers compared to low-frequency smokers following smoking WP with PHWL compared to the no-PHWL session (puff liking −1.2 vs. −0.5; puff satisfaction −1.0 vs. −0.3; craving reduction −0.5 vs. 1.2) (p < 0.05 for all).ConclusionOur findings indicate that placing PHWL on the WP device may be a promising strategy with differential effectiveness among WP smokers: low-frequency (reduce puffing behaviors) and high-frequency (reduce smoking experience).
Journal Article
Time‐Domain Factorized Wave Model and Iterative Beamforming for Localizing Multiple Leaks in Water Pipes
Time‐domain full‐waveform inversion is a robust method for localizing leaks in urban water distribution pipes. However, its built‐in classical wave model suffers from coupled and interdependent leak parameters; thus, the localization of multiple leaks becomes a 2N $2N$‐parameter optimization problem (N $N$ is the number of leaks), which is high‐dimensional, non‐convex, and riddled with local optima. To address this problem, we analytically derive a time‐domain factorized wave model with decoupled leak parameters via the Born approximation. Based on this model, we propose an iterative beamforming algorithm that decomposes the complex 2N $2N$‐dimensional optimization problem into 2N $2N$ sequential one‐dimensional sub‐problems. This approach largely reduces complexity of both forward modeling and inverse estimation, enabling real‐time leak localization. Numerical experiments show that the proposed approach is accurate, efficient, super‐resolved, and robust in localizing multiple leaks. Moreover, it can estimate the unknown number of leaks without any prior information. Finally, the proposed approach is verified by recent laboratory experiments conducted in a viscoelastic pipe system, where unknown leaks are successfully localized.
Journal Article