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Shearston JA, Eazor J, Lee L, Vilcassim MJR, Reed TA, Ort D, Weitzman M, Gordon T. Effects of electronic cigarettes and hookah (waterpipe) use on home air quality. Tob Control 2023; 32:36-41. [PMID: 34021062 PMCID: PMC10787574 DOI: 10.1136/tobaccocontrol-2020-056437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred. METHODS Non-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a 'primary' smoking room and in an adjacent 'secondary' room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests. RESULTS Use of hookah significantly increased PM2.5 levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5 levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms. CONCLUSIONS Use of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5 penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.
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Affiliation(s)
- Jenni A Shearston
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - James Eazor
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - Lily Lee
- State University of New York Downstate Medical Center, New York, New York, USA
| | - M J Ruzmyn Vilcassim
- Department of Environmental Health Sciences, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Taylor A Reed
- Department of Social Welfare, University of California Los Angeles, Los Angeles, California, USA
| | - Deborah Ort
- Nemours Children's Urgent Care, Orlando, Florida, USA
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
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Hussein T. Indoor Exposure and Regional Inhaled Deposited Dose Rate during Smoking and Incense Stick Burning-The Jordanian Case as an Example for Eastern Mediterranean Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:587. [PMID: 36612906 PMCID: PMC9819828 DOI: 10.3390/ijerph20010587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Tobacco smoking and incense burning are commonly used in Jordanian microenvironments. While smoking in Jordan is prohibited inside closed spaces, incense burning remains uncontrolled. In this study, particle size distributions (diameter 0.01-25 µm) were measured and inhaled deposited dose rates were calculated during typical smoking and incense stick-burning scenarios inside a closed room, and the exposure was summarized in terms of number and mass concentrations of submicron (PNSub) and fine particles (PM2.5). During cigarette smoking and incense stick-burning scenarios, the particle number concentrations exceeded 3 × 105 cm-3. They exceeded 5 × 105 cm-3 during shisha smoking. The emission rates were 1.9 × 1010, 6.8 × 1010, and 1.7 × 1010 particles/s, respectively, for incense, cigarettes, and shisha. That corresponded to about 7, 80, and 120 µg/s, respectively. Males received higher dose rates than females, with about 75% and 55% in the pulmonary/alveolar during walking and standing, respectively. The total dose rates were in the order of 1012-1013 #/h (103-104 µg/h), respectively, for PNSub and PM2.5. The above reported concentrations, emissions rates, and dose rates are considered seriously high, recalling the fact that aerosols emitted during such scenarios consist of a vast range of toxicant compounds.
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Affiliation(s)
- Tareq Hussein
- Environmental and Atmospheric Research Laboratory (EARL), Department of Physics, School of Science, The University of Jordan, Amman 11942, Jordan;
- Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, FI-00014 Helsinki, Finland
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3
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Exploring motivation to quit and risk appraisals of hookah tobacco smoking for self and partner among a member of single and dual smoker couples. J Behav Med 2022:10.1007/s10865-022-00369-4. [DOI: 10.1007/s10865-022-00369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
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Tariq U, Butt MS, Pasha I, Faisal MN. Prophylactic role of olive fruit extract against cigarette smoke-induced oxidative stress in Sprague-Dawley rats. Cell Stress Chaperones 2022; 27:545-560. [PMID: 35951259 PMCID: PMC9485526 DOI: 10.1007/s12192-022-01291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022] Open
Abstract
Cigarette smoke exposure increases the production of free radicals leading to initiation of several pathological conditions by triggering the oxidative stress and inflammatory cascade. Olive fruit owing to its unique phytochemical composition possesses antioxidant, immune modulatory, and anti-inflammatory potential. Considering the compositional alterations in olive fruits during ripening, the current experimental trail was designed to investigate the prophylactic role of green and black olives against the oxidative stress induced by cigarette smoke exposure in rats. Purposely, rats were divided into five different groups: NC (negative control; normal diet), PC [positive control; normal diet + smoke exposure (SE)], drug (normal diet + SE + citalopram), GO (normal diet + SE + green olive extract), and BO (normal diet + SE + black olive extract). Rats of all groups were exposed to cigarette smoke except "NC" and were sacrificed for collection of blood and organs after 28 days of experimental trial. The percent reduction in total oxidative stress by citalopram and green and black olive extracts in serum was 29.72, 58.69, and 57.97%, respectively, while the total antioxidant capacity increased by 30.78, 53.94, and 43.98%, accordingly in comparison to PC. Moreover, malondialdehyde (MDA) was reduced by 29.63, 42.59, and 45.70% in drug, GO, and BO groups, respectively. Likewise, green and black olive extracts reduced the leakage of hepatic enzymes in sera, alkaline phosphatase (ALP) by 23.44 and 25.80% and 35.62 and 37.61%, alanine transaminase (ALT) by 42.68 and 24.39% and 51.04 and 35.41%, and aspartate transaminase (AST) by 31.51 and 16.07% and 40.50 and 27.09% from PC and drug group, respectively. Additionally, olive extracts also maintained the antioxidant pool, i.e., superoxide dismutase, catalase, and glutathione in serum. Furthermore, histological examination revealed that olive extracts prevented the cigarette smoke-induced necrosis, pyknotic alterations, and congestion in the lung, hepatic, and renal parenchyma. Besides, gene expression analysis revealed that olive extracts and citalopram decreased the brain and lung damage caused by stress-induced upregulation of NRF-2 and MAPK signaling pathways. Hence, it can be concluded that olives (both green and black) can act as promising antioxidant in alleviating the cigarette smoke-induced oxidative stress.
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Affiliation(s)
- Urwa Tariq
- Faculty of Food, Nutrition and Home Sciences, National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
- Department of Human Nutrition and Dietetics, Riphah International University, Faisalabad, 38000, Pakistan
| | - Masood Sadiq Butt
- Faculty of Food, Nutrition and Home Sciences, National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan.
| | - Imran Pasha
- Faculty of Food, Nutrition and Home Sciences, National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Naeem Faisal
- Institute of Pharmacy, Physiology and Pharmacology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
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Tabatabaei Z, Shamsedini N, Mohammadpour A, Baghapour MA, Hoseini M. Exposure assessment of children living in homes with hookah smoking parents to polycyclic aromatic hydrocarbons: urinary level, exposure predictors, and risk assessment. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:68667-68679. [PMID: 35543784 PMCID: PMC9091547 DOI: 10.1007/s11356-022-20589-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Children are extremely liable to indoor air pollutants as their physiology and a few metabolic pathways are different from those of adults. The present cross-sectional study aimed to assess exposure of children living with parents who use hookah tobacco smoke to polycyclic aromatic hydrocarbons (PAHs) using a biomonitoring approach. The study was conducted on 25 children (7-13 years of age) exposed to hookah smoke at home and 25 unexposed age-matched children. Urinary levels of five metabolites of PAHs were quantified via headspace gas chromatography-mass spectrometry (GC-MS). Urinary malondialdehyde (MDA) was measured, as well. Information regarding the sociodemographic and lifestyle conditions was collected through interviews using managed questionnaires. The urinary 1-OH-NaP and 9-OH-Phe concentrations were respectively 1.7- and 4.6-folds higher in the case samples compared to the control group (p < 0.05). In addition, urinary MDA levels were 1.4 times higher in the exposed children than in the unexposed group, but the difference was not statistically significant (p > 0.05). Increasing the consumption of grilled and meat food in the diet increased the participants' urinary 2-OH-Flu and 1-OH-Pyr levels, respectively. Moreover, sleeping in the living room instead of the bedroom at night was a significant predictor of high 1-OH-NaP and 2-OH-NaP concentrations in the children's urine. Overall, the findings confirmed that children living in their homes with hookah-smoking parents were significantly exposed to naphthalene and phenanthrene. Hence, implementing protective measures is critical to reduce the exposure of this group of children.
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Affiliation(s)
- Zeynab Tabatabaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Shamsedini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Fars Water and Wastewater Company, Shiraz, Iran
| | - Amin Mohammadpour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Baghapour
- Research Center for Health Sciences, Department of Environmental Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hoseini
- Research Center for Health Sciences, Department of Environmental Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Tabatabaei Z, Hoseini M, Fararooei M, Shamsedini N, Baghapour MA. Biomonitoring of BTEX in primary school children exposed to hookah smoke. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:69008-69021. [PMID: 35554839 PMCID: PMC9100313 DOI: 10.1007/s11356-022-19882-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/20/2022] [Indexed: 05/16/2023]
Abstract
Hookah smoking is one of the major indoor sources of benzene, toluene, ethylbenzene, and xylenes (BTEX). This study aimed to investigate the potential exposure to BTEX among primary school children, particularly those exposed to hookah smoke. This cross-sectional study was conducted in Khesht, one of the southwestern cities in Iran, in mid-June 2020. Totally, 50 primary school children exposed to hookah smoke were chosen as the case group and 50 primary school children were selected as the control group. Urinary un-metabolized BTEX was measured by a headspace gas chromatography mass spectrometry (GC-MS). Additionally, a detailed questionnaire was used to gather data and information from the students' parents. The mean levels of urinary benzene, toluene, ethylbenzene, m,p-xylene, and o-xylene were 1.44, 5.87, 2.49, 6.93, and 7.17 μg/L, respectively in the exposed children. Urinary BTEX was 3.93-folds higher in the case group than in the controls (p<0.05). Household cleaning products, the floor on which the house was located, children's sleeping place, and playing outdoors were found to be important factors in predicting urinary BTEX levels. Overall, it was found necessary to avoid indoor smoking to prevent the emission of BTEX compounds via exhaled mainstream smoke and to protect vulnerable non-smokers, especially children, from exposure to second-hand and third-hand smoke.
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Affiliation(s)
- Zeynab Tabatabaei
- Department of Environment Health Engineering, School of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hoseini
- Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararooei
- Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Shamsedini
- Department of Environment Health Engineering, School of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Fars Water and Wastewater Company, Shiraz, Iran
| | - Mohammad Ali Baghapour
- Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lipkus IM, Sanders C, Mays D. Influencing Perceptions of Harm of Waterpipe Tobacco Smoking Among One Member of Couples Who Use Waterpipe. Nicotine Tob Res 2021; 24:1071-1078. [PMID: 34953166 PMCID: PMC9199946 DOI: 10.1093/ntr/ntab261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/11/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Waterpipe tobacco smoking (WTS) often occurs socially, increasing health risks for the smoker and others through secondhand smoke effects. While messages on WTS harms enhance perceived risks for self, whether these messages elevate perceived risks for others, such as one's romantic partner who engages in WTS, is unclear. We tested this idea by surveying one member of dual-smoking couples who engages in WTS. AIMS AND METHODS As part of an online study, we enrolled adults ages 18-30 who engaged in WTS and were in a committed relationship of at least 6 months whose partner engaged in WTS. Participants were randomized to a control arm or to one of two arms consisting of watching a brief video on health harms or overcoming myths about WTS, respectively. Outcomes were perceived harms and measures of desire and probability of quitting for self and partner. RESULTS Participants (N = 238) who watched either video, compared with participants who did not watch a video, reported greater perceived health risks for self and partner and that their own WTS harmed their partner. Participants who watched either video reported a greater desire to quit for themselves, perceived that their partner had a greater desire to quit, and reported a higher likelihood of quitting together in the next 6 months. CONCLUSIONS Brief videos containing risk-based messaging increase young adult waterpipe tobacco smokers' perceived harms and desire to quit for self and partner. This can be a useful strategy to motivate cessation in couples who engage in WTS. IMPLICATIONS This study shows for the first time that at least among one member of dual-smoking couples who engages in WTS, brief videos on harms of WTS influences perceived harms and motivation to quit for the self and one's partner. This can be a useful strategy to promote cessation.
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Affiliation(s)
- Isaac M Lipkus
- Corresponding Author: Isaac M. Lipkus, PhD, Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, USA. Telephone: 919-668-2348; Fax: (919)-681-8899;
| | | | - Darren Mays
- Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
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Tabatabaei Z, Baghapour MA, Hoseini M, Fararouei M, Abbasi F, Baghapour M. Assessing BTEX concentrations emitted by hookah smoke in indoor air of residential buildings: health risk assessment for children. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2021; 19:1653-1665. [PMID: 34900296 PMCID: PMC8617227 DOI: 10.1007/s40201-021-00721-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/07/2021] [Indexed: 05/24/2023]
Abstract
Hookah smoke is one of the major indoor sources of Volatile Organic Compounds (VOCs), including Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX). The present study aimed to investigate potential exposure to BTEX compounds among primary school children whose parents smoked hookah at home. BTEX concentrations in indoor air were measured in 60 residential buildings of Khesht, southwestern Iran (case = 30 and control = 30). Target compounds were sampled by charcoal tubes, and the samples were then analyzed by GC-FID. Monte Carlo simulation was used to assess the carcinogenic and non-carcinogenic risks of BTX exposure for the children aged 7-13 years. The concentrations of benzene (7.19 ± 3.09 vs. 0.82 ± 0.5 μg/m3), toluene (1.62 ± 0.69 vs. 0.3 ± 0.22 μg/m3), and xylenes (2.9 ± 1.66 vs. 0.31 ± 0.22 μg/m3) were considerably higher in the indoor air of the case houses compared with the control houses (p < 0.05). The Incremental Lifetime Cancer Risk (ILCR) of benzene for non-smoking and smoking houses were estimated 1.8 × 10-6 and 15 × 10-6, respectively, exceeding the recommendations of the World Health Organization (WHO) and the Environmental Protection Agency (EPA) (1 × 10-6). Moreover, Hazard Quotients (HQs) of all BTX compounds were < 1. The indoor benzene concentration was significantly influenced by the floor at which families lived and type of the kitchen. In order to prevent children's exposure to BTX emitted by hookah, banning indoor smoking is the only way to eliminate these compounds in the indoor air.
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Affiliation(s)
- Zeynab Tabatabaei
- Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Baghapour
- Research Center for Health Sciences, Institute of Health, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hoseini
- Research Center for Health Sciences, Institute of Health, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Abbasi
- Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Baghapour
- Department of Biology, Faculty of Science, York University, Toronto, Canada
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Lipkus I, Sanders C. A Pilot Study Assessing Reactions to Educational Videos on Harm of Waterpipe among Young Adults Susceptible to Waterpipe Tobacco Smoking. JOURNAL OF HEALTH COMMUNICATION 2021; 26:743-752. [PMID: 34758698 DOI: 10.1080/10810730.2021.2000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Young adults who never engaged in waterpipe tobacco smoking (WTS) yet are open to trying it, that is, are susceptible, is a high-risk group for initiation WTS. Very few interventions dissuade this group from WTS. Thus, we explored how four short videos that varied themes of WTS harms influenced susceptible young adults' risk perceptions, risk beliefs, and susceptibility to future WTS. As part of online cross-sectional study, 208 participants aged 18-34 were randomized to watch or not a short video; each video focused on different themes of WTS risks: physical harms, myths about WTS, addiction, and harms to others. The main outcomes were perceived personal risks, risk beliefs, perceived harm of WTS compared to cigarettes, and susceptibility to future WTS. Watching any video increased beliefs of harm of WTS and lowered susceptibility to future WTS compared to not watching a video. The theme of physical harms was most effective at increasing risk beliefs and lowering susceptibility to future WTS. All four videos were rated as credible, engaging, personally relevant, producing negative affect toward WTS, and effective at dissuading WTS. These promising findings suggest further testing is needed to determine if effects persist and prevent WTS among adults susceptible to WTS.
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Affiliation(s)
- Isaac Lipkus
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Camilla Sanders
- Duke University School of Nursing, Durham, North Carolina, USA
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Kalan ME, Ghobadi H, Taleb ZB, Adham D, Cobb CO, Ward KD, Behaleh R, Fazlzadeh M. COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:40346-40354. [PMID: 33029777 PMCID: PMC7541093 DOI: 10.1007/s11356-020-11038-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/28/2020] [Indexed: 05/02/2023]
Abstract
There is mixed evidence surrounding the relationship between tobacco use and COVID-19 infection/progression. The current study investigates beliefs and tobacco use behaviors and COVID-19 infection among a sample of smokers and never-smokers. Data were collected using an online survey distributed through Telegram, a cloud-based social media networking application in Iran from April 1 to May 31, 2020. The study participants included never-smokers (n = 511), current (past-month) waterpipe smokers (n = 89), current cigarette smokers (n = 158), and ex-smokers (n = 172). Multinomial logistic regression was used to compare tobacco use groups with never- smokers on beliefs, controlling for potential confounders. The study participants (n = 944) was mostly male (64%), had > high school education (76%), and lived in an urban area (91%), with mean ± SD age of 35.3 ± 10.8. Key findings of this study are that compared with never-smokers: (1) cigarette smokers were less likely to believe that smoking cigarette can lead to spreading COVID-19; (2) waterpipe smokers were more likely to believe that smoking waterpipe at home was a safe practice, that waterpipe protects against COVID-19, and smoking waterpipe may lead to a more rapid recovery from COVID-19; (3) both waterpipe and cigarette smokers believed that using e-cigarettes in public places was a safe practice during the COVID-19 pandemic; and (4) more than half of the ex-smokers stopped smoking due to COVID-19 and most of them planned to continue abstaining from smoking after the pandemic. Our findings underscore the need to raise awareness about the unsupported claims of a lower hazard of using tobacco products or possible protective effects against COVID-19 and to promote cessation programs.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Hassan Ghobadi
- Department of Internal Medicine, Pulmonary Division, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Davoud Adham
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Raed Behaleh
- School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Mehdi Fazlzadeh
- Department of Environmental Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran.
- Department of Environmental Health, School of Health, Tehran University of Medical Sciences, Tehran, Iran.
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Kassem NOF, Peterson LA, Liles S, Kassem NO, Zaki FK, Lui KJ, Vevang KR, Dodder NG, Hoh E, Hovell MF. Urinary metabolites of furan in waterpipe tobacco smokers compared to non-smokers in home settings in the US. Toxicol Lett 2020; 333:202-210. [PMID: 32814080 PMCID: PMC10883161 DOI: 10.1016/j.toxlet.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Determine uptake of furan, a potential human carcinogen, in waterpipe tobacco (WPT) smokers in home settings. METHODS We analysed data from a US convenience sample of 50 exclusive WPT smokers, mean age 25.3 years, and 25 non-smokers, mean age 25.5 years. For WPT smokers, data were collected at a home visit by research assistants during which participants smoked one WPT head of one brand for a mean of 33.1 min in their homes. Research assistants provided and prepared a WP for participants by weighing and loading 10 g of WPT in the WP head. At the completion of the smoking session, research assistants measured the remaining WPT. Cotinine and six furan metabolites were quantified in first morning urine samples provided on 2 consecutive days for non-smokers, and on the morning of a WPT smoking session and on the following morning for smokers. RESULTS WPT smokers consumed a mean of 2.99 g WPT. In WPT smokers, urinary cotinine levels increased significantly 26.1 times the following morning; however, urinary metabolites of furan did not increase significantly. Compared to non-smokers, 2 furan metabolites, N-acetyl-S-[1-(5-acetylamino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine and N-acetyl-S-[1-(5-amino-5-carboxypentyl)-1H-pyrrol-3-yl]-L-cysteine sulfoxide, were significantly higher in WPT smokers in pre and in post WPT smoking levels. CONCLUSIONS To enable a more rigorous assessment of furan exposure from WPT smoking, future research should determine furan concentrations in WPT smoke, quantify furan metabolites from users of various WPT brands; and extend the investigation to social settings where WPT smoking is habitually practiced.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States.
| | - Lisa A Peterson
- Division of Environmental Health Sciences and the Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Flora K Zaki
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Kung-Jong Lui
- San Diego State University Research Foundation, 5250 Campanile Dr., San Diego, CA 92182, United States
| | - Karin R Vevang
- Division of Environmental Health Sciences and the Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Nathan G Dodder
- San Diego State University Research Foundation, 5250 Campanile Dr., San Diego, CA 92182, United States
| | - Eunha Hoh
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, United States
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
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Fauzi R, Areesantichai C. Determinants of waterpipe smoking among high school students in Jakarta, Indonesia. Int J Adolesc Med Health 2020; 34:269-274. [PMID: 32862148 DOI: 10.1515/ijamh-2020-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/12/2020] [Indexed: 11/15/2022]
Abstract
Objectives The study aimed to examine factors associated with past 30 days waterpipe use among high school students in Jakarta, Indonesia. Methods We surveyed a multistage cluster random sample of 1,318 students of grade 10th and 11th from 14 schools in Jakarta. Multiple logistic regressions were employed to examine the association between past 30 days waterpipe use with sociodemographic characteristics, cigarettes smoking status, parental and peer use, availability and affordability. Results Of 1,318 participants, 3.3% of female and 8.4% of male currently smoked waterpipe. Multivariate analysis revealed that current waterpipe use was significantly associated with family use (AOR: 4.844, 95% CI: 1.225-19.151), friend use (AOR: 2.554, 95% CI: 1.424-4.582), and availability (AOR: 2.143, 95% CI: 1.127-4.076). Being current smokers were six times more likely (AOR: 6.055, 95% CI: 3.123-11.739) to use waterpipe in the past 30 days. Conclusions The finding suggests that smoking by a family member, friends, use of conventional cigarettes, and availability are significantly associated with increased probability of current waterpipe used among adolescents.
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Affiliation(s)
- Ridhwan Fauzi
- Faculty of Public Health, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia.,College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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Brinkman MC, Kim H, Buehler SS, Adetona AM, Gordon SM, Clark PI. Evidence of compensation among waterpipe smokers using harm reduction components. Tob Control 2020; 29:15-23. [PMID: 30377243 PMCID: PMC7350613 DOI: 10.1136/tobaccocontrol-2018-054502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined two waterpipe tobacco smoking components advertised to reduce harm to determine if they result in lower levels of biomarkers of acute exposure. METHODS We conducted a crossover study of 34 experienced waterpipe smokers smoking a research-grade waterpipe in three configurations ad libitum in a controlled chamber: control (quick-light charcoal), electric (electric heating) and bubble diffuser (quick-light charcoal and bubble diffuser). We collected data on smoking topography, environmental carbon monoxide (CO), subjective effects, heart rate, plasma nicotine and exhaled CO and benzene. RESULTS Smokers' mean plasma nicotine, heart rate, and exhaled benzene and CO boost were all significantly lower for electric compared with control. However, smokers puffed more intensely and took significantly more and larger volume puffs for a larger total puffing volume (2.0 times larger, p<0.0001) when smoking electric; machine yields indicate this was likely due to lower mainstream nicotine. Smokers rated electric smoking experience less satisfying and less pleasant. For charcoal heating, the mean mass of CO emitted into the chamber was ~1 g when participants smoked for a mean of 32 minutes at a typical residential ventilation rate (2.3 hr-1). CONCLUSION Waterpipe smokers engaged in compensation (i.e., increased and more intense puffing) to make up for decreased mainstream nicotine delivery from the same tobacco heated two ways. Waterpipe components can affect human puffing behaviours, exposures and subjective effects. Evidence reported here supports regulation of waterpipe components, smoking bans in multifamily housing and the use of human studies to evaluate modified or reduced risk claims.
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Affiliation(s)
- Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| | - Hyoshin Kim
- Battelle Public Health Center for Tobacco Research, Battelle, Seattle, Washington, USA
| | - Stephanie S Buehler
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Anna M Adetona
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Sydney M Gordon
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Pamela I Clark
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
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15
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Khalil C, Chahine JB, Chahla B, Hobeika T, Khnayzer RS. Characterization and cytotoxicity assessment of nargile smoke using dynamic exposure. Inhal Toxicol 2019; 31:343-356. [DOI: 10.1080/08958378.2019.1683104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christian Khalil
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
- Institute of Environmental Studies, University of New South Wales (UNSW), Sydney, Australia
| | - Joe Braham Chahine
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Brenda Chahla
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Tamara Hobeika
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Rony S. Khnayzer
- Department of Natural Sciences, Lebanese American University, Chouran, Beirut, Lebanon
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16
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Moon KA, Rule AM, Magid HS, Ferguson JM, Susan J, Sun Z, Torrey C, Abubaker S, Levshin V, Çarkoglu A, Radwan GN, El-Rabbat M, Cohen JE, Strickland P, Breysse PN, Navas-Acien A. Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo. Nicotine Tob Res 2019; 20:482-491. [PMID: 28582531 DOI: 10.1093/ntr/ntx125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/30/2017] [Indexed: 11/12/2022]
Abstract
Background Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hoda S Magid
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline M Ferguson
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jolie Susan
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Zhuolu Sun
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christine Torrey
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Salahaddin Abubaker
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Asli Çarkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | - Ghada Nasr Radwan
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha El-Rabbat
- Department of Psychology, Kadir Has University, Istanbul, Turkey
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Patrick N Breysse
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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17
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Kaplan B, Sussan T, Rule A, Moon K, Grau-Perez M, Olmedo P, Chen R, Carkoglu A, Levshin V, Wang L, Watson C, Blount B, Calafat AM, Jarrett J, Caldwell K, Wang Y, Breysse P, Strickland P, Cohen J, Biswal S, Navas-Acien A. Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees. ENVIRONMENT INTERNATIONAL 2019; 127:495-502. [PMID: 30981020 PMCID: PMC6513716 DOI: 10.1016/j.envint.2019.03.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. METHOD We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. RESULTS Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. CONCLUSION Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees.
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Affiliation(s)
- Bekir Kaplan
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America.
| | - Thomas Sussan
- U.S. Army Public Health Center, Toxicology Directorate, United States of America
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Katherine Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America; Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Asli Carkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | | | - Lanqing Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Clifford Watson
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Benjamin Blount
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Jeffery Jarrett
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Kathleen Caldwell
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Yuesong Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Pattrick Breysse
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Joanna Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Shyam Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
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18
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Posis A, Bellettiere J, Liles S, Alcaraz J, Nguyen B, Berardi V, Klepeis NE, Hughes SC, Wu T, Hovell MF. Indoor cannabis smoke and children's health. Prev Med Rep 2019; 14:100853. [PMID: 30976488 PMCID: PMC6441784 DOI: 10.1016/j.pmedr.2019.100853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022] Open
Abstract
Cannabis use is increasing and cannabis is typically consumed by smoking. This study explored how indoor secondhand cannabis smoke (SCS) was associated with child health. As part of a larger trial, air particle monitors were placed in 298 homes of families with at least one cigarette smoker and one child under 14 years old in San Diego County, California. Assessment included past 7-day indoor cigarette and cannabis use, the youngest child's exposure to cigarette smoke, and 5 smoke-related past-year child health outcomes: emergency department use for coughing/difficulty breathing; physician diagnosis of ear infection, bronchitis/bronchiolitis, asthma, or eczema/atopic dermatitis. An ordinal measure of adverse health outcomes (0, 1, or ≥2) was regressed on reported indoor cannabis smoking—the main measure of exposure (yes/no). Of 221 parents/guardians asked about cannabis use, 192 (86.9%) provided all required data, and 29 (15.1%) reported indoor cannabis smoking; reports were supported by air particle data. Homes without indoor smoking had lower average 7-day particle concentrations (1968 particles/0.01ft3) than homes with cannabis smoking only (3131 particles/0.01ft3), cigarette smoking only (3095 particles/0.01ft3), or both cigarette and cannabis smoking (6006 particles/0.01ft3). Odds of reporting a greater number of adverse health outcomes were 1.83 (95% CI = 0.89–3.80, p = 0.10) times higher for children of families with indoor cannabis smoking vs families without cannabis smoking, after controlling for exposure to cigarette smoke and other covariates. Our results do not indicate a statistically significant association. However, the magnitude of the (non-significant) association between indoor cannabis smoking and adverse health outcomes warrants more studies. Indoor cannabis smoking raises particle levels and risk of child particle exposure. Smoking cannabis in-home may adversely impact child health. This adverse impact may occur in homes with or without indoor cigarette smoking. Health effects of secondhand cannabis smoke exposure need to be further explored.
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Affiliation(s)
- Alexander Posis
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Corresponding author at: Center for Behavioral Epidemiology and Community Health, 9245 Sky Park Court, San Diego, CA 92123, USA.
| | - John Bellettiere
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- Corresponding author.
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - John Alcaraz
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Benjamin Nguyen
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Vincent Berardi
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Department of Psychology, Chapman University, CA, USA
| | - Neil E. Klepeis
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Suzanne C. Hughes
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tianying Wu
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Melbourne F. Hovell
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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Abstract
Tobacco use and exposure to tobacco smoke remain major but avoidable causes of premature mortality and disease worldwide. Although the age-standardized prevalence of daily smoking has declined for both men and women in many countries, the number of smokers continues to increase because of global population growth. Although cigarettes are the most commonly used tobacco product, the tobacco epidemic has become tremendously complex with the emergence and popularity of alternative products such as waterpipes and electronic cigarettes (also known as e-cigarettes). Exposure sciences play a major role in characterizing the tobacco epidemic as well as in the promotion, enactment, and implementation of tobacco control initiatives including legislation and voluntary measures in countries worldwide. We reviewed several studies in Latin America and other regions, showing how high-quality exposure assessment has contributed to smoke-free policies. Although there are many toxicants in tobacco products, metals could be playing an important role in tobacco-related disease. Tobacco plants accumulate cadmium and lead from soil. In e-cigarettes, a metallic coil heats the e-liquid to produce the aerosol that is inhaled by the vaper, and studies have found high aerosol levels of nickel, chromium, lead, and zinc. Despite many tobacco control successes, including the enactment of the Framework Convention on Tobacco Control, which has been ratified by 181 countries, tobacco control faces many challenges globally. Given the continuing increase in the number of smokers worldwide and the rapid emergence of new tobacco products, additional creative efforts are needed to achieve a smoke-free world, help smokers to quit, and protect youth from initiating tobacco use.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
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20
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Kassem NOF, Kassem NO, Liles S, Zarth AT, Jackson SR, Daffa RM, Chatfield DA, Carmella SG, Hecht SS, Hovell MF. Acrolein Exposure in Hookah Smokers and Non-Smokers Exposed to Hookah Tobacco Secondhand Smoke: Implications for Regulating Hookah Tobacco Products. Nicotine Tob Res 2018; 20:492-501. [PMID: 28591850 PMCID: PMC5896480 DOI: 10.1093/ntr/ntx133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/05/2017] [Indexed: 12/31/2022]
Abstract
Introduction Acrolein is a highly ciliatoxic agent, a toxic respiratory irritant, a cardiotoxicant, and a possible carcinogen present in tobacco smoke including hookah tobacco. Methods 105 hookah smokers and 103 non-smokers attended exclusively hookah smoking social events at either a hookah lounge or private home, and provided urine samples the morning of and the morning after the event. Samples were analyzed for 3-hydroxypropylmercapturic acid (3-HPMA), a metabolite of acrolein. Results Geometric mean (GM) urinary 3-HPMA levels in hookah smokers and non-smokers exposed to secondhand smoke (SHS) increased significantly, 1.41 times, 95% CI = 1.15 to 1.74 and 1.39 times, 95% CI = 1.16 to 1.67, respectively, following a hookah social event. The highest increase (1.68 times, 95% CI = 1.15 to 2.45; p = 0.007) in 3-HPMA post a hookah social event was among daily hookah smokers (GM, from 1991 pmol/mg to 3348 pmol/mg). Pre-to-post event change in urinary 3-HPMA was significantly positively correlated with pre-to-post event change in urinary cotinine among hookah smokers at either location of hookah event, (ρ = 0.359, p = 0.001), and among non-smokers in hookah lounges (ρ = 0.369, p = 0.012). Conclusions Hookah tobacco smoke is a source of acrolein exposure. Findings support regulating hookah tobacco products including reducing humectants and sugar additives, which are precursors of acrolein under certain pyrolysis conditions. We suggest posting health warning signs for indoor smoking in hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes. Implications Our study is the first to quantify the increase in acrolein exposure in hookah smokers and non-smokers exposed to exclusively hookah tobacco SHS at hookah social events in homes or hookah lounges. Our findings provide additional support for regulating hookah tobacco product content, protecting non-smokers' health by posting health warning signs for indoor smoking in hookah lounges, and encouraging home bans on hookah tobacco smoking to safeguard vulnerable residents.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Adam T Zarth
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Reem M Daffa
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Dale A Chatfield
- San Diego State University Department of Chemistry, San Diego, CA, USA
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
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21
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Kassem NOF, Kassem NO, Liles S, Jackson SR, Posis AIB, Chatfield DA, Hovell MF. Levels of Urine Cotinine from Hookah Smoking and Exposure to Hookah Tobacco Secondhand Smoke in Hookah Lounges and Homes. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2018; 7. [PMID: 29805963 PMCID: PMC5967845 DOI: 10.5812/ijhrba.67601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Nicotine, an addictive drug, is present in all forms of tobacco products, including hookah tobacco, which is not yet regulated in the United States. Objectives This study aimed to investigate the uptake of nicotine in hookah smokers and non-smokers exposed to secondhand smoke (SHS) at indoor hookah social events in natural settings where hookah tobacco was smoked exclusively. Patients and Methods We quantified cotinine, a metabolite of nicotine, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home. Results Following a social event where exclusively hookah tobacco was smoked, urinary cotinine levels increased significantly 8.5 times (geometric mean (GM): 16.0 ng/mg to 136.1 ng/mg) among hookah smokers, and 2.5 times (GM: 0.4 ng/mg to 1.0 ng/mg) among non-smokers exposed exclusively to hookah tobacco SHS. Among hookah smokers, the highest increase in urinary cotinine levels post a hookah event was found in occasional hookah smokers in which GM levels increased significantly 31.2 times post smoking (from 2.0 ng/mg to 62.3 ng/mg). Reported reasons for preference to smoke hookah at home by hookah smokers who attended a hookah social event in a private home included recreational purposes, socializing with friends and family, ‘Me’ time and relaxing at home, more comfortable to smoke hookah at home, owning a hookah and hookah tobacco, eating and drinking while smoking hookah, and saving money by smoking at home and not going to hookah lounges. Conclusions Hookah tobacco smoke is a source of substantial nicotine exposure. Our results call for protecting hookah smokers’ and non-smokers’ health by requiring accurate hookah tobacco labels, raising taxes on hookah tobacco, reducing the spread of hookah lounges, and encouraging voluntary bans on smoking hookah tobacco in private homes.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
- Corresponding author: Nada O F Kassem, Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, United States. Tel: +1-6193707488,
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Alexander Ivan B Posis
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Dale A Chatfield
- Department of Chemistry, San Diego State University, San Diego, California, U.S.A
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
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Weitzman M. American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco. Pediatr Res 2018; 83:23-30. [PMID: 28945701 DOI: 10.1038/pr.2017.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022]
Abstract
This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.
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Affiliation(s)
- Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York City, New York
- Department of Environmental Medicine, New York University School of Medicine, New York City, New York
- College of Global Public Health, New York University, New York City, New York
- NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
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Kassem NOF, Kassem NO, Liles S, Jackson SR, Chatfield DA, Jacob P, Benowitz NL, Hovell MF. Urinary NNAL in hookah smokers and non-smokers after attending a hookah social event in a hookah lounge or a private home. Regul Toxicol Pharmacol 2017; 89:74-82. [PMID: 28716579 PMCID: PMC5582991 DOI: 10.1016/j.yrtph.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/08/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
Tobacco smoking and exposure to tobacco secondhand smoke (SHS) can cause lung cancer. We determined uptake of NNK (4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone), a tobacco specific potent pulmonary carcinogen, in hookah smokers and non-smokers exposed to hookah tobacco SHS. We analyzed data from a community-based convenience sample of 201 of adult (aged ≥18 years) exclusive hookah smokers (n = 99) and non-smokers (n = 102) residing in San Diego County, California. Participants spent an average of three consecutive hours indoors, in hookah lounges or private homes, where hookah tobacco was smoked exclusively. Total NNAL [the sum of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides], the major metabolites of NNK, were quantified in spot urine samples provided the morning of and the morning after attending a hookah event. Among hookah smokers urinary NNAL increased significantly (p<0.001) following a hookah social event; the geometric mean doubled, from 1.97 to 4.16 pg/mg. Among non-smokers the increase was not significant (p = 0.059). Post hookah event urinary NNAL levels were highest in daily hookah smokers, and significantly higher than in non-daily smokers or non-smokers (GM: 14.96 pg/mg vs. 3.13 pg/mg and 0.67 pg/mg, respectively). For both hookah smokers and non-smokers, pre-to-post event change in urinary NNAL was not significantly different between hookah lounges and homes. We suggest posting health warning signs inside hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, 92123, United States.
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, 92123, United States
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, 92123, United States
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, 92123, United States
| | - Dale A Chatfield
- San Diego State University Department of Chemistry, San Diego, CA 92182, United States
| | - Peyton Jacob
- School of Medicine, Departments of Psychiatry and Medicine, Division of Clinical Pharmacology and Experimental Therapeutics, San Francisco General Hospital Medical Center, University of California, San Francisco, CA 94110, United States
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, 92123, United States
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Weitzman M, Yusufali AH, Bali F, Vilcassim MJR, Gandhi S, Peltier R, Nadas A, Sherman S, Lee L, Hong Z, Shearston J, Park SH, Gordon T. Effects of hookah smoking on indoor air quality in homes. Tob Control 2016; 26:586-591. [PMID: 27798320 DOI: 10.1136/tobaccocontrol-2016-053165] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/24/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke. METHODS Air samples from 33 homes-11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking-were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room. RESULTS Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different. CONCLUSIONS This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.
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Affiliation(s)
- Michael Weitzman
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA.,College of Global Public Health, New York University, New York, New York, USA.,Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA.,New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
| | - Afzal Hussein Yusufali
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,Hatta Hospital, Dubai Health Authority, Dubai, UAE
| | - Fatma Bali
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,Hatta Hospital, Dubai Health Authority, Dubai, UAE
| | - M J Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA
| | - Shashank Gandhi
- Department of Biology, New York University, New York, New York, USA
| | - Richard Peltier
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Arthur Nadas
- Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA
| | - Scott Sherman
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,College of Global Public Health, New York University, New York, New York, USA.,Department of Population Health, New York University, School of Medicine, New York, New York, USA
| | - Lily Lee
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA.,Brooklyn College, Brooklyn, New York, USA
| | - Zhang Hong
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA
| | - Jenni Shearston
- Department of Population Health, New York University, School of Medicine, New York, New York, USA
| | - Su Hyun Park
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA
| | - Terry Gordon
- College of Global Public Health, New York University, New York, New York, USA.,Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA.,New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
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Zhou S, Behrooz L, Weitzman M, Pan G, Vilcassim R, Mirowsky JE, Breysee P, Rule A, Gordon T. Secondhand hookah smoke: an occupational hazard for hookah bar employees. Tob Control 2016; 26:40-45. [PMID: 26811352 DOI: 10.1136/tobaccocontrol-2015-052505] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite the increasing popularity of hookah bars, there is a lack of research assessing the health effects of hookah smoke among employees. This study investigated indoor air quality in hookah bars and the health effects of secondhand hookah smoke on hookah bar workers. METHODS Air samples were collected during the work shift of 10 workers in hookah bars in New York City (NYC). Air measurements of fine particulate matter (PM2.5), fine black carbon (BC2.5), carbon monoxide (CO), and nicotine were collected during each work shift. Blood pressure and heart rate, markers of active smoking and secondhand smoke exposure (exhaled CO and saliva cotinine levels), and selected inflammatory cytokines in blood (ineterleukin (IL)-1b, IL-6, IL-8, interferon γ (IFN-γ), tumour necrosis factor (TNF-α)) were assessed in workers immediately prior to and immediately after their work shift. RESULTS The PM2.5 (gravimetric) and BC2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 µg/m3 and 2.2 µg/m3, respectively. The mean CO level was 12.9 ppm with a peak value of 22.5 ppm CO observed in one hookah bar. While heart rate was elevated by 6 bpm after occupational exposure, this change was not statistically significant. Levels of inflammatory cytokines in blood were all increased at postshift compared to preshift testing with IFN-Υ increasing from 0.85 (0.13) to 1.6 (0.25) (mean (standard error of the mean; SEM)) pg/mL (p<0.01). Exhaled CO levels were significantly elevated after the work shift with 2 of 10 workers having values >90 ppm exhaled CO. CONCLUSIONS These results demonstrate that hookah bars have elevated concentrations of indoor air pollutants that appear to cause adverse health effects in employees. These data indicate the need for further research and a marked need for better air quality monitoring and policies in such establishments to improve the indoor air quality for workers and patrons.
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Affiliation(s)
- Sherry Zhou
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA.,Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA.,NYU College of Global Public Health, New York, New York, USA
| | - Grace Pan
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | | | - Patrick Breysee
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ana Rule
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA.,NYU College of Global Public Health, New York, New York, USA
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Jawad M, Choaie E, Brose L, Dogar O, Grant A, Jenkinson E, McEwen A, Millett C, Shahab L. Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners. PLoS One 2016; 11:e0146799. [PMID: 26745806 PMCID: PMC4706414 DOI: 10.1371/journal.pone.0146799] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Hampshire, SO16 6YD, United Kingdom
- * E-mail:
| | - Elham Choaie
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Leonie Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8BB, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom
| | - Aimee Grant
- Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, CF14 4YS, United Kingdom
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Andy McEwen
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
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Kassem NOF, Jackson SR, Boman-Davis M, Kassem NO, Liles S, Daffa RM, Yasmin R, Madanat H, Hovell MF. Hookah Smoking and Facilitators/Barriers to Lounge Use among Students at a US University. Am J Health Behav 2015; 39:832-48. [PMID: 26450551 DOI: 10.5993/ajhb.39.6.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine hookah tobacco use, hookah lounge attendance, and facilitators and barriers to hookah lounge attendance. METHODS A cross-sectional Web-based survey of a random sample of 1332 undergraduate students (Mean Age = 21.2 years) attending a United States university. RESULTS The majority of respondents (72.8%) had ever smoked hookah tobacco, and 28% of those had ever smoked during adolescence. The majority of ever hookah smokers (81.5%) and a portion of never hookah smokers (20%) had ever been to a hookah lounge. The adjusted odds of ever visiting a hookah lounge were 2.1 times higher among participants who reported that the closest hookah lounge to the university was < 5 miles away than those who reported that the closest hookah lounge was ≥ 5 miles away. Facilitators of visiting hookah lounges included friends and close proximity of hookah lounges to campus; barriers included cost of smoking hookah, crowded lounges, and having to be 18 years old. CONCLUSION Youth are vulnerable to experimenting with hookah tobacco smoking. Hookah lounges provide patrons the opportunity to smoke hookah tobacco with smoker and non-smoker friends in entertaining settings. Our findings suggest that zoning laws and anti-hookah smoking legislation may help curb hookah uptake by prohibiting hookah lounges from opening in close proximity to universities, reducing the density of hookah lounges in cities, and raising the admission age for hookah lounges to 21 years.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
| | | | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
| | - Reem M Daffa
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
| | - Roxana Yasmin
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
| | - Hala Madanat
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA
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Abstract
Shisha smoking, with origins in India and the Arab world, is today spreading rapidly into other parts of the world. One such region is Southeast Asia,where shisha bars are commonly seen around educational institutions. The general public remains unaware of the harmful effects of shisha smoking and many assume that shisha smoking does not involve tobacco. Shisha smoking is not adequately addressed in the current anti-tobacco policies by most governments of Southeast Asia. Only a few countries have already taken concrete measures of including shisha smoking in anti-tobacco policies. We highlight the emerging trend of shisha smoking in Southeast Asian nations, associated health effects, and the loopholes in the governmental policies that are being exploited by the vendors of shisha. While most research, taxation policies, and health education on tobacco-related products have focused on cigarettes, additional methods of tobacco delivery become more common.
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Akl EA, Ward KD, Bteddini D, Khaliel R, Alexander AC, Lotfi T, Alaouie H, Afifi RA. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control 2015; 24 Suppl 1:i13-i21. [PMID: 25618895 PMCID: PMC4345979 DOI: 10.1136/tobaccocontrol-2014-051906] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review. Data sources The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms. Study selection Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years. Data extraction Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results. Data synthesis The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels. Conclusions The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.
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Affiliation(s)
- E A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - K D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - D Bteddini
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R Khaliel
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - A C Alexander
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - T Lotfi
- Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - H Alaouie
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R A Afifi
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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