ObjectivesIn the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally.Data sourcesPeer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used.Study selectionThe focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking.Data extractionMultiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review.Data synthesisWaterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns.ConclusionsWaterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.
Objective Identifying and understanding determinants of alcohol use behavior among Hispanic immigrants is an increasingly significant public health concern. Although prior research has examined associations of cultural stressors with alcohol use among Hispanics, few studies have tested these associations among recent adult immigrants. As such, this study aimed to (a) examine the association of immigration stress on alcohol use severity among recently immigrated Hispanic adults (≤ 1 year in the U.S.); and (b) examine the moderating effects of gender, immigration status, and social support. Method A hierarchical multiple regression and moderation analyses were conducted on a sample of 527 participants in South Florida. Results Results indicated that after controlling for demographic variables, pre-immigration drinking behavior, and dimensions of social support, the association of higher immigration stress with higher alcohol use severity was statistically significant. Moderation analyses indicated that immigration stress had a statistically significant association with alcohol use severity among men, but not among women. Also, dimensions of social support consistently reduced the deleterious effect of immigration stress on alcohol use severity. Conclusion This study adds to the scarce literature on cultural stressors and alcohol use among recent Hispanic immigrants. Findings suggest that it may be important to design gender-specific interventions and that increasing levels of social support may offset the effects of immigration stress on alcohol use.
Summary Setting Waterpipe smoking is increasing worldwide. Nevertheless, little is known about nicotine dependence in tobacco smokers who use waterpipes. Objective To assess evidence of dependence among non-cigarette smoking waterpipe smokers in Egypt. Methods A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We adapted the Fagerström test for nicotine dependence and the Reasons for Smoking (RFS) scales and related these to smoking behavior. Results The mean age of the subjects was 47 ± 14 years, the mean age at smoking initiation was 22 ± 9 years, and average daily consumption was 4 ± 8 hagars (tobacco units). The time to the first smoke of the day (P < 0.001), smoking even when ill (P = 0.003), time to tobacco craving (P < 0.001), and hating to give up the first smoke of the day (P = 0.033) were each significantly associated with the number of hagars smoked per day. The RFS subscales of addictive smoking, smoking to relieve negative affect, and smoking for stimulation were also associated with these variables. Conclusion The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.
Research has indicated that Hispanics have high rates of heavy drinking and depressive symptoms during late adolescence. The purpose of this study was to test a bicultural transaction model composed of two enthnocultural orientations (acculturation and enculturation); and stressful cultural transactions with both the U.S. culture (perceived ethnic discrimination) and Hispanic culture (perceived intragroup marginalization) to predict alcohol use severity and depressive symptoms among a sample of 129 (men = 39, women = 90) late adolescent Hispanics (ages 18 to 21) enrolled in college. Results from a path analysis indicated that the model accounted for 18.2% of the variance in alcohol use severity and 24.3% of the variance in depressive symptoms. None of the acculturation or enculturation domains had statistically significant direct effects with alcohol use severity or depressive symptoms. However, higher reports of ethnic discrimination were associated with higher reports of alcohol use severity and depressive symptoms. Similarly, higher reports of intragroup marginalization were associated with higher depressive symptoms. Further, both ethnic discrimination and intragroup marginalization functioned as mediators of multiple domains of acculturation and enculturation. These findings highlight the need to consider the indirect effects of enthnocultural orientations in relation to health-related outcomes.
Background and Objectives Emerging adulthood is often marked with elevated symptoms of anxiety and depression. Hispanic emerging adults may face cultural stressors such as ethnic discrimination that further increase levels of anxiety and depression symptoms. The study aims were to examine if (a) self-esteem mediated effects of ethnic discrimination on symptoms of anxiety and depression, and (b) if gender moderated the indirect effects of discrimination. Design The study design was cross-sectional self-report. Method Two moderated mediation models were tested, with 1,084 Hispanic emerging adults (ages 18–25) enrolled in institutions of post-secondary in the U.S. Results Results indicated that (a) higher ethnic discrimination was associated with higher anxiety symptoms (β = .05, p = .04), higher depression symptoms (β = .06, p = .02), and lower self-esteem (β = −.30, p < .001); (b) self-esteem mediated the associations of ethnic discrimination with anxiety and depression symptoms; and (c) gender moderated the indirect effects of discrimination, whereby self-esteem was a stronger mediator among men than women. Each moderated mediation model explained 26% of variability in symptoms of anxiety and depression, respectively. Conclusions Findings suggest that the mediating effects of self-esteem linking ethnic discrimination with symptoms of anxiety and depression vary between gender.
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