Waterpipe smoking patterns and symptoms of nicotine dependence: The Waterpipe Dependence in Lebanese Youth Study

Abstract

Introduction Waterpipe typically is smoked intermittently over long smoking sessions. Waterpipe is addictive and its users show symptoms of nicotine dependence (ND). This study examined the risk of developing ND symptoms across waterpipe use patterns among Lebanese youth. Methods Waterpipe use patterns (length of smoking session, smoking a whole waterpipe without sharing, past-30 day use frequency, number of waterpipes smoked) were assessed. Symptoms of ND were assessed using the 10-item Hooked on Nicotine Checklist (HONC; endorsement of ≥1 symptom) and the 6 criteria of the International Classification of Diseases-10th revision (ICD-10 ND; presence of ≥3 criteria during 12 months). Results Both the proportion of participants endorsing ND symptoms and the average number of endorsed ND symptoms increased with increasing waterpipe use frequency, number of waterpipes smoked, and length of smoking session. The risk of endorsing ≥1 HONC symptom increased with increasing number of waterpipes smoked in the past 30-days (≥10 vs. <4 waterpipes; Hazard ratio (HR) =2.05, 95% CI: 1.52–2.58, p=0.007), and session length (>60 min vs. <30 min; HR=2.87, 95% CI: 2.83–2.91, p=0.001). The risk of attaining ICD-10 ND increased with increasing number of waterpipes used in the past 30-days (≥10 vs. <4 waterpipes; HR=2.56, 95% CI: 1.89–3.22, p=0.006), and smoking every day/almost every day vs. less than once weekly (HR=2.86, 95% CI: 2.12–3.60, p=0.007). Conclusions Increasing use frequency, number of waterpipes smoked, and longer smoking sessions were associated with higher risk of ND. The length of smoking session emerged as a novel indicator of ND among waterpipe smokers.

Attachment style and addictions (alcohol, cigarette, waterpipe and internet) among Lebanese adolescents: a national study

“…Its prevalence is also rising among adolescents (3.9% frequent smokers in 2012), especially in the presence of a family member or friend who smokes [26]. Similarly, the prevalence of waterpipe use is high in Lebanon, with up to 35% of the 13 to 15 years old category having already used it [27]. Actually, waterpipes are more appealing to adolescents due to the different flavors and look, and due to the false idea of waterpipe smoking being a non-harmful method [28], its use in adolescent population is popular [29,30].…”

A Machine Learning Approach for Predicting Nicotine Dependence

“…We use these factors since they perform well in traditional tobacco prediction research and represent standard factors for the desire for women to smoke waterpipe [2,16]. Another rational is that these factors also cover experiencing cravings that leads them to smoke waterpipe [17,20]. It was demonstrated that young initiation age of smoking linked to being a regular smoker at a later age [17,18,19].…”

“…Another rational is that these factors also cover experiencing cravings that leads them to smoke waterpipe [17,20]. It was demonstrated that young initiation age of smoking linked to being a regular smoker at a later age [17,18,19]. Moreover, it was shown that number of tobaccos smoked significantly related to level of nicotine dependence [17,21,25,29,30].…”

Association between parental separation and addictions in adolescents: results of a national Lebanese study

“…Lebanon is smoking prevalence ranks first in the Middle East and for Arab females, with 43% of men and 28% of women in Lebanon being smokers 13 . Waterpipe smoking prevalence is high in Lebanon especially in youth, with 35% of teens aged between 13 and 15 having used it; among them, 47% smoked less than once weekly, 38% weekly but not daily, 16% daily 14 . A study showed that divorce increased the risk of drinking and smoking initiation 15 .…”