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Integrating the impact of cigarette and waterpipe tobacco use among adolescents in the Eastern Mediterranean region: a cross sectional population level model of toxicant exposure

Integrating the impact of cigarette and waterpipe tobacco use among adolescents in the Eastern Mediterranean region: a cross sectional population level model of toxicant exposure
Integrating the impact of cigarette and waterpipe tobacco use among adolescents in the Eastern Mediterranean region: a cross sectional population level model of toxicant exposure
Background: Waterpipe smoking is more prevalent than cigarette smoking among adolescents in the Eastern Mediterranean Region (EMR); however, simple prevalence masks complex waterpipe smoking patterns and makes uncertain its contribution to risk of tobacco-related harm. This study aimed to integrate the impact of cigarette and waterpipe tobacco use on toxicant exposure among EMR adolescents.

Methods: A cross-sectional model made equivalent individual-level toxicant exposure data for cigarettes and waterpipes, and aggregated it to 23 countries in the EMR using the Global Youth Tobacco Survey. The waterpipe model adjusted for estimated frequency of use, session duration and sharing behaviours. The final model included 60?306 12–17-year olds, and modelled as outcomes nicotine, carbon monoxide (CO) and 14 carcinogens. Sensitivity analyses substantially reduced session duration and proportion of solo use.

Results: Our model suggests waterpipe use may contribute a median of 36.4% (IQR 26.7–46.8%, n=16) of the total toxicant exposure from tobacco, and may reach up to 73.5% and 71.9% of total CO and benzene exposure, respectively. Sensitivity analyses reduced all values by 4.3–21.0%, but even the most conservative scenarios suggested over 50% of benzene and CO exposure was from waterpipe use. Between 69.2% and 73.5% of total toxicant exposure derived from dual cigarette and waterpipe users, who smoked cigarettes and waterpipe more frequently and intensely than single users.

Conclusions: More research is warranted to refine our model's parameters. Tobacco control researchers should consider a move towards a single unit of measure for cigarette and waterpipe tobacco exposure in order to better inform health policy.
0964-4563
1-8
Jawad, Mohammed
2f8ebb89-4b95-4436-8e37-42fe1ddcb02e
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Jawad, Mohammed
2f8ebb89-4b95-4436-8e37-42fe1ddcb02e
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Jawad, Mohammed and Roderick, Paul (2016) Integrating the impact of cigarette and waterpipe tobacco use among adolescents in the Eastern Mediterranean region: a cross sectional population level model of toxicant exposure. Tobacco Control, 1-8. (doi:10.1136/tobaccocontrol-2015-052777). (PMID:27354679)

Record type: Article

Abstract

Background: Waterpipe smoking is more prevalent than cigarette smoking among adolescents in the Eastern Mediterranean Region (EMR); however, simple prevalence masks complex waterpipe smoking patterns and makes uncertain its contribution to risk of tobacco-related harm. This study aimed to integrate the impact of cigarette and waterpipe tobacco use on toxicant exposure among EMR adolescents.

Methods: A cross-sectional model made equivalent individual-level toxicant exposure data for cigarettes and waterpipes, and aggregated it to 23 countries in the EMR using the Global Youth Tobacco Survey. The waterpipe model adjusted for estimated frequency of use, session duration and sharing behaviours. The final model included 60?306 12–17-year olds, and modelled as outcomes nicotine, carbon monoxide (CO) and 14 carcinogens. Sensitivity analyses substantially reduced session duration and proportion of solo use.

Results: Our model suggests waterpipe use may contribute a median of 36.4% (IQR 26.7–46.8%, n=16) of the total toxicant exposure from tobacco, and may reach up to 73.5% and 71.9% of total CO and benzene exposure, respectively. Sensitivity analyses reduced all values by 4.3–21.0%, but even the most conservative scenarios suggested over 50% of benzene and CO exposure was from waterpipe use. Between 69.2% and 73.5% of total toxicant exposure derived from dual cigarette and waterpipe users, who smoked cigarettes and waterpipe more frequently and intensely than single users.

Conclusions: More research is warranted to refine our model's parameters. Tobacco control researchers should consider a move towards a single unit of measure for cigarette and waterpipe tobacco exposure in order to better inform health policy.

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More information

Accepted/In Press date: 20 April 2016
e-pub ahead of print date: 27 June 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 399535
URI: http://eprints.soton.ac.uk/id/eprint/399535
ISSN: 0964-4563
PURE UUID: 20cc4351-e511-4ad1-9060-bb5d552e9f57
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 19 Aug 2016 10:47
Last modified: 07 Oct 2020 01:38

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Author: Mohammed Jawad
Author: Paul Roderick ORCID iD

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