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Tob Control. 2018 Jun 12. pii: tobaccocontrol-2018-054244. doi: 10.1136/tobaccocontrol-2018-054244. [Epub ahead of print]

Determinants of progression of nicotine dependence symptoms in adolescent waterpipe smokers.

Author information

1
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.
2
Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen.
3
University of Memphis School of Public Health, Memphis, Tennessee, USA.
4
Syrian Center for Tobacco Studies, Aleppo, Syria.
5
Reliant Medical Group, Worcester, Massachusetts, USA.
6
Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA.
7
Baptist Health South Florida, Miami, Florida, USA.
8
American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, USA.

Abstract

INTRODUCTION:

Waterpipe smoking continues to pose significant challenges to tobacco control efforts and many adolescent waterpipe smokers experience symptoms of nicotine dependence (ND). This study examined the predictors of progression of ND symptoms in adolescent waterpipe smokers.

METHODS:

We assembled a cohort of Lebanese adolescents enrolled in eighth and ninth grades at baseline, and surveyed them every 6 months over the next 24 months. Progression of ND symptoms was defined as an increase over time in the number of items endorsed on the Hooked on Nicotine Checklist. Predictors included individual (eg, psychological factors, attitudes towards waterpipe, school performance, physical activity) and socioenvironmental (eg, smoking among parents, siblings and close friends; the café environment) attributes.

RESULTS:

Among 264 adolescent waterpipe smokers (baseline mean age=14.6 years, 50.4% females), 105 (39.7%) progressed on ND symptoms during follow-up. Predictors of progression were higher baseline stress (OR 1.11, 95% CI 1.03 to 1.19) and higher self-esteem (OR 1.14, 95% CI 1.05 to 1.24). Reporting difficulty refraining from smoking waterpipe while in a restaurant was the strongest predictor of progression (OR 4.04, 95% CI 1.44 to 11.34). Having a mother with ≥12 years of education protected against progression of ND (OR 0.46, 95% CI 0.21 to 0.99).

CONCLUSIONS:

A significant proportion of adolescent waterpipe smokers progressed on ND. Venue-based policies such as limiting youth access to waterpipe cafés are warranted.

KEYWORDS:

addiction; non-cigarette tobacco products; public policy

PMID:
29895703
PMCID:
PMC6291353
[Available on 2019-12-12]
DOI:
10.1136/tobaccocontrol-2018-054244

Conflict of interest statement

Competing interests: TE is a paid consultant in litigation against the tobacco industry and is named on a patent application for a device that measures the puffing behaviour of electronic cigarette users.

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