Mohammad Ebrahimi Kalan1, Raed Behaleh2, Joseph R DiFranza3, Zoran Bursac4, Ziyad Ben Taleb5, Malak Tleis6, Taghrid Asfar7, Rima Nakkash6, Kenneth D Ward8, Thomas Eissenberg9, Wasim Maziak10. 1. Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida. 2. School of Health Sciences, Baldwin Wallace University, Berea, Ohio. 3. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts. 4. Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, Florida. 5. Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas. 6. Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. 7. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida; Syrian Center for Tobacco Studies, Aleppo, Syria. 8. Syrian Center for Tobacco Studies, Aleppo, Syria; School of Public Health, University of Memphis, Memphis, Tennessee. 9. Syrian Center for Tobacco Studies, Aleppo, Syria; Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia. 10. Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Syrian Center for Tobacco Studies, Aleppo, Syria. Electronic address: wmaziak@fiu.edu.
Abstract
PURPOSE: Waterpipe (WP) smoking patterns and setting can result in a unique trajectory of nicotine dependence (ND) compared with cigarette smoking. This longitudinal study compared the development of ND symptoms among adolescent WP and cigarette smokers. METHODS: A cohort of 647 eighth and ninth graders in Lebanon were followed over 5 years. This study was based on 283 current exclusive WP and 146 current exclusive cigarette smokers. Kaplan-Meier survival analyses were conducted to evaluate 50% cumulative probability for the development of initial Hooked on Nicotine Checklist symptoms and the International Classification of Diseases, 10th revision (ICD-10) ND. RESULTS: An initial Hooked on Nicotine Checklist symptom was endorsed by 59% of WP and 50% of cigarette smokers after smoking onset. Among those, 50% of both WP and cigarette smokers did so within 9.7 and 18.5 months, respectively. Approximately 28% of WP smokers and 22% of cigarette smokers developed ICD-10 ND. Among those, 50% of both WP and cigarette smokers did so within 15 and 22 months, respectively. The most common first to fourth ICD-10 criteria reported by WP smokers were "a strong desire to use tobacco," "difficulties in controlling tobacco taking behavior," "neglect of alternative pleasure," and "use despite harm." The most common first to fourth ICD-10 criteria reported by cigarette smokers were "a strong desire to use tobacco," "difficulties in controlling tobacco taking behavior," "withdrawal," and "tolerance". CONCLUSIONS: Compared with adolescent cigarette smokers, initial ND symptoms and ICD-10 ND can develop sooner after starting to smoke and progress more rapidly among adolescent WP smokers. Developing, implementing, and evaluating intervention programs with adolescent WP smokers should be guided by the WP-specific trajectory of ND.
PURPOSE: Waterpipe (WP) smoking patterns and setting can result in a unique trajectory of nicotine dependence (ND) compared with cigarette smoking. This longitudinal study compared the development of ND symptoms among adolescent WP and cigarette smokers. METHODS: A cohort of 647 eighth and ninth graders in Lebanon were followed over 5 years. This study was based on 283 current exclusive WP and 146 current exclusive cigarette smokers. Kaplan-Meier survival analyses were conducted to evaluate 50% cumulative probability for the development of initial Hooked on Nicotine Checklist symptoms and the International Classification of Diseases, 10th revision (ICD-10) ND. RESULTS: An initial Hooked on Nicotine Checklist symptom was endorsed by 59% of WP and 50% of cigarette smokers after smoking onset. Among those, 50% of both WP and cigarette smokers did so within 9.7 and 18.5 months, respectively. Approximately 28% of WP smokers and 22% of cigarette smokers developed ICD-10 ND. Among those, 50% of both WP and cigarette smokers did so within 15 and 22 months, respectively. The most common first to fourth ICD-10 criteria reported by WP smokers were "a strong desire to use tobacco," "difficulties in controlling tobacco taking behavior," "neglect of alternative pleasure," and "use despite harm." The most common first to fourth ICD-10 criteria reported by cigarette smokers were "a strong desire to use tobacco," "difficulties in controlling tobacco taking behavior," "withdrawal," and "tolerance". CONCLUSIONS: Compared with adolescent cigarette smokers, initial ND symptoms and ICD-10 ND can develop sooner after starting to smoke and progress more rapidly among adolescent WP smokers. Developing, implementing, and evaluating intervention programs with adolescent WP smokers should be guided by the WP-specific trajectory of ND.
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