Document Type : Original Article
Authors
- Abdolhalim Rajabi 1
- Mohammad Ebrahimi Kalan 2
- Ali Shahryari 3
- Maryam Ahmadi-Livani 4
- Arezoo Foroughi 5
- Teimoor Jorjani 6
- Mehdi Fazlzadeh 7
- Ziyad Ben Taleb 8
- Abdurrahman Charkazi 3
1 Faculty of Health, Environmental Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
2 School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia. USA
3 Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
4 Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
5 Public Health Education Organization, Gonbad-e-Kavous, Iran
6 Shahid Motahari Hospital, Golestan University of Medical Sciences, Gonbad-e-Qabous, Iran
7 Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
8 Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
Abstract
Background: In the early days of the pandemic, the rise in COVID-19 cases prompted many governments to lockdown the waterpipe-serving venues, which may affect the patterns of use among this centuries-old tobacco product. Here, we studied the pattern of WP smoking among Iranian adults during the COVID-19 epidemic.
Methods: In this cross-sectional study, we conducted an online survey among sample of 213 waterpipe(WP) smokers who were selected by convenience sampling method from the Golestan province, in Northern Iran using WP smoking patterns, Lebanese Waterpipe Dependence Scale, 11 (LWDS11), and selected demographic variables. Collected data comprises demographic and WP smoking patterns during COVID-19.
Results: About 70% of participants reduced their WP use compared to the time before COVID-19, modestly due to pandemic effects. Around 38.5% of the subjects believed WP bars were covertly operating during the lockdown and continued serving their customers. Singles and less educated adults had lower mean attitude scores regarding the decrease in WP smoking during the COVID-19 pandemic (P<0.05). Structural equation analysis revealed that the immune system improvement with WP smoking had the strongest effect. (0.74). A strong inverse correlation exists between the WP dependence level and the negative belief toward WP smoking during the COVID-19 epidemic (r=-0.66, P<0.001).
Conclusion: There is a clear need for appropriate interventions to change the belief of WP smokers regarding the dangers of this practice during the COVID-19 outbreak, particularly among single people and those with lower levels of education. Furthermore, regulatory authorities should exercise stricter controls to ensure the complete closure of WP bars.
Keywords
- Sohal SS. Inhaled corticosteroids and increased microbial load in COPD: potential role of epithelial adhesion molecules . Eur Respir J. 2018 Jan 31;51(2):1702257. doi: 10.1183/13993003.02257-2017. PMID: 29386338.
- Atto B, Eapen MS, Sharma P,Frey U,Ammit A,Markos J, et al. New therapeutic targets for the prevention of infectious acute exacerbations of COPD: role of epithelial adhesion molecules and inflammatory pathways. Clin Sci. (Lond)2019;133(14):1663-1703. doi: 1042/ CS20181009. PMID:31346069.
- Eapen MS, Sharma P, Moodley YP, Hansbro PM, Sohal SS. Dysfunctional immunity and microbial adhesion molecules in smoking-induced pneumonia.Am Respir Crit CareMed. 2019;199(2):250-251. doi:1164/rccm.201808-1553LE.PMID:30290125.
- Eapen MS, Sharma P, Sohal SS. Mitochondrial dysfunction in macrophages: A key to defective bacterial phagocytosis in COPD. Eur Respir J. 2019 Oct 10;54(4):1901641.doi: 1183/13993003.01641-2019. PMID:31601722.
- World Health Organization . Smoking and COVID-19: Scientific brief. 2020;
- Teimourpour A, Yaseri M, Parsaeian M, Bagherpour Kalo M, Hosseini M. Application of Mixture Cure with the Doubly Censoring Model in Estimation of Initiation Age and Prevalence of Water-Pipe Smoking in Iran: a New Approach in Population-Based Studies. Tanaffos. 2020;19(3):243-249. PMID: 33815545.
- Afrashteh S, Ansarifar A, Vali M,Nazari LN,Keshtkar N,Memar S, et al. Geographic distribution and time trends of water-pipe use among Iranian youth and teenage students: A meta-analysis and systematic review. J Ethn Subst Abuse. 2021 Sep 6:1-31. doi:10.1080/15332640.2021.1943097. PMID: 34486927.
- Lai C-C, Wang C-Y, Wang Y-H, Hsueh S-C, Ko W-C, Hsueh P-R. Global epidemiology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative index, mortality, and their association with country healthcare resources and economic status. Int J Antimicrob Agents. 2020 Apr;55(4):105946. doi: 1016/j.ijantimicag.2020.105946. PMID: 32199877. PMCID: PMC7156123.
- Kalan ME, Ghobadi H, Taleb ZB,Adham D,Cobb CO,Ward KD, et al. COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran. Environ Sci Pollut Res Int. 2021 Aug;28(30):40346-40354. doi: 1007/s11356-020-11038-x. PMID: 33029777. PMCID: PMC7541093.
- Heinz AJ, Giedgowd GE, Crane NA, Veilleux JC,Conrad M,Braun AR,et al. A comprehensive examination of hookah smoking in college students: use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use.Addict Behav.2013 Nov;38(11):2751-2760. doi: 1016/j.addbeh.2013.07.009. PMID: 23934006.
- Davaji RBO, Shahamat YD, Davaji FH,Mirkarimi K,Charkazi A,Pahlavanzadeh B, et al. Patterns, beliefs, norms and perceived harms of hookah smoking in north Iran. Asian Pac J Cancer Prev. 2017;18(3):823. doi: 22034/APJCP.2017.18.3.823. PMID: 28441793. PMCID: PMC5464506.
- Phalavanzadeh B NS, Ozouni- Davaji RB, Shahbazi S, Zarghami F, Mirkarimi K,et al. . Evaluation of the Psychometric Properties of the Lebanon Waterpipe Dependence Scale (LWDS-11) in a Sample of Iranian Waterpipe Smokers. S Addict Health. 2020 Oct;12(4):287293. doi:10.22122/ahj.v12i4.283. PMID: 33623648.PMCID: PMC7878004.
- Salameh P, Waked M, Aoun ZJN, Research T. Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11). 2008;10(1):149-158. Nicotine Tob Res. 2008 Jan;10(1):149-58. doi: 10.1080/14622200701767753. PMID: 18188755.
- Maziak W, Taleb ZB, Bahelah R,Islam F,Jaber R,Auf R, et al. The global epidemiology of waterpipe smoking. Tob Control. Mar 2015;24 Suppl 1(Suppl 1):i3-i12. doi:10.1136/tobaccocontrol-2014-051903. PMID: 25298368. PMCID: PMC4345835.
- Akl EA, Jawad M, Lam WY, Co CN, Obeid R, Irani J. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduct J. Jul 2 2013;10:12. doi:10.1186/1477-7517-10-12. PMID: 23816366.PMCID: PMC3706388.
- Hammal F, Mock J, Ward KD, Eissenberg T, Maziak W. A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control. Apr 2008;17(2):e3. doi:10.1136/tc.2007.020529. PMID: 18375726.
- Kowitt SD, Cornacchione Ross J, Jarman KL,Kistler CE,Lazard AJ,Ranney LM, et al. Tobacco quit intentions and behaviors among cigar smokers in the United States in response to COVID-19. Int J Environ Res Public Health. 2020 Jul 25;17(15): 5368.doi: 10.3390/ijerph17155368. PMID: 32722469. PMCID: PMC7432467.
- Afifi R, Khalil J, Fouad F,Hammal F,JarallahY,Abu Farhat H, et al. Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region. Soc Sci Med. 2013 Dec;98:125-34. doi: 10.1016/j. socscimed. 2013 .09.007.PMID: 24331890.
- Dar-Odeh NS, Abu-Hammad O. The changing trends in tobacco smoking for young Arab women; narghile, an old habit with a liberal attitude. Harm Reduct J. 2011 Aug 30;8:24.doi: 10.1186/1477-7517-8-24. PMID: 21878112. PMCID: PMC3176153.
- Nakhostin-Roohi B.The comparison of hookah smoking prevalence in medical students between 2009 and 2014. Epidemiol Biostatist Pub Health J.2016;13(2).doi: https://doi.org/10.2427/11714 .
- Hammal F, Mock J, Ward KD, Eissenberg T, Maziak W. A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control. 2008 Apr;17(2):e3. doi: 10.1136/tc.2007.020529. PMID: 18375726.
- Xu X, Chen P, Wang J, Feng J,Zhou X,Li X,et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020 Mar;63(3):457-460. doi: 10.1007/s11427-020-1637-5. PMID: 32009228. PMCID: PMC7089049.
- Heffner JL, Watson NL, Dahne J,Croghan I,Kelly MM,Mc Clure JB, et al. Recognizing and Preventing Participant Deception in Online Nicotine and Tobacco Research Studies: Suggested Tactics and a Call to Action. Nicotine Tob Res. 2021 Aug 29;23(10):1810-1812. doi: 10.1093/ntr/ntab077. PMID: 33876244. PMCID: PMC8562415
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