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Background: Late-onset multiple sclerosis (LOMS), defined as the development of MS after the age of 50, has shown a substantial surge in incidence rates and is associated with more rapid progression of disability. Besides, studies have linked tobacco smoking to a higher chance of MS progression. However, the role of smoking on the risk of developing LOMS remains unclear. This study aims to evaluate the possible association between lifetime exposure to cigarette and waterpipe smoking, drug abuse, and alcohol consumption and the risk of LOMS. Methods: This population-based case-control study involved LOMS cases and healthy sex and age-matched controls from the general population in Tehran, Iran. The primary data for confirmed LOMS cases were obtained from the nationwide MS registry of Iran (NMSRI), while supplementary data were collected through telephone and on-site interviews. Predesigned questionnaire for multinational case-control studies of MS environmental risk factors was used to evaluate the LOMS risk factors. The study employed Likelihood ratio chi-square test to compare qualitative variables between the two groups and utilized two independent sample t-test to compare quantitative data. Adjusted odds ratio (AOR) for age along with 95% confidence intervals (CI) were calculated using matched logistic regression analysis in SPSS 23. Results: Totally, 83 LOMS cases and 207 controls were included in the analysis. The female to male ratio in the cases was 1.5: 1. The mean ± SD age of 83 cases and 207 controls was 61.14 ± 5.38) and 61.51 ± 7.67 years, respectively. The mean ± SD expanded disability status scale (EDSS) score was 3.68 ± 2.1. Although the results of waterpipe exposure had no significant effect on LOMS development (P-value: 0.066), ever cigarette-smoked participants had a significantly higher risk of developing LOMS than those who never smoked (AOR: 2.57, 95% CI: 1.44–4.60). Furthermore, people with a history of smoking for more than 20 years had 3.45 times the odds of developing MS than non-smokers. Drug and alcohol abuse were both associated with LOMS in our study; of which opioids (AOR: 5.67, 95% CI: 2.05–15.7), wine (AOR: 3.30, 95% CI: 1.41–7.71), and beer (AOR: 3.12, 95% CI: 1.45–6.69) were found to pose the greatest risk of LOMS, respectively. Conclusion: For the first time, we identified smoking, drug, and alcohol use as potential risk factors for LOMS development. According to the global increase in cigarette smoking and alcohol use, these findings highlight the importance of conducting interventional approaches for prevention. [ABSTRACT FROM AUTHOR]

Background: Water pipe smoking by women threatens their health. Therefore, it is necessary to take measures to reduce this unhealthy behavior. This study aimed to determine the effect of happiness-based education on women's success of water pipe smoking cessation and happiness. Methods: This quasi-experimental study was conducted on female water pipe smokers in Iran, from September to January 2021. The participants (n = 68) were selected using convenience sampling and assigned to the intervention and control groups (34 subjects per group) by blocked randomization. The intervention group received a happiness-based education for one month (eight sessions) based on the Fordyce happiness program. The control group did not receive any special education. Data were collected using the Water Pipe Dependence Scale and the Oxford Happiness Questionnaire before and two months after the intervention. Data were analyzed using descriptive statistics, Chi-square, Fisher's exact test, Independent t-test, Mann-Whitney, and Wilcoxon tests by SPSS software version 22. Results: Two months after the intervention, the mean change in the happiness score was significantly higher in the intervention group (2.32 ± 2.31) than that in the control group (-0.29 ± 1.81) (P < 0.001). Furthermore, the mean change in the score of water pipe dependence was significantly different between the intervention (-1.44 ± 1.4) and control (0.38 ± 0.85) groups (P < 0.001). Conclusion: The results showed that education based on Fordyce happiness program can increase the success of water pipe smoking cessation and happiness in women. Therefore, it is recommended to use similar interventions in women's health promotion programs. [ABSTRACT FROM AUTHOR]

Background: Water pipe smoking has become a global public health problem as its popularity increased over time, especially among youth. The objective of our study was to estimate water pipe tobacco smoking prevalence and to assess socioeconomic factors associated with ever water pipe smoking by public and private university students in Ankara, Turkey.Methods: This descriptive study was based on a survey conducted among public (n=2685) and private (n=2485) university students via an online questionnaire on demographics and water pipe consumption patterns. For every student in the sample, a socioeconomic status index was calculated using principal component analysis. Binary logistic regressions for the outcome variable of ever-using water pipe yielded estimates of adjusted odds ratios (aORs) for the associated factors such as the respondent's age, gender, university type, and socioeconomic status.Results: The prevalence of ever use of water pipe was 69.1% (95% CI: 67.2-70.9%) among private and 59.1% (95% CI: 57.2-60.9%) among public university students. A substantial share of ever users were current users (25.5% in private versus 21.6% in public, p=0.008). On average, private university students had higher socioeconomic status than public university students (for example, access to a car (51.7% versus 35.8%, p=0.008), financial support from family (71.5% versus 65.1%, p<0.001)), also demonstrated by a higher socioeconomic status index. Being a private university student (aOR 1.57, 95% CI: 1.38-1.79), older (aORs 1.50 to 2.39, p<0.001), male (aOR 2.36, 95% CI:2.06-2.70), as well as having greater financial resources, such as having access to a car (aOR 1.24, 95% CI:1.07-1.42), or having income support from family (aOR 1.32, 95% CI:1.13-1.54), were associated with ever-using water pipe. A higher SES index was significantly associated with higher odds of ever using water pipe among both private (aOR 1.13, 95% CI:1.06,1.20) and public university (aOR 1.12, 95% CI:1.06,1.19) students.Conclusions: Water pipe smoking was common in both public and private universities; however, private university students had higher odds of ever using water pipe. There is an urgent need to implement evidence-based interventions, taking into account the socioeconomic status of young adults, to prevent them from water pipe smoking. [ABSTRACT FROM AUTHOR]

Background: Waterpipe is one of the oldest methods of tobacco smoking, which has become the public health challenge, especially in the Eastern Mediterranean countries such as Iran. This study aimed to investigate the waterpipe smoking (WPS) in the young people of Kermanshah in 2020, using a qualitative method.Methods: This was a qualitative study conducted with the approach of content analysis. Participants were young waterpipe user aged 17 to 25 years selected by purposeful sampling method in Kermanshah city, located in the west of Iran. Data were collected through semi-structured interviews in face-to-face and audio-recorded methods based on an interview guideline during June to August 2020. Then researchers transcribed verbatim and analyzed the content of the interviews thematically.Results: In this study, 23 young people who were waterpipe users at the time of the study participated. The results showed that social aspects in three sub-categories were involved in WPS including "socio-cultural aspects", "socio-environmental aspects", and "social relations". Individual aspects of waterpipe use as second category also consisted of two sub-categories including "motivational aspects" and "lack of psycho-protective aspects".Conclusions: It seems that the implementation of the policy of reducing access to waterpipe in public environments is effective in reducing waterpipe consumption. It is suggested that educational and interventions, based on targeted models and theories be implemented in order to increase young people's belief and perception on dangers of WPS, and to improve their self-efficacy to smoking cessation. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding health effects of tobacco cessation during pregnancy is mainly restricted to cigarette while water pipe is the preferred method of tobacco smoking among women in the Middle-East. The present study aimed to assess the effects of cessation of water pipe during pregnancy on birth anthropometric measures in the south of Iran.Methods: Data on 1120 singleton pregnancies (response rate = 93.4%) from a population-based prospective cohort study in suburban communities in Bandar Abbas city was used. Based on water pipe smoking status, the study subjects were categorized into: 1) those who never smoke water pipe (never smoker); 2) those who stopped water pipe during pregnancy and resumed it postpartum (quitters); 3) those who continued smoking water pipe during their pregnancy (always smokers). The Generalized Linear Models (GLMs) were utilized for the analyses.Results: Compared to never smokers, quitting water pipe in pregnancy decreased mean birthweight of infants by 99.30 g (β:-99.30, 95%CI:-204.35,-5.75) and an additional decrease of 37.83 g occurred in infants of always smokers (β:-137.13;95%CI:- 262.21,-12.05). Means of birth length did not significantly differ among the three water pipe groups. Means of head circumference, however, significantly increased by 0.79 cm in infants of always smokers (β:079,95%CI:0.13,1.45).Conclusion: Quitting water pipe during pregnancy had positive effects on infant growth, especially birth weight. Awareness campaigns about health benefits of quitting water pipe during routine prenatal checkups and integration of active follow-up visits into prenatal care protocols for smoking mothers are provided. [ABSTRACT FROM AUTHOR]

Background: Waterpipe tobacco smoking has increased tremendously at a global level among all age groups, particularly young people. Previous studies have examined the impact of waterpipe tobacco pictorial health warnings on adults but scarce studies were done on adolescents. The aim of this study was to assess the association of textual versus pictorial warnings on tumbac boxes and the motivation to quit waterpipe smoking among adolescents located in two Eastern Mediterranean countries Lebanon and Iraq., Methods: A cross-sectional study was conducted between May and November 2022, involving 294 adolescents waterpipe smokers from Lebanon and Iraq. The questionnaire included the Lebanese Waterpipe Dependence Smoking-11, the Depression, Anxiety and Stress Scale, the Waterpipe Harm Perception Scale, Waterpipe Knowledge Scale, Waterpipe Attitude Scale, the Fagerstrom Test for Nicotine Dependence, and the Motivation to Stop Scale., Results: When adjusting the results over confounding variables, the results showed that compared to finding the warnings to stop smoking not efficacious at all, adolescents who find the warnings moderately (aOR = 2.83) and very (aOR = 6.64) efficacious had higher motivation to quit. Compared to finding the warnings not increasing their curiosity for information about how to stop waterpipe smoking at all, participants who confessed that warnings increased their curiosity a little (aOR = 2.59), moderately (aOR = 3.34) and very (aOR = 3.58) had higher motivation to quit. Compared to not considering changing the tumbac brand if the company uses pictorial warnings, adolescents who would consider changing the tumbac brand (aOR = 2.15) had higher motivation to quit., Conclusion: Pictorial and textual warnings on waterpipe packs were associated with higher motivation to stop waterpipe smoking. Public health education programs for this purpose seem warranted., (© 2024. The Author(s).)

Background: The present research aimed to determine the effect of an educational intervention based on the extended theory of planned behavior (ETPB) on waterpipe (WT) smoking cessation in women., Methods: The present quasi-experimental had a pre-test, post-test design with 3, 6 and 12 months follow-ups was conducted in Bandar Abbas city, south of Iran in December 2021-March 2023. A total of 448 women over the age of 15 (224 in the intervention group (IG), 224 in the control group (CG)), using a two-stage cluster sampling method participated. The educational intervention focused on WT smoking cessation implemented in 14 sessions. The educational methods in the training sessions were lectures, collaborative discussions, Q&As, brainstorming, role plays, and peer education. The main outcome was WT cessation behavior. Repeated measures ANOVA tests and post hoc were run to compare the IG and CG at baseline in terms of demographic variables, t-test and chi square test, and in the four points of time of data collection. The data were analyzed in Stata14. A p-value < 0.05 was considered as statistically significant., Results: The mean and standard deviation of WT cessation behavior and all ETPB constructs in the IG was significantly higher than the CG. After the educational intervention, in the IG, the perceived behavioral control, attitude, subjective norm, intention and knowledge increased, and the weekly smoking and WT smoking habit decreased (P < 0.001). The CG did not have any significant change in other variables except for the increased knowledge score. During the 12-month follow-up, the cessation rate was 43.81% (P = 0.645) in the IG and 7.45% in the CG (P = 0.081)., Conclusions: The educational intervention positively affected WT smoking reduction and cessation in women through influencing the ETPB constructs. It is strongly recommended to design theory-based interventions beyond the individual level with an emphasis on interpersonal relationships to facilitate WT cessation as far as possible., (© 2024. The Author(s).)

Background: The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran., Methods: In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants' characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations., Results: The results showed no significant difference between women enrolled in control and intervention groups regarding participants' characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively., Conclusions: HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings., Trial Registration: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129., (© 2022. The Author(s).)

Background: Maternal smoking is suspected to have negative impacts on breastfeeding, such as decreasing the quantity of breast milk, and reducing vitamin and fat concentrations in the milk in the late lactation period. Cigarette and water pipe tobacco products are widely used in Jordan. We aimed to estimate the association between use of different tobacco products and the rates of current breastfeeding., Methods: Data from Jordan's Population and Family Health Surveys 2012 and 2017-18 were examined. Last-born, living children, aged < 25 months, from singleton births, ever breastfed, and living with their mother were included. The key outcome variables were the current breastfeeding (during last 24 h) and tobacco usage status [water pipe tobacco (hookah or narghile) and/or cigarette tobacco]. Complex sample multivariate logistic regression analysis was used to evaluate the association of the current breastfeeding with maternal smoking status., Results: Overall, 6726 infants were included in the study. The current breastfeeding rate in infants aged 0-6 months was 87%, compared with 43.9% in infants aged 12-17 months and 19.4% in infants aged 18-24 months. Overall, 4.4% had mothers who smoked cigarettes, 5.4% smoked water pipe, and 1.6% both cigarettes and water pipe. The proportion of breastfed infants in non-smoking mothers was 57.7% and, those in smoke water pipe, cigarette and both tobacco products were 55.4, 44.9, and 51.0% respectively. Univariate analysis revealed that women cigarette smokers had a lower odds ratio (OR) for current breastfeeding (OR 0.60, 95% Confidence Interval [CI] 0.39, 0.92). Multivariate analysis revealed that maternal cigarette smoking was associated with a lower odds ratio for current breastfeeding compared with mothers who smoked neither water pipe nor cigarettes (AOR 0.51, 95% Cl 0.30, 0.87)., Conclusions: These results indicate that maternal smoking is associated with termination of breastfeeding, suggesting that structured training should be organized for healthcare professionals, expectant mothers and the general public about the association between maternal smoking and cessation of lactation.

Background: Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide., Methods: A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories., Results: After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels., Conclusion: The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.

Background: Exposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters., Methods: We surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO., Results: In analysis limited to men (93.5% of all surveyed), 42% were daily cigarette; 1% were waterpipe smokers; 94% were exposed to SHS, 29% used coal for heating and 4% used biomass for cooking. The median CO was 4 (interquartile range 3;8) ppm. Age (beta 0.74 per 10 years, p < 0.001), use of biomass fuel for cooking (beta 1.38, p = 0.05), cigarette smoked in the last 12 h (beta 8.22, p < 0.001), waterpipe smoked in the last 12 h (beta 23.10, p < 0.001) were statistically associated with CO, but not time since last fire (≤6 h) (beta 4.12, p = 0.12). There was a significant interaction between older age and firefighting for exhaled CO (p = 0.03)., Conclusions: Cigarette and recent waterpipe smoking are associated with increased exhaled CO in firefighters. Firefighting itself was a less potent contributor to exhaled CO when measured at an annual screening, but an age interaction was manifested.

Background: The prevalence in the Lebanese general population of cigarette and waterpipe smoking, alcohol drinking and internet use seems to be increasing lately. So far, no study was done relating the above to attachment styles in Lebanese adolescents. Consequently, the objective of our study was to assess the relationship between attachment styles (secure, preoccupied, fearful, and dismissing) and addictions (cigarettes, water pipes, alcohol, and internet) among this population., Methods: It is a cross-sectional study that took place between January and May 2019. Two thousand questionnaires were distributed out of which 1810 (90.5%) were completed and collected back. A proportionate random sample of schools from all Lebanese Mohafazat was used as recruitment method., Results: A secure attachment style was significantly associated with lower addiction to alcohol, cigarette, and waterpipe, whereas insecure attachment styles (preoccupied, dismissing and fearful) were significantly associated with higher addiction to cigarette, waterpipe, alcohol, and internet., Conclusion: Lebanese adolescents with insecure attachment had higher rates of addiction to cigarette, waterpipe, alcohol, and internet. They should be closely monitored in order to reduce the risk of future substance use disorder and/or behavioral addiction development.