Tobacco use in shisha: Studies on waterpipe smoking

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2.2 Subjects and methods In 2002, a smok<strong>in</strong>g and morbidity questionnaire accompanied a predesigned hepatitis C virus survey <strong>in</strong> order to identify the additional health hazards described above. A representative sample of six Egyptian governorates (of a total 27) was targeted, represent<strong>in</strong>g governorates <strong>in</strong> both Upper and Lower Egypt. Of the total population of 70 million, about 20 million citizens <strong>in</strong>habit these governorates. [12, 13] A cluster sample technique was <strong>use</strong>d to recruit <strong>in</strong>dividuals from each governorate. The sample comprised 6950 <strong>in</strong>dividuals. An <strong>in</strong>terview ho<strong>use</strong>hold survey was carried out. The questionnaire conta<strong>in</strong>ed sections on the follow<strong>in</strong>g topics: • sociodemographic data • smok<strong>in</strong>g pattern, type, duration, and amount • history of hypertension and <strong>in</strong>take of medication (to treat hypertension) • abnormal high blood glucose and history of diabetes mellitus type 2. All adults above 18 years old <strong>in</strong> the ho<strong>use</strong>hold were <strong>in</strong>terviewed. Blood pressure, random blood glucose and anthropometric measurements were evaluated. The follow<strong>in</strong>g steps were followed. Field nurses and physicians were <strong>in</strong>formed and tra<strong>in</strong>ed on blood pressure measurement and other anthropometric measurements and tested for reliability of their work. Also the steps to be followed <strong>in</strong> the cl<strong>in</strong>ic were stuck on the wall as a rem<strong>in</strong>der. Anthropometric measurements taken were weight, height, waist and hip circumferences (WC and HC). Body weight was measured by a regularly titrated balance. The height was measured by a scale aga<strong>in</strong>st a wall from the lowest po<strong>in</strong>t at the heel to the highest po<strong>in</strong>t of the head with the subject stand<strong>in</strong>g upright and head not tilted. Body mass <strong>in</strong>dex (BMI) was calculated us<strong>in</strong>g the follow<strong>in</strong>g formula: weight divided by the square of the height (kg/m 2 ). It was further classified <strong>in</strong> adults <strong>in</strong>to: [13,14]. Underweight < 18.5 kg/m 2 Average 24.9–18.5 kg/m 2 Overweight 25–29.9 kg/m 2 Obese ≥30 kg/m 2 The WC was measured with a tape measure comfortably encircl<strong>in</strong>g the smallest abdom<strong>in</strong>al area below the rib cage and above the umbilicus. A waist circumference of ≥102 cm and ≥88 cm among adult males and females, respectively, are considered to be an <strong>in</strong>dicator of risky abdom<strong>in</strong>al obesity. [15] The HC was measured with a tape measure placed around the most protrud<strong>in</strong>g part of the buttocks. 17
2 Waist–hip ratio (WHR) was def<strong>in</strong>ed as waist measurement/hip measurement. The cutoff po<strong>in</strong>t for abdom<strong>in</strong>al obesity was considered 0.9 and 0.8 for adult males and females, respectively. [16,17] Blood pressure was measured twice us<strong>in</strong>g a regularly titrated, mercury sphygmomanometer by a physician with the subject <strong>in</strong> a seated position with the arm supported by a table at heart level. The average of the two read<strong>in</strong>gs was <strong>use</strong>d to assess the blood pressure. Hypertension was def<strong>in</strong>ed as read<strong>in</strong>gs with systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥ 90 mmHg. [18] F<strong>in</strong>gerprick blood samples were tested for random blood glucose (RBG) us<strong>in</strong>g portable field equipment accord<strong>in</strong>g to manufacturer’s <strong>in</strong>structions (Accu-Check SoftClix, Roche Diagnostics GmbH, D-68298 Mannheim, Germany). Individuals with blood glucose level ≥ 140 mg/dl were classified as hav<strong>in</strong>g high random blood glucose levels accord<strong>in</strong>g to the American Diabetic Association guidel<strong>in</strong>es. [19] 2.3 Statistical analysis Birth cohorts were calculated by subtract<strong>in</strong>g an <strong>in</strong>dividual’s age at survey from the survey year (2002). The sample was divided <strong>in</strong>to 10-year <strong>in</strong>tervals but those born before 1930 were put <strong>in</strong> one group (the most recent cohort, born after 1980 <strong>in</strong>cluded only those born before 1985). The regular smokers’ age of <strong>in</strong>itiation was compared among different birth cohorts. Generally smokers were older than the nonsmokers, and analysis was stratified by age group to exclude age effect. The relationship of smok<strong>in</strong>g to other health risk factors, high random blood sugar and hypertension was studied among adult males only beca<strong>use</strong> of the scarce number of smokers <strong>in</strong> female population groups. The effect of smok<strong>in</strong>g cigarettes and waterpipe compared with nonsmokers was studied separately us<strong>in</strong>g a chi-squared test. The odds ratio was calculated us<strong>in</strong>g nonsmokers as the reference group. Those hav<strong>in</strong>g comb<strong>in</strong>ed systolic and diastolic hypertension were compared to normotensive <strong>in</strong>dividuals among each smoker group (cigarettes and waterpipe) separately and among nonsmokers <strong>in</strong> order to estimate the risk of be<strong>in</strong>g hypertensive. Mixed smokers were excluded from the analysis beca<strong>use</strong> of their small numbers and to avoid the confusion <strong>in</strong> attribut<strong>in</strong>g the effects to cigarette or waterpipe smok<strong>in</strong>g. 2.4 Results and discussion More than half of 6950 adult participants were female and they were on average younger than males (Table 2.1). The mean age for the sample population was only 38.17, reflect<strong>in</strong>g the fact that Egypt has a young population <strong>in</strong> contrast to western populations. About half the adult females did not have any school education, be<strong>in</strong>g illiterate or barely able to read and write, versus one-quarter of adult males. Adult males were twice as likely as females to be university graduates (19% versus 10%; Table 2.2) <strong>Tobacco</strong> <strong>use</strong> <strong>in</strong> <strong>shisha</strong> Table 2.1 Sex and mean age at survey of participants Sex No. % Mean age+ SD P value Adult males 3077 44 39.5 ± 14.8 P < 0.001 Adult females 3873 56 37.2 ± 14.6 Total 6950 100 38.17 ± 14.7
Page 3 and 4: WHO Library Cataloguin</str
Page 5 and 6: 7. The micronucleus test in
Page 8 and 9: Summary The waterpipe (also known a
Page 10 and 11: 14. As an example of biomarker-base
Page 12 and 13: 1.2 Structure of waterpipes Parts a
Page 14 and 15: The average nicotin</strong
Page 16 and 17: (shisha) smok<stro
Page 20 and 21: Type of smoker Adult male (%) Exclu
Page 22 and 23: Overall cigarette consumption (mill
Page 24 and 25: Table 2.6 Hypertension, high random
Page 26 and 27: individuals are cu
Page 28 and 29: 2.6 Limitations of the study and re
Page 30 and 31: [23] Gomma RA. Report of health <st
Page 32 and 33: 13 National survey on cigarettes an
Page 34 and 35: Table 3.1 Age, sex and residence di
Page 36 and 37: It is very well shown that there is
Page 38 and 39: Group 2: non-current waterpipe smok
Page 40 and 41: 4 Epidemiology of waterpipe smok<st
Page 42 and 43: 16% 4% 1% 79% Figure 4.1 Overall sm
Page 44 and 45: Waterpipe smoking
Page 46 and 47: Many waterpipe smokers (57%) have a
Page 48 and 49: Nearly one-third of all smokers wer
Page 50 and 51: In the present study the prevalence
Page 52 and 53: [24] Fadel AK, Hamam MH, Abdel Aziz
Page 54 and 55: could encourage smokin</str
Page 56 and 57: It is less harmful To decrease smok
Page 58 and 59: population was aware that smok<stro
Page 60 and 61: 6 Behavioural and biological aspect
Page 62 and 63: turn, health is affected by occupat
Page 64 and 65: Percentage Figure 6.2 Carboxyhaemog
Page 66 and 67: oth groups) levels in</stro
Page 68 and 69:
to cigarette smokers needs further
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significant association between tob
Page 72 and 73:
[15] El-Shaer AAA, El-Mosalamy MA,
Page 74 and 75:
[43] Amin AAA. Eff
Page 76 and 77:
[70] El Shimy WS, Shallouf MA, Ghor
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[98] Bayoumi W, Muhamed SF, Mursi.
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7.2 Subjects and methods The Egypti
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Table 7.1 Mean TMN and smok
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[7] Desai SS, Ghaisas SD, Jakhi SD,
Page 86:
The rules and regulations stipulate
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