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Hookah Smoking: The Past and Future of Tobacco?. Brian Primack, MD, EdM, MS Assistant Professor of Medicine and Pediatrics April 2009. Terminology. Hookah Waterpipe Shisha-Pipe Narghile Bong Hubble-bubble. www.hookah-bars.com. Hours. Sunday – Thursday: 4 PM – 12:30 AM
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Hookah Smoking:The Past and Future of Tobacco? Brian Primack, MD, EdM, MS Assistant Professor of Medicine and Pediatrics April 2009
Terminology • Hookah • Waterpipe • Shisha-Pipe • Narghile • Bong • Hubble-bubble
Hours • Sunday – Thursday: 4 PM – 12:30 AM • Friday – Saturday: 4 PM – 2 AM
Fruit Apple Banana Cherry Melon Candy Bubble gum Chocolate mint Alcohol Margarita Piña colada Flavors
Good Quality Regular $7.00Large $10.00 Arabic Coffee, Apple, Apple Alex, Double Apple, Apricot, Banana, Candy, Cappuccino, Cherry, Carmel, Coconut, Cola, Grape, Jasmine, Lemon, Mint, Mango, Mandarin, Mixed Fruit, Orange, Pistachio, Peach Rose, Salloum, Strawberry, Vanilla, Zaghoul Light, Zaghoul, Licorice
Excellent QualityRegular $8.00Large $11.00 Double apple, Apricot, Banana, Cantaloupe, Cappuccino, Cherry, Coconut, Mint, Melon, Orange, Peach, Pineapple, Rose, Raspberry, Strawberry, Tutti-Frutti, Vanilla Cognac, Margarita, Pina Colada, Strawberry Daiquiri
Premiume Quality Regular $8.50Large $11.50 Apple, Special Apple, Bahrany Apple, Apple Eskandarani, Banana, Cola, Cappuccino, Fruit Cocktail, Honey Melon, Mango, Orange, Peach, Pipe, Rose, Strawberry
Superior Quality Regular $9Large $12 Apple, Strawberry, Grape, Rose
* Make your Hookah Cool with adding ice for $1 * Mix & Match Flavors Add $2 * Flavor Your Hookah Water Add $3 * Add 0.25 Per Each Person** Minimum 1 Order Per Person ** ** Bring your own bottle $2 cork charge ** You Must Be 21 to bring your own alcohol bottle
Also Have • Fruit Smoothies (e.g. Strawberry, Banana, Mango, Guava) • Ice Cream • Coffee and Tea • Milk Shakes • Desserts • Games (Mancala, Dominoes)
Smoke Exposure • 30-60 minute sessions • Each session ~100 inhalations • Each inhalation ~500 mL in volume • Total volume • Waterpipe session: 50,000 mL • Cigarette: 500-600 mL
Smoking Topography 1Shihadeh 2003; Shihadeh 2004 2Breland 2005; Djordjevic 2000
Blood Nicotine Level = Shafagoj, 2002
Known Harm • Waterpipe smoke contains ... • Carcinogens • Carbon monoxide • Nicotine • Tar • Metals • Waterpipe smoking associated with ... • Cancer • Cardiovascular disease • Decreased pulmonary function • Nicotine dependence
History • India, ~1600? • EMR = Eastern Mediterranean Region • Syria • Lebanon • Israel • Egypt • Jordan
Prevalence Globally • EMR • Syria: 45% report ever use • Lebanon: 30% report weekly use • Europe • Germany • Sweden • Other • Brazil • Korea • Canada • Ukraine
What about the US? • 200-300 new waterpipe cafés opened in the U.S. between 1999 and 2004 • Particularly in college towns • Convenience sample surveys suggest high current use (past 30 days) • 411 first-year college students: 15.3% • 744 introductory psychology students: 20%
Holes in Literature • Random sample • Associations between waterpipe smoking and • Demographics • Beliefs (e.g., harm, addiction, popularity) • Populations outside college
Purpose • Determine the 30-day, annual, and lifetime prevalence of waterpipe smoking in a random sample of college students • Associations between smoking and predictors?
Design • Cross-sectional survey • Random sample of students at the University of Pittsburgh • Collect data via web-based version of the American College Health Association’s (ACHA) National College Health Assessment (NCHA) • Added items related to waterpipe use
Approvals • University of Pittsburgh Institutional Review Board • University Vice Provost
Procedure • April 2007 during a three-week period • Avoided the 30-day period following Spring Break • Email invitation sent to 3600 randomly selected Pitt students • Incentive: lottery to win cash prizes ranging from $25 to $100 • Three reminder e-mails sent to students during the three-week period
Demographic Measures • Age • Gender • Race • Residence (on-vs. off-campus) • Undergraduate vs. graduate • Membership in a fraternity or sorority • Self-reported academic achievement