Saba Kassim , Ali Al- Bakri , Mustafa al’Absi , Ray Croucher

1. Saba Kassim, Ali Al-Bakri, Mustafa al’Absi, Ray Croucher

2. Introduction • Smoke passes through water before inhalation (1) • Getting popular in Europe especially among young people (2) • Few studies which lack validation and standardization (3) • Has common and unique dependency aspects, and can not be measured in traditional cigarette dependency tools (4)

3. How to measure waterpipe tobacco smoking dependency (WPTS)? • New validated tool: Lebanon Waterpipe Dependence Scale (LWDS-11) (5) • 4 domains covered: • Physiological dependency - Psychological craving • Positive reinforcement, - Negative reinforcement • 11 questions: each question (0-3),score (0-33) • Arabic and English sets • less likely (≤ 9 scores) and more likely (≥10 scores) WPTS dependent

4. Research Aims • To evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11) • To assess, estimate and identify factors associated with WPTS dependence syndrome amongst UK male adult resident waterpipe smokers

5. Methodology • Cross sectional survey • 8 shisha premises participated • Random time table,180 participants in 4 weeks. • Questionnaire in face to face interview • QMUL Research Ethics Committee approved the study

6. Questionnaire

7. Sample Background

8. What is the level of WPTS in the sample

9. Factors associated with WPTS dependency *p<0.05

10. LWDS-11 Evaluation • Two questions did not discriminate validity • Adequate reliability (Cronbach’salpha coefficient α=0.74) • Physiological dependency (33.62 variance, α =0.8) • Positive and negative reinforcement (14.80 variance, α =0.5) • LWDS-11 discrimates between mild, moderate and heavy WPTS based on number of tobacco waterpipe smoked per a week

11. LWDS-11 Evaluation • Two questions did not discriminate validity • Adequate reliability (Cronbach’salpha coefficient α=0.74) • Physiological dependency (33.62 variance, α =0.8) • Positive and negative reinforcement (14.80 variance, α =0.5) • LWDS-11 discrimates between mild, moderate and heavy WPTS based on number of tobacco waterpipe smoked per a week

12. Conclusion Just below half of sample were more likely WPTS dependents Adequate reliability of LWDS-11 especially in physiological dependency in addition to positive and negative reinforcement. Validity and cross cultural usage of LWDS-11 should be further investigated in future research WPTS dependency were associated with being Arab, smoking WPTS daily in the past, and increasing duration of last WPTS session

13. References 1- KNISHKOWY, B. & AMITAI, Y. 2005. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116, e113-9. 2- MAZIAK, W. 2011. The global epidemic of waterpipe smoking. Addict Behav, 36, 1-5 3- AklEA, Aleem S, Gunukula SK, Honeine R, AbouJaoudeP, Irani J. Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review. BMC Public Health. 2010;10:415 4- MAZIAK, W., WARD, K. D. & EISSENBERG, T. 2004e. Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users. Drug Alcohol Depend, 76, 101-6. 5-SALAMEH, P., WAKED, M. & AOUN, Z. 2008. Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11). Nicotine Tob Res, 10, 149-58.

14. Thanks for the authors of the study for their support Special thanks for the Tobacco cessation for funding my participation Thank you for the UKNSCC panel for giving me the opportunity to present the study The contribution of the owners of the shisha premises in the study is appreciated Acknowledgments

15. Thank you for listening