La Chicha qui sert à fumer du tabac parfumé est utilisé par des millions de personnes. Il y a peu de données sur les effets du chicha sur la santé, peu de régulation et les utilisateurs pensent que la chicha n’est ni addictif ni nocif. Nous avons émis l’hypothèse que la consommation même occasionnelle de la chicha chez le sujet jeune a des conséquences sur la biologie pulmonaire. Nous avons ainsi comparé 21 sujets jeunes fumeur occasionnel de Chicha à un groupe de 19 non fumeur apparié pour le sexe et l’ethnicité. Les premières anomalies chez le fumeur de cigarette étant présent au niveau des cellules pulmonaires nous avons évalué plusieurs paramètres : (1) taux plasmatique de carboxyhemoglobine (CO), (2) Score de toux et d’expectoration; (3) fonction pulmonaire; (4) Métabolites présent dans les fluides des voies respiratoires basses (ELF); (5différences cellulaires et de transcriptome des petites voies aériennes (6) composition cellulaire des lavages broncho-alvéolaires (7) le transcriptome et (9) niveau des microparticules endothéliales circulantes. Le groupe d’étude montrait des anomalies dans tous les paramètres étudiés. Comparé au groupe contrôle les fumeurs avaient plus de toux et d’expectoration, un niveau de CO plus élevé, une diminution de la capacité de diffusion du CO , des anomalies du profil métabolique des fluides alvéolaires, une augmentation des cellules sécrétoires et intermédiaires et une diminution des cellules ciliées et basales, des anomalies du transcriptome des cellules pulmonaires et de macrophages alvéolaires et une augmentation des microparticules endothéliales.LA capacité de diffusion du monoxyde de carbone qui est un paramètre lié à l’emphysème et aux pathologies des petites voies pulmonaires était affectée par l’utilisation de la chicha. Nos précédentes études avaient montré que chez les sujets fumeurs de cigarette la réduction de la capacité de diffusion malgré une spirométrie normale était associée à un risque de développer un BPCO. Nous avons ainsi évalué le risque de développer une BPCO chez le sujet fumeur avec spirométrie normale par des scanners haute résolution comparant des groupes avec capacité de diffusion diminuée (46) et normale (59). La réduction de la capacité de diffusion était associée à un risque élevé de développer une BPCO dans les 4 ans.Par ailleurs les niveaux plasmatiques des microparticules endothéliales totales et apoptotiques était élevé dans le groupe d’étude. Dans une étude chez les sujets fumeurs de cigarette, nous avons comparé des non fumeurs (28) à des fumeurs sains (61) et des fumeurs BPCO (49) sur un an. Nous avons montré que le niveau de microparticules endothéliales apoptotiques étaient élevé en continu chez les sujets fumeurs sains et avec BPCO. Un sous groupe des fumeurs sains (17) et BPCO (18) a accepté d’arrêter de fumer. 12 mois après l’arrêt de la cigarette le niveau des microparticules endothéliales totale et apoptotique était retourné à la normale pour les fumeurs sains mais restait élevé chez les fumeurs BPCO. Ainsi le niveau élevé de ces microparticules indiquait des lésions persistantes et irréversibles des capillaires pulmonaires et pourrait servir à évaluer les fumeurs de chicha au long cours.Au total, l’utilisation occasionnelle de chicha chez le sujet jeune a des conséquence clinique et biologique pulmonaire en relation avec une diminution de la capacité de diffusion. Certaines anomalies mises en évidence dans notre étude (diminution de la capacité de diffusion, Microparticules endothéliales) pourraient prédire la survenue de maladies pulmonaires chroniques obstructives. / Waterpipe, an instrument for smoking fruit-flavored tobacco, is used by millions of people worldwide. There is limited data on the health effects of waterpipe smoking, and no regulations to its use. We hypothesized that even young, light-use waterpipe smokers have abnormalities relevant to lung health. Based on the knowledge that the first abnormalities associated with cigarette smoking are in lung cells long before there are clinical abnormalities, we compared young, light-use waterpipe smokers to nonsmokers, using a variety of lung-related parameters, including: blood carboxyhemoglobin (CO) levels; cough and sputum scores; lung function; metabolites present in lower respiratory tract epithelial lining fluid (ELF); cell differentials and transcriptome of small airway epithelium (SAE); cellular composition of ELF; transcriptome of alveolar macrophages (AM); and levels of total and apoptotic endothelial microparticles (EMPs). Light-use waterpipe smokers displayed abnormalities in all parameters assessed. Compared to nonsmokers, waterpipe smokers had more cough and sputum, higher CO levels, reduced diffusing capacity for carbon monoxide (DLCO), abnormal ELF metabolome profile, increased proportions of SAE secretory and intermediate cells, reduced proportions of SAE ciliated and basal cells, markedly abnormal SAE and AM transcriptomes, and elevated levels of total and apoptotic EMPs.DLCO, a lung function parameter linked to emphysema and small airway disease, was affected by light-use waterpipe smoking. The relevance of this comes from our studies that demonstrated, in a separate cohort of cigarette smokers with normal spirometry, that reduced DLCO predicted a high risk for developing chronic obstructive pulmonary disease (COPD), a leading cause of death worldwide. We assessed the risk for developing COPD, a clinical disorder characterized by a mixture of small airway disease and parenchymal destruction (emphysema), with a serial lung function in cigarette smokers with normal spirometry and no emphysema as assessed by HRCT, by comparing smokers with reduced DLCO vs normal DLCO. Despite having normal spirometry, cigarette smokers with reduced DLCO were at significantly higher risk for developing COPD within <4 years compared to those with normal DLCO i.e., the DLCO can be used to identify smokers at high risk for developing COPD, and could be a unique parameter in future studies to assess waterpipe smokers over time.Plasma levels of total and apoptotic EMPs, indicative of pulmonary capillary endothelial apoptosis, were elevated in light-use waterpipe smokers. The possible importance of this observation was highlighted by a parallel study, where we assessed the stability and reversibility of EMP levels in nonsmokers, healthy cigarette smokers and COPD cigarette smokers at 4 time points over a period of 1 year. The levels of total and apoptotic EMPs remained high with continuous smoking in healthy and COPD cigarette smokers. A subset of the healthy cigarette smokers and COPD cigarette smokers agreed to quit smoking. Following smoking cessation for 1 year, total and apoptotic EMP levels returned to normal nonsmoker levels in healthy cigarette smokers but remained abnormally high in COPD cigarette smokers. High levels of circulating and apoptotic EMPs are indicative of persistent and irreversible destruction of pulmonary capillaries and may be another unique parameter to assess waterpipe smokers over time.In summary, young, light-use waterpipe smokers have a number of lung clinical and biologic abnormalities compared to nonsmokers, including reduced DLCO, found to predict high risk for developing COPD in cigarette smokers, and elevated plasma levels of total and apoptotic EMPs, a marker of alveolar destruction, shown to be persistent and irreversible in COPD cigarette smokers despite smoking cessation. Together, these studies suggest that even light-use waterpipe smokers may be at risk for developing lung disease.

Caffeine and nicotine are the two most commonly consumed licit psychoactive drugs in the world. In addition, they are frequently co-administered with over 86% of cigarette smokers reporting caffeine use versus 77% of non-smokers. Research suggests the combination of nicotine and caffeine produces effects that are more rewarding or pleasurable than either drug alone, and this potential reward enhancement may influence patterns of tobacco use initiation and maintenance. Waterpipe tobacco smoking is an alternative tobacco use method that is increasing in prevalence in the U.S. and offers a novel opportunity for nicotine and caffeine co-administration via a caffeinated tobacco product (Tangiers F-Line). Based on previous work, this caffeinated tobacco product was hypothesized to enhance reward-related and cardiovascular effects in waterpipe users relative to tobacco-only waterpipe preparations. Thirty-two waterpipe tobacco smokers who regularly drank caffeinated beverages participated in a four condition, Latin-square ordered, within-subjects study. In each condition, there was a 45-minute double-blind product administration period that differed by the content of waterpipe product smoked: caffeine and nicotine (Tangiers F-Line), nicotine and no caffeine (Tangiers), reduced (low) nicotine and caffeine (low nicotine Tangiers F-Line), or neither nicotine nor caffeine (Soex). Outcome measures included blood plasma caffeine and nicotine, cardiovascular response, expired air carbon monoxide (CO), puff topography, and subjective ratings. Plasma analyses revealed no detectable levels of caffeine from either caffeinated product, but significant nicotine exposure from all nicotine-containing products. Few differences between conditions were observed for subjective measures. Larger puff volumes were observed for products that contained low or no nicotine, resulting in higher CO concentrations for these conditions. While findings do not address whether caffeine can be delivered via volatilization, they suggest that measurable caffeine exposure was not observed for the products examined and under the conditions explored here. Importantly, study results support continued investigation of the effects of waterpipe tobacco smoking using a placebo-controlled design as well as demonstrate that tobacco dependence and toxicity capabilities are still concerns for these and other waterpipe products.

Magister Artium - MA / Hookah-pipe smoking escalated from being a cultural phenomenon to being a social phenomenon. Studies suggest that the hookah-pipe is a high-risk phenomenon which has become a highly acceptable social practice influenced by social factors such as smoking initiations among peers. What is unknown is whether peer pressure and social acceptance have an influence on the use of the hookah-pipe. The aim of this study is therefore to compare the relationship between peer pressure and social acceptance among adolescent hookah-pipe users and non-users. The objectives of the study are to determine the prevalence of peer pressure, social acceptability and smoking tobacco using the hookah-pipe among adolescents; establish the relationship between peer pressure and social acceptability of adolescent hookah-pipe users and non-users and to compare the relationship between peer pressure and social acceptability among adolescent hookah-pipe users and non-users. A cross-sectional comparative correlation study was conducted with a sample of Grade 9 adolescents attending secondary schools in the Metro East Education District in Cape Town. Structured questionnaires constructed from the NationalASH 10 Year Snapshot Survey, the 10-year in-depth survey, the health and lifestyle survey and peer pressure, as well as an NICHD Study of Early Child Care and Youth Development questionnaire were completed by the participants. The Statistical Package for the Social Science (SPSS) software was used to analyse the data. The results show that no relationship was found between peer pressure and social acceptance, but a relationship was found between parental rules and monitoring around tobacco use for hookah-pipe users. A significant difference was also found in the attitudes towards hookah use between users and non-users. The ethics for this study included voluntary participation, informed consent and anonymity.

The prevalence of waterpipe smoking exceeds that of cigarettes among adolescents in the Middle East where waterpipe is believed as less harmful, less addictive and can be a safer alternative to cigarettes. This dissertation tested the gateway hypothesis that waterpipe can provide a bridge to initiate cigarette smoking, identified the predictors of cigarette smoking progression, and identified predictors of waterpipe smoking progression among a school-based sample of Jordanian adolescents (mean age ± SD) (12.7 ±0.61) years at baseline. Data for this research have been drawn from Irbid Longitudinal Study of smoking behavior, Jordan (2008-2011). The grouped-time survival analysis showed that waterpipe smoking was associated with a higher risk of cigarette smoking initiation compared to never smokers (P < 0.001) and this association was dose dependent (P < 0.001). Predictors of cigarette smoking progression were peer smoking and attending public schools for boys, siblings’ smoking for girls, and the urge to smoke for both genders. Predictors of waterpipe smoking progression were enrollment in public schools, frequent physical activity, and low refusal self-efficacy for boys, ever smoking cigarettes, friends’ and siblings’ waterpipe smoking for girls. Awareness of harms of waterpipe among boys and seeing warning labels on the tobacco packs by girls were protective against waterpipe smoking progression. In Conclusion, waterpipe can serve as a gateway to cigarette smoking initiation among adolescents. Waterpipe and cigarette smoking progressions among initiators were solely family-related among girls, and mainly peer-related among boys. The unique gender differences for both cigarette and waterpipe smoking among Jordanian adolescents in Irbid call for cultural and gender-specific smoking prevention interventions to prevent the progression of smoking among initiators.

No description available.

ABSTRACT Background: Waterpipe (hookah) smoking is gaining in popularity as a form of smoking tobacco. There is a noticeable increase in hookah smoking worldwide, among young adults. There is a growing body of literature that indicates that college students may not be as knowledgeable as should be in making decisions about smoking waterpipes. Purpose: This study was performed to evaluate the prevalence, knowledge, attitudes and beliefs regarding hookah (waterpipe) use among college-based health care students. Methods: Participants in this study were chosen based on their readiness and willingness to participate. The questionnaire was distributed by the researcher to graduate students through a link for a web-based survey. A paper copy was distributed in class to undergraduate students only. There were 319 college-based health care students who participated in this study from the following specialties: nursing, physical therapy, respiratory therapy, occupational therapy and nutrition. Data were analyzed using descriptive statistics. Results: Respondents have used or tried hookah (waterpipe) smoking before (n=156, 49%), while the majority of students who have not tried or used the hookah smoking (n=163, 51%). Students were able to identify health hazards that might result from hookah smoking, for example cancer (n=258, 80.9%), respiratory problems (n=308, 97%), cardiovascular impairments (n=202, 63%), hematological impairments (n= 98, 31%), harm during pregnancy (n=214, 67%), and diarrhea (n=37, 11.6%) as potential health hazard. This study showed that 187 students (58.6%) believed that cigarette smoking is more harmful than water pipe smoking due to the false beliefs that they have. There was also general disagreement regarding students’ attitudes and opinions about waterpipe smoking. Finally, this study showed the reasons why students engage in hookah smoking; for example, (241, 75.5%)of the students reported that the reason for water pipe smoking is an increased opportunity to smoke a water pipe in cafes, etc. Also, students said other reasons like flavor/aroma of Hookah itself (219, 68.7%), and utility of water pipe in leisure & pleasure activities (217, 68%). Conclusion: This study showed that the prevalence of hookah (waterpipe) smoking is common among students in health care especially in young adults. Further studies are needed to ask more students and at different institutions. Finally, we recommended conducting educational campaigns to increase students’ knowledge and awareness and to correct the wrongs beliefs and attitudes.

Medan cigarettrökning och bruk av rökfri tobak under flera decennier har varit föremål för studier som visat att tobak är skadligt för hälsan, är vattenpiperökning är ännu ett outforskat område. Det har sedan 1990-talet blivit allt mer populärt att röka vattenpipa men kunskaper om dess utbredning, skadlighet och vilka risker som finns förknippade med användning är ännu bristande. Den forskning som finns tyder på liknande hälsoeffekter som vid cigarettrökning vilket skapar oro för att vattenpiperökning kan vara ett hot mot folkhälsan. Syftet med denna studie var att kartlägga förekomst, vanor, köns- och åldersskillnader gällande vattenpiperökning bland studenter på lärarprogrammet, samt redogöra för deras uppfattningar kring riskerna med vattenpiperökning. En enkät med 14 frågor delades ut till totalt 90 studenter vid lärarprogrammet på ett svenskt universitet. Av dessa svarade 52 att de provat att röka vattenpipa och 38 att de inte provat. Undersökningen visade även att vattenpipa inte röks ofta och inte heller på regelbunden basis. Endast lärarstudenter ingick i urvalet och inga slutsatser kan dras om andra studentgrupper. För att utöka kunskaperna om vattenpiperökning bland studenter behövs mer forskning och framtida i studier bör mer varierade studentgrupper studeras. / While the harm caused by cigarettes and smokeless tobacco has been confirmed in many studies during the past decades, waterpipe use is still a field that needs more research. Since the 1990’s waterpipe smoking has increased and more knowledge is needed to examine how widespread the use is and to examine health risks that can be associated with waterpipe smoking. Research suggests that the health effects might be similar to cigarette smoking, which leads to concern that waterpipe smoking may be a public health issue. The purpose of this study was to account for prevalence, habits, gender and age differences in waterpipe smoking among students in the teacher program and account for their perceptions about risks with smoking waterpipe. A questionnaire consisting of 14 questions was collected from 90 students at a Swedish university. Of these students 52 had tried smoking waterpipe at least once and 38 had not tried. Waterpipe was not smoked often or on a regular basis. One factor that might have affected the results was primarily the sample, since only students in the teacher program were included in the population. For further knowledge about water pipe use among Swedish students more research is needed, more studies should be performed and with a wider range of students.

The most commonly attributed causes of failure of smoking cessation are non-adherence to treatment, experiencing severe nicotine withdrawal symptoms and post-cessation weight gain. However, there is a lack of information regarding these factors among smokers who attempt to quit in low-income country settings. The main objective of this study was to identify predictors of: 1) adherence to cessation treatment; 2) severity of withdrawal symptoms: and 3) post-cessation changes in body mass index among 269 smokers who attempted to quit in a randomized smoking cessation trial in a low-income country setting (Aleppo, Syria). All participants received behavioral counseling and were randomized to receive either 6 weeks of nicotine or placebo patch and were followed for one year. Findings from logistic regression showed that lower adherence to cessation treatment was associated with higher daily smoking, greater withdrawal symptoms, waterpipe use, being on placebo patch and the perception of receiving placebo patch. Generalized estimating equation (GEE) analyses indicated that throughout the study, lower total withdrawal score was associated with greater education, older age of smoking initiation, higher confidence in ability to quit, higher adherence to patch, lower nicotine dependence, lower reported depression, waterpipe use and the perception of receiving nicotine patches rather than placebo. Further, smoking abstainers gained 1.8 BMI units (approximately 4.8kg) greater than non-abstainers over one year post quitting. In addition, greater BMI was associated with being female, smoking to control weight and having previously failed to quit due to weight gain. In conclusion, nicotine dependence, waterpipe use and expectancies regarding cessation treatment are important factors that influence adherence to cessation treatment and severity of nicotine withdrawal symptoms. Moreover, targeted interventions that take into consideration the prevailing local and cultural influences on diet and levels of physical activity are recommended especially for females and smokers with weight concerns prior to quitting. Collectively, these findings will help in conducting future tailored effective cessation programs in Syria and other low-income countries with similar levels of developments and tobacco use patterns.

Les phénotypes de l’asthme sont affectés par l’exposition à de multiples facteurs durant la grossesse. Pour évaluer cette hypothèse, deux études ont été menées : l’une en France, l’autre au Liban. Dans l'étude française, l'objectif était de décrire les phénotypes respiratoires de sifflement chez l’enfant entre l’âge de deux mois et d’un an, et d'évaluer les facteurs de risque associés à ces phénotypes de sifflement dans une grande cohorte de naissance. Dans l'étude libanaise, les objectifs étaient d'évaluer les associations entre l'utilisation de médicaments, d'alcool, de cigarettes et/ou de narguileh, et l'exposition aux pesticides/détergents pendant la grossesse avec l'asthme infantile au Liban et de valider la version arabe du test de contrôle de l'asthme (ACT) chez ces enfants et d’identifier les facteurs de risque qui pourraient affecter le contrôle de l'asthme.Méthodes: Nous avons étudié 18 041 nourrissons de la cohorte de naissance ELFE (Étude Longitudinale Française depuis l'Enfance). Les parents ont signalé une respiration sifflante et des symptômes respiratoires à deux et 12 mois, et ont répondu à un questionnaire complet (exposition pendant la grossesse, allergie parentale). Le plan d'étude du projet libanais consistait en une étude cas-témoins, menée entre Décembre 2015 et Avril 2016, recrutant 1503 enfants, âgés de 3 à 17 ans. Le questionnaire administré évaluait les caractéristiques sociodémographiques (âge, sexe, niveau d'éducation des deux parents), les antécédents familiaux d'asthme et d'autres facteurs de risque connus de l'asthme (système de chauffage à domicile, antécédents d'otites récidivantes, humidité dans la maison, enfant allant à une garderie, fumer et boire de l'alcool pendant la grossesse, exposition aux pesticides et aux détergents).Résultats: Les enfants sans symptômes (témoins) représentaient 77,2%, 2,1% avaient une respiration sifflante à deux mois mais pas de respiration sifflante à un an (sifflement intermittent), 2,4% avaient une respiration sifflante persistante et 18,3% avaient une respiration sifflante à un an. En comparant les sifflements persistants aux contrôles, on a observé qu’avoir un frère ou une sœur (ORa = 2,19) ou deux frères et sœurs (ORa = 2,23) contre aucun, une toux nocturne (OR = 5,2), une détresse respiratoire (OR = 4,1) et un excès de sécrétions bronchiques (OR = 3,47 ) à deux mois, un reflux chez l'enfant à 2 mois (OR = 1,55), des antécédents d'asthme maternel (OR = 1,46) et le tabagisme maternel pendant la grossesse (OR = 1,57) étaient significativement associés à une respiration sifflante persistante. Ces mêmes facteurs, avec en sus une éruption cutanée chez l'enfant à 2 mois (OR = 1,13) et des antécédents paternels d'asthme (OR = 1,32) étaient significativement associés à une augmentation de la probabilité d'une respiration sifflante. Avoir un frère (ORa = 1,9) en comparaison à ne pas en avoir, une toux nocturne à 2 mois (OR = 1,76) et un excès de sécrétions bronchiques à 2 mois (OR = 1,65) étaient significativement associés à une respiration sifflante persistante par rapport à une respiration sifflante intermittente.... / Asthma in childhood seems affected by exposure to various factors in early life. To assess this hypothesis, we conducted 2 studies: one in France, and the other in Lebanon. In the French study, we aimed at describing wheezing phenotypes between the ages of two months and one year, and assess risk factors associated with these wheezing phenotypes in a large birth cohort. In the Lebanese study, the aims were to evaluate the associations between caregiver-reported use of medications, alcohol, cigarette and/or waterpipe (WP), and exposure to pesticides/detergents during pregnancy with childhood-onset asthma in Lebanon and to validate the Arabic version of the Asthma Control Test (ACT) among these children and identify risk factors that might affect asthma control.Methods: We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy).The study design of the Lebanese project consisted of a case-control study, conducted between December 2015 and April 2016, recruited 1503 children, aged between 3-16 years old. A questionnaire assessed the sociodemographic characteristics (age, gender, education level of both parents), the family history of asthma, and other known risk factors of asthma (heating system at home, child history of recurrent otitis, humidity in the house, child went to a daycare, smoking and drinking alcohol during pregnancy, exposure to pesticides and detergents).Results: Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent wheezing), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa=2.19) or 2 siblings (ORa=2.23) compared to none, nocturnal cough (OR=5.2), respiratory distress (OR=4.1) and excess bronchial secretions (OR=3.47) at two months, reflux in the child at 2 months (OR=1.55), maternal history of asthma (OR=1.46) and maternal smoking during pregnancy (OR=1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR=1.13) and paternal history of asthma (OR=1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa=1.9) compared to none, nocturnal cough at 2 months (OR=1.76) and excess bronchial secretions at 2 months (OR=1.65) were significantly associated with persistent compared to intermittent wheezing.In the Lebanese study, the multivariate analysis showed that children living in North and South Lebanon and the children living in areas where pesticides are frequently used had an increased risk of asthma (ORa=1.625; ORa=13.65; ORa=3.307) respectively. Smoking WP during pregnancy and cigarette during lactation would increase the risk of asthma in children (ORa=6.11; ORa=3.44 respectively). A high Cronbach’s alpha was found for the full scale (0.959). As for the asthma control scale (ACT), the correlation factors between each item of the ACT scale and the whole scale ranged between 0.710 and 0.775 (p<0.001 for all items). Mother’s low educational level as well as the history of asthma in the mother and the father would significantly increase the risk of uncontrolled asthma (Beta= 1.862; Beta= 3.534; and Beta= 1.885 respectively). Cigarette smoking during breastfeeding and waterpipe smoking by the mother during pregnancy were both significantly associated with uncontrolled asthma (Beta= 2.105; Beta=2.325 respectively). Mother’s high educational level was significantly associated with more asthma control (Beta= -0.715).

Background. This dissertation focuses on two major epidemics, Waterpipe (WP) and Cigarette tobacco smoking, as two considerable global public health issues. It consists of three papers that were published in international peer review journals. We aimed at evaluating the acute and chronic effects of WP and cigarette smoking on the cardiovascular and respiratory systems, as well as evaluating the patient's acceptability of shocking pictorial versus actual textual warnings on tobacco packages as an effective control intervention towards smoking cessation".Methods. In the first part of the study, patients were recruited from restaurants in Beirut and Mount Lebanon in order to evaluate the acute (after 45 minutes of waterpipe smoking or immediately following one cigarette smoking) and chronic (before the smoking session) effects on the Forced Expiratory Volume at 1 second (FEV1), Forced Expiratory Volume at 6 seconds (FEV6), FEV1/FEV6, Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and heart rate (HR). The second part of the study recruited patients from 5 outpatient clinics located in 5 hospitals in Lebanon. The purpose was to evaluate the acceptability of shocking pictorial health warnings versus the actual textual warnings on packages as an effective tobacco control intervention by evaluating their impact on smoking behaviors and motivation.Results. Mean values of FEV1, FEV6, FEV1/FEV6, DBP, SBP in the acute effect of smoking WP and cigarette smokers were very close. There was a trend to significant acute variation between the three groups for DBP (p=0.05) and a significant variation for HR (p˂0.001): DBP increased in WP smokers while it decreased in cigarette smokers. However, the HR increased in both WP and cigarette smokers after the smoking session, but much more with WP. The pulmonary functions (FEV1, FEV6 and FEV1/FEV6) and the cardiovascular values (DBP, SBP and HR) were significantly associated with the following factors: duration of smoking, age at first WP and quantity of smoking. Among the 127 WP smokers, a higher effect of the shocking pictorial warnings was observed in the highly motivated group versus the lower motivated group (OR=4.47, p=0.001); indeed, a higher switching in their favorite tobacco brand was observed in the highly motivated group versus the lower group (OR=2.76, p=0.008). In addition, smokers who had chronic cough were highly motivated to quit waterpipe smoking compared to smokers without chronic cough (OR=7.24, p=0.03).Higher motivation to quit cigarette smoking was seen among male smokers versus females (OR=1.8, p=0.02), among smokers who had stopped smoking for at least 1 month during the last year due the textual warning (OR=2.79, P˂0.001), among smokers who considered very important to report health warning on cigarette packs (OR=1.92, p=0.01), among smokers who had chronic expectorations (OR=1.81, P=0.06) and among smokers who would change their favorite cigarette pack if they put shocking images on the pack (OR=1.95, p=0.004).Conclusions. WP smokers seem as affected as cigarette smokers for the pulmonary values and that acute effect of WP immediately measured after the smoking session increases DBP and SBP; however, acute effect of cigarette decreases DBP and SBP, while both cigarette and WP smoking increase HR. The reduction of most Pulmonary Function Test (PFT) values could be due to the long duration of smoking, younger age of smoking the first WP and quantity of smoking. It differs between cigarette and WP, and between chronic and acute effect of smoking. Moreover, pictorial graphic warnings are more influencing on the behavior of waterpipe smokers than textual warning. On the other hand, low dependent and highly motivated to quit cigarette smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit cigarette smoking was affected by sensitivity to warnings, but not to the presence of all chronic respiratory symptoms. Thus, our study provides further reasons to the policymakers in Lebanon to incorporate more tobacco labeling policies in order to help in reducing the widespread of waterpipe and cigarette tobacco smoking and in increasing the awareness concerning the health symptoms effect of smoking. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished