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Introduction: The World Health Organization (WHO) has declared hookah smoking to be a significant public health problem. According to Martinasek et al. the increase in the number of hookah smokers is due to lack of education and public awareness, there is a general impression that hookah is a safe alternative to cigarettes. (Martinasek et al., 2011). On the other hand, hookah is affordable and has appealing flavor. The US Food and Drug Administration does not regulate hookah and there is a lack of regulation in packet labeling (Martinasek et al., 2011). Hookah smoking and cigarette smoking produces the exact same toxic chemicals and carcinogens (Martinasek et al., 2011). The US Environmental Protection Agency claims that hookah smoking releases secondhand smoke which contains cancer causing agents (Martinasek et al., 2011). Overall, hookah smoking is increasing rapidly among youth due to social acceptance, low cost, appealing flavors, lack of regulatory policies and incorrect harm perception. Therefore, I propose a study that will aim to answer the following research questions: 1) What are the socio-demographic characteristics of middle school and high school students who have awareness of hookah? 2) What are the characteristics of middle school and high school students who report hookah is less harmful than cigarettes? 3) Does awareness of hookah, harm perception of hookah, ever user and current user of hookah differ by living with hookah users? 4) How does harm perception of hookah correlate with use of hookah among US youth? I hypothesize that American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful. Methods: The secondary data analysis was conducted using the data from the 2013 National Youth Tobacco Survey (NYTS). The study population was middle and high school students. The independent variables of interest were students who were current users of hookah, had ever used hookah, as well as those aware of hookah smoking. The dependent variable was harm perception of hookah smoking. A weighting factor was adjusted in the survey to get a weighted proportion of students in each grade to match with the national population. The prevalence of current and ever users of hookah, as well as those aware of hookah among middle school and high school students, was examined. The frequency of high school and middle school students who are living with hookah users, and those who were not evaluated. The association of harm perception of hookah among current and ever users, as well as those aware of hookah smoking adjusted by those who are living with hookah users was assessed. Data was analyzed in SAS 9.3 to examine the association between the independent and dependent variables. Frequency, logistic regression and a chi-square tests were used to find the odds ratio and p-value between the dependent and independent variables. Results: Association of harm perception of hookah among current users of hookah, ever users, as well as those aware of hookah smoking, reported that 55.64% of current users of hookah (Adjusted OR = 4.99, CI: 3.78-6.59), 43.80% of ever users of hookah (Adjusted OR = 4.96, CI: 4.02-6.13) and 21.50% of those who were aware of hookah smoking (Adjusted OR = 3.20, CI: 2.82-3.91) believed that hookah smoking is less harmful than cigarette smoking in both middle and high school. Participants who were current users of cigar smoking i.e.26.57% (crude OR = 2.80 CI: 2.45-3.20), Adjusted OR = 1.18, CI: 0.96-1.45)) as well as ever users of cigar smoking i.e. 24.76% (crude OR= 3.18, CI: 2.78-3.65), adjusted OR = 2.24, CI: 1.85-2.71)) believe hookah smoking is less harmful than cigarette smoking compared to individuals who were not current as well as ever users of cigar smoking. There was no significant difference between odds of male and female in believing that hookah smoking is less harmful than cigarette smoking. Discussion: Overall these results suggest that students who were associated with hookah usage believe that hookah smoking is less harmful than cigarette smoking. Moreover, students who were ever users of cigar smoking had 2.24 odds of believing that hookah smoking is less harmful than cigarette smoking compared to individuals who were not ever users of cigar smoking. Conclusion: Therefore, American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful

Magister Artium - MA / Hookah pipe use is widely viewed as a safe alternative to cigarette smoking rather than a potential health-risk. In fact, for young people hookah pipe use may represent an initial stage of later addiction and the transition to cigarette smoking. Furthermore, studies conducted abroad, suggest that the use of the hookah pipe firstly started as a cultural phenomenon, and secondly, as with cigarette smoking, the hookah pipe has become a social phenomenon. Despite these challenges, studies provide sufficient evidence that hookah pipe use is a potential health risk. The primary aim of the study was to compare male and female university students’ knowledge, risk perceptions and behaviours concerning hookah pipe smoking. A quantitative methodological approach, with a cross-sectional design, was used to conduct the research study. A final self-selected sample of 389 participants voluntarily participated in this study. The final sample included 64% females and 36% males with a mean age of 22.2 years; with the mean age for first-time hookah pipe smoking was 15.7 years. The instrument used was a self-administered questionnaire constructed from The College Health Behavior Survey (2010-2011) which was developed at the University of Missouri-Columbia. Descriptive quantitative results were conducted using Statistical Package for Social Sciences (SPSS version 20) and presented. The results suggest 70% of hookah pipe users daily smoke the hookah pipe with more than 20% smoking on campus. This was similar for males and females. Users perceived the hookah pipe to be less harmful and less addictive than cigarette smoking. Furthermore, smoking the hookah pipe is considered socially acceptable and is also smoked in the family home. Implications for policy are stated.

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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.

M.A. / Literature indicates that childhood ADHD has received considerable attention and recognition in today’s society and is effectively represented in the DSM. In comparison, there is still much controversy surrounding ADHD in adults (aADHD), despite the fact that almost 50 to 70% of people diagnosed with childhood ADHD continue to manifest symptoms in adulthood. Research indicates that aADHD manifests differently to childhood ADHD, in that the core symptom is inattention and not hyperactivity. Research also indicates that there is a high comorbidity between aADHD and substance dependence, including nicotine dependence. It is hypothesized that these individuals present with hypodopamine, and nicotine acts on a number of neurotransmitter pathways, including the dopaminergic and acetylcholinergic pathways, effectively stimulating the release of dopamine. Whilst there is considerable literature on nicotine and ADHD, there is a complete lack of literature on the relationship between aADHD and Hookah Pipe smoking. This study aimed to rectify this situation. The present study was conducted with two major purposes in mind: (1) to investigate the relationship between Hookah Pipe smoking and its effects on attention and concentration in young adults with Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology, and (2) to demonstrate whether Hookah has a greater effect than cigarettes (as Hookah reportedly has higher concentrations of nicotine than cigarettes). A total sample of 39 participants (14 males, 35 females) aged 18 to 26 years was recruited and divided into the following six groups using the ASRS, the Burke-Austin Self-Report ADHD Questionnaire and a substance abuse questionnaire as screening tools: ADHD (Hookah), ADHD (Nicotine), ADHD (Non-Smoking), Non-ADHD (Hookah), Non-ADHD (Nicotine) and Non-ADHD (Non-Smoking). Furthermore, a quasi-experimental research design was used, whereby the Cambridge Neuropsychological Test Automated Battery (CANTAB) ADHD Battery was administered across three test conditions, with a seven minute intervention between the pre- and post-intervention, and a 90 minute waiting period between the immediate and intermediate post-intervention, so as to test the effects of the nicotine as it neared its elimination half-life of two hours.

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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.

Waterpipe tobacco smoking has migrated from being a custom of some cultures to becoming a staple around college campuses. The social nature and flavored tobacco encourage initiation in this tobacco naïve age group. The study was a sequential mixed method design, employing primary data collection and analysis of a random sample of university students who live on campus at a single university. The study involved observations (N=6), intercept interviews with smokers and nonsmokers (N=63), three focus groups (N=31), and an online survey (N=288). Findings were centered on the constructs of the Theory of Reasoned Action by Ajzen and Fishbein (1975), who propose there are specific precursors that lead to intention to perform a behavior. The data suggested that attitudes were more positively correlated with intention to smoke waterpipe tobacco than subjective norm. Attitude is influenced by outcome expectancies. The data suggest that positive outcome expectancies are influenced primarily by the social nature of hookah smoking and other perceived positive benefits. Negative health effects and family/culture were also influential, albeit to a lesser extent. Development of interventions focused on an attitudinal shift may help to decrease uptake and continuation of waterpipe tobacco smoking in this population.