I-Hsuan Wu

Ethnicity and waterpipe smoking among US students

OBJECTIVES To examine the effect of ethnicity on waterpipe smoking among college students. DESIGN A cross-sectional study utilized data from University of Houston students through an online survey (n = 2334) from March to April 2011. The survey included questions on demographic characteristics (sex, age, race/ethnicity), tobacco use experience, risk perception, social acceptability and popularity. Multivariate logistic regression was used to determine predictors of waterpipe use with three outcomes: ever-use vs. no use, past-year use vs. no use and past-month use vs. no use. RESULTS Half of the sample had previously smoked tobacco using a waterpipe, approximately a third in the past year and 12.5% in the past month. Significant predictors included Middle Eastern ethnicity, Middle Eastern friend, past cigarette or cigar use. Perception of harm was associated with less use in the ever-use model, while perceived addictiveness, social acceptability and popularity of waterpipes were predictors in all models. CONCLUSION Our findings underscore the importance of developing culturally appropriate interventions to control waterpipe smoking among Middle Eastern Americans and those of Indian/Pakistani descent to curb further spread in US society, and highlight the importance of developing interventions that target the perceived addictiveness, social acceptability and popularity of waterpipe smoking.

Waterpipe smoking among students in one US university: predictors of an intention to quit.

Abstract Objective: To examine the intention to quit waterpipe smoking among college students. Participants: A total of 276 University of Houston students identified through an online survey administered in February 2011. Participants indicated they had smoked a waterpipe in the month prior to the survey. Methods: Cross-sectional study. Questions included demographics, tobacco use, perceived risk of waterpipe smoking, and social acceptability. Multivariate logistic regression was used to determine predictors of an intention to quit. Results: Most of the sample participants (n = 227; 83%) reported that they had no intention to quit. Students believing that waterpipe smoking was harmful were more likely to have an intention to quit (odd ratio [OR] = 2.38, 95% confidence interval [CI; 1.05, 5.36]). Those who smoked for more than 60 minutes were less likely to have a desire to quit (OR = 0.29, 95% CI [0.12, 0.73]). Conclusions: The low level of a desire to quit demonstrated underscores the urgent need to develop interventions that educate users about expected harms of continued use.

Predictors of Persistent Waterpipe Smoking Among University Students in The United States

Background: Waterpipe smoking is an understudied form of tobacco use with growing popularity among college students and a misconception of relative safety. Our objectives were to identify predictors of persistent waterpipe smoking among college students who have tried using a waterpipe to smoke tobacco in the past. The participants of our study included students from the University of Houston (UH) who previously used a waterpipe to smoke tobacco (N=1,141). Methods: Cross-sectional study through an online survey. Survey questions included demographics (gender, age, race /ethnicity), tobacco use, risk perception, social acceptability, and popularity of waterpipe smoking. Two outcome variables were identified in this study: outcome 1: monthly waterpipe smoking or more vs. less than monthly use, outcome 2: weekly waterpipe smoking or more vs. less frequent use. Descriptive statistics and chi-square analyses were used to determine the frequencies and associations of participant characteristics and multivariate logistic regression models were carried out to determine predictors of persistent waterpipe use. Results: Among those who previously used a waterpipe, approximately one fifth reported smoking a waterpipe on a monthly basis or more, and 5% reported smoking on a weekly basis or more. Significant predictors of persistent waterpipe use included: White Middle-Eastern ethnicity, Indian Asian or Pakistani Asian ethnicity, past 30-day cigar use, ownership of a waterpipe, believing waterpipe smoking was cool, and longer than 30 minutes waterpipe smoking sessions. Those who believed that waterpipe smoking was harmful to ones health and those who thought government should evaluate the safety before selling the waterpipes were less likely to become persistent users. Conclusion: Findings of this study highlight the importance of developing interventions that address the predictors identified. Educational programs that explain the potential harms of waterpipe smoking and modify the cool image associated are needed to prevent the spread of this rapidly emerging health hazard.

Cigarette smoking among Jordanian adults

The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Cigarette Smoking among Taiwanese Adults

Introduction: On January 11, 2009, Taiwan initiated a new anti-smoking law - smoking is not permitted at any public place with more than three people. No studies regarding cigarette smoking have been conducted after the implementation of the new policy. The objective of the study was to examine cigarette smoking among a sample of Taiwanese adults and correlates of its use. Methods: A cross-sectional study was conducted in a convenient sample of willing adults 18 years or older in Taipei, Taiwan, from January 2011 to May 2011. Survey questions included: socio-demographic characteristics, health status and mental health, tobacco use history, attitudes and intentions of tobacco use, and factors associated with tobacco use. Logistic regression models were constructed to determine predictors of ever-use (model 1) and past 30- day use (model 2) of cigarette. Results: A total of 926 participants completed the survey. More than half of the study sample had previously smoked a cigarette (54.4%), and approximately 42% in the past 30 days. Male gender (OR=2.02 in model 1), having lower grades (OR=4.11 in model 1, OR=4.19 in model 2), having seen an anti-smoking advertisement on TV (OR=1.96 in model 2), used betel nuts before (OR=11.27 in model 1, OR=3.78 in model 2), drank alcohol in the last 30 days (OR=1.86 in model 1, OR=3.10 in model 2), having a brother or sister who smokes cigarettes (OR=1.97 in model 1), having more than half of friends who smoke (OR=2.24 in model 2), and having more than one close friend who smokes (OR=4.70 in model 1, OR=5.92 in model 2) were significant predictors of cigarette smoking. Participants older than 25 years (OR=0.61 in model 2) and those who previously heard an anti-smoking message from their teacher (OR=0.54 in model 1, OR=0.44 in model 2) were less likely to smoke. Conclusion: The study demonstrated high rates of cigarette smoking in Taiwan. These findings underscore the magnitude of the smoking problem in the Taiwanese population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Predictors of Intention to Quit Cigarette Smoking among Jordanian Adults

Objective: Having an intention to quit smoking is associated with quitting and is a step toward the required behavioral change. This study examines the predictors of an intention to quit and predictors of previous quitting attempt in a sample of adult Jordanian smokers (n=260). Methods: A cross-sectional study in a convenient sample of willing adults in Amman, Jordan (n=600). The survey included socio-demographic characteristics, history of tobacco smoking, environmental and behavioral determinants of smoking like peer influence, and perceived harm. Individuals who smoked a cigarette during the previous month were considered smokers and included in further analysis (n=260). Three multivariate logistic regression models were constructed to determine predictors of intention to quit in the next year, next 30-days, and predictors of a previous quitting attempt. Results: We found a high level of interest in quitting with the majority of the sample having had a previous quitting attempt (60%), more than half of the population considering quitting in the next year (57%), and 42% considering quitting in the next 30 days. Predictors found to be significant in this study, include heaviness of smoking, media antismoking message exposure, medical education, previous quit attempts, and smoker’s mental health. Conclusion: Findings document a high level of interest in quitting underscoring the urgent need to develop interventions that foster this desire and ensure success. Predictors found to be significant in this study should be considered in designing an effective intervention in this Middle Eastern country.

Comparison of Diabetes Risk Following Smoking Cessation Treatment Using Varenicline Versus Bupropion Among Obese Smokers

Background: Recent literature suggests an initial increased risk of diabetes following smoking cessation. Objectives: To compare the risk of developing diabetes among obese smokers who tried to quit smoking using bupropion versus varenicline. Methods: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006–2011). The cohort consisted of obese adult smokers without a diabetes diagnosis at baseline and newly initiating use of either bupropion or varenicline. This cohort was then followed for 1 year to observe the risk of developing diabetes. The relative risk of bupropion versus varenicline on developing diabetes was assessed using Cox Proportional Hazards regression model after controlling for covariates. Results: The sample comprised of 78,002 obese smokers of which 1,937 (2.36%) developed diabetes during 1 year follow-up. Diabetes incidence rate was relatively comparable who used varenicline and bupropion (23.50 versus 25.80 per 1,000 person-years). Obese smokers who were prescribed bupropion had a statistically significant higher risk of developing diabetes during 1 year following cessation treatment than those who were prescribed varenicline. ([HR]: 1.58, 95% CI: 1.09–2.27) in the multivariate model. Conclusions/Importance: Obese smokers who were prescribed bupropion might have a higher risk of developing diabetes during 1 year follow up compared to those who were prescribed varenicline. The clinical significance of the finding that bupropion had a higher risk of developing diabetes may need further investigation.

Beliefs in various smoking cessation interventions among Jordanian adult smokers

BACKGROUND/OBJECTIVES: To examine smokers’ beliefs in potential effectiveness of available smoking cessation interventions in Jordan. METHODS: A cross-sectional survey-based study in a convenient sample of willing adults in Amman, Jordan (n=600) from 07/2009 to 07/2010. Participants who reported using a cigarette or a waterpipe to smoke tobacco in the past 30 days were considered current smokers and included in further analysis. Cigarette and waterpipe smoking were being analyzed separately with two outcomes for each smoking behavior: 1) believing smoking cessation medications are helpful in quitting vs. not, and 2) believing educational programs/counseling by healthcare providers are helpful vs. not. Multivarite logistic regression was used to determine participant characteristics associated with the defined outcomes. RESULTS: More smokers believed in the effectiveness of educational program as compared to the medications. Cigarette smokers who find it hard to abstain from smoking where they are not allowed to were more likely to believe cessation medications are helpful (OR=1.79, 95%CI= 1.01–3.15). Cigarette smokers with a lower education level (OR=0.33, 95%CI= 0.14–0.78), with a father who smokes (OR=0.39, 95%CI= 0.21–0.75), or who tried cigar smoking in the past month (OR=0.39, 95%CI= 0.18–0.86) were less likely to think educational programs are helpful. Waterpipe smokers who were older were less likely to believe cessation medications (OR=0.41, 95%CI= 0.17–0.99) and educational programs (OR=0.38, 95%CI= 0.18–0.80) are useful. Males (OR=6.07, 95%CI= 1.82–20.26) were more likely to believe cessation medications are helpful. Waterpipe smokers who have used cigar before (OR=0.16, 95%CI= 0.05–0.51) were less likes to perceive the effectiveness of medication. On the other hand, whose father is also a waterpipe smoker (OR=0.39, 95%CI= 0.17–0.89) was less likely to believe in educational programs. CONCLUSIONS: Understanding these opinions from a smoker’s perspective is important in designing culturally appropriate interventions to help smokers quit.