Khalid A. Kheirallah

Impact of environmental stress desiccation, acidity, alkalinity, heat or cold on antibiotic susceptibility of Cronobacter sakazakii.

Cronobacter sakazakii is an emerging foodborne pathogen that has been implicated in severe forms of meningitis, septicemia or necrotizing colitis in pre-term neonates. Although illness outbreaks (primarily associated with powdered infant formula, PIF) caused by this pathogen are rare, the case-fatality rate may reach 50%. Successful treatment of C. sakazakii infection is reliant upon clinical use of antibiotics (AB) such as ampicillin. Recent reports showed increased resistance of C. sakazakii to broad-spectrum antibiotics. The objective of this study was to evaluate the effect of extreme pH (3.5 for 30 min or 11.25 for 5 min), cold (4°C for 24h), heat (55°C for 5 min), and desiccation (cells were dried at 40°C for 2h and held at 21°C for 4 d) stresses on susceptibility of five isolated strains of C. sakazakii to streptomycin, gentamicin, kanamycin, neomycin, tetracycline, doxycycline, tilmicosin, florfenicol, ampicillin, amoxicillin, vancomycin, ciprofloxacin and enrofloxacin. All unstressed strains of C. sakazakii were sensitive to streptomycin, gentamycin, kanamycin, ciprofloxacin, enrofloxacin, ampicillin and amoxicillin, but were moderately resistant or resistant to the rest. Exposing cells to alkaline or acidic stress did not change their sensitivity toward streptomycin, gentamycin, kanamycin or ciprofloxacin, but their resistance toward the other AB was increased. Cells stressed by desiccation showed increased sensitivity toward streptomycin, gentamicin, kanamycin, ciprofloxacin, enrofloxacin, ampicillin and doxycycline, but showed resistance toward the others. Cold-stressed cells were more sensitive to streptomycin, gentamicin, kanamycin, and ciprofloxacin compared with heat-stressed cells, but both heat and cold-stressed cells showed increased resistance toward all the other AB. Results obtained will help in understanding the effect of environmental stresses during processing on C. sakazakii susceptibility to AB.

Waterpipe Smoking among Middle and High School Jordanian Students: Patterns and Predictors

Despite the increase in attention to waterpipe tobacco smoking, the patterns and predictors of this method of tobacco use among Jordanian youth are not well known. The current study was conducted to assess the patterns and the predictors of waterpipe tobacco smoking among school aged students in one of Jordan’s Central Governorates. A cross-sectional survey was conducted to investigate the patterns and predictors of waterpipe tobacco smoking among youth (grades 6, 8, 10 and 12). Using a multistage random sampling more than 1,000 students was selected. Data were collected using the Arabic Youth Tobacco Use Composite Measure (YTUCM). Waterpipe smoking was assessed for “past 12 months”, “past month” and “past week”. Students’ ages ranged from 11 to 18 years, (mean age ± 14.7; SD ± 1.9 years). The percentage of girls who smoked waterpipe was greater for all frequencies of use than it was for boys. Age, gender, and belief that smoking makes more friends were predictors of smoking among study participants. This is the first known study to examine waterpipe smoking among youth aged 11 and 12. Our findings illustrate the need for public health campaigns to reach and educate youth, their families, teachers and school systems regarding the growing recognized health risks of waterpipe smoking.

Tobacco smoking status and perception of health among a sample of Jordanian students.

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.

Agreement Between Exhaled Breath Carbon Monoxide Threshold Levels and Self-Reported Cigarette Smoking in a Sample of Male Adolescents in Jordan

This study aimed to measure the percent agreement between Exhaled Breath Carbon Monoxide (eBCO) measure using a piCO+ smokerlyzer® and self-reported cigarette smoking status and to determine the optimal thresholds for definite identification of cigarette smokers of male school students in Jordan. A descriptive, cross sectional, study of a random sample of male adolescents in grades 7 and 8 from four public high schools in Irbid, completed an adaptation of a standardized Arabic-language tobacco smoking questionnaire and an eBCO measure. Sensitivity and specificity of the eBCO were calculated against self-reported cigarette smoking. Participants (n = 439) had a mean age of 12.5 years (SD = 0.50) and 174 (39.9%) reported being an ever smoker of whom 59 (33.9%) reported being a recent (30-day) smoker. The optimal eBCO cut-off point for recent smoking was 4.5 ppm with a sensitivity of 84.7% and specificity of 65.5%. Overall, eBCO can accurately identify recent smokers and distinguish them from non-smokers. The eBCO use enables healthcare professionals and researchers to assess efficacy of smoking cessation and prevention programs without necessarily relying on self-report. Further research is indicated to validate our findings and should be expanded to include females, detailed characteristics of cigarette and waterpipe smoking.

Waterpipe Use and Susceptibility to Cigarette Smoking Among Never-Smoking Youth

INTRODUCTION Susceptibility to cigarette smoking, defined as the lack of a firm decision against smoking, is a strong predictor of regular smoking and addiction. Several modifiable risk factors have been identified among never cigarette smokers, and one potential factor of interest is waterpipe use. The purpose of this study is to determine the association of waterpipe use with susceptibility to cigarette smoking among never-smoking youth. METHODS In a pooled analysis of 17 Arab nations with nationally representative Global Youth Tobacco Surveys conducted during 2002-2011, tobacco-related information was obtained from 30,711 never-smoking adolescents representing 4,962,872 youth. Study outcome was susceptibility to cigarette smoking, and primary exposure was waterpipe use. Data were analyzed in 2014 using weighted logistic regression models, including stratified models by gender, to determine the odds of susceptibility to cigarette smoking with waterpipe use, adjusting for confounders. RESULTS Overall, 20% of never-smoking youth were susceptible to cigarette smoking, ranging from 13.1% in Oman to 32.6% in Somalia; 5.2% currently used waterpipe, ranging from 0.3% in Morocco to 23.5% in Kuwait. The estimated odds of susceptibility to cigarette smoking were 2.5 (95% CI=1.9, 3.4) times higher for adolescents who used waterpipe in the past month compared with those who did not, controlling for confounders. Estimates were similar when stratified by gender. CONCLUSIONS Waterpipe use is associated with susceptibility to cigarette smoking. Study findings identify a novel risk factor for never smokers to initiate smoking and will help the public health community develop and implement policies around waterpipe use prevention.

Waterpipe Use and Cognitive Susceptibility to Cigarette Smoking Among Never-Cigarette Smoking Jordanian Youth: Analysis of the 2009 Global Youth Tobacco Survey

INTRODUCTION Susceptibility to cigarette smoking, defined as lack of a firm decision to not initiate smoking, predicts youth smoking initiation and experimentation and is a first step in the transition to regular smoking. This study investigated whether waterpipe (WP) smoking, an increasingly prevalent form of tobacco use among Arab adolescents, was associated with increased susceptibility to cigarette smoking. METHODS A secondary analysis of the 2009 Jordan Global Youth Tobacco Survey was conducted to assess the association between WP use and cigarette susceptibility, after adjusting for important confounders. RESULTS A total of 1,476 youth aged 13-15 years old who had never smoked cigarettes were identified and represented 166,593 never-cigarette smoking Jordanian youth. We found 40% of boys and 29% of girls were susceptible to cigarette smoking, and both boys (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI] = 1.41-1.54) and girls (AOR = 1.95, 95% CI = 1.83-2.04) who had ever smoked WP were more susceptible to cigarette smoking than those who never smoked WP. CONCLUSION This is the first study to report that WP use may increase youths susceptibility to initiate cigarette smoking.

Patterns of Waterpipe Use among Arab Immigrants in the USA: A Pilot Study

Aim: Waterpipe smoking is becoming increasingly popular in the U.S., especially among minority groups. The purpose of this preliminary study was to explore the patterns of waterpipe use, as well as the association between acculturation factors and waterpipe use among Arab immigrants living in the Richmond, Virginia (VA) metropolitan area. Methods: We surveyed self-identified Arab American Immigrants in Middle Eastern Original Research Article British Journal of Medicine & Medical Research, 4(3): 816-827, 2014 817 restaurants/lounges and Middle Eastern groceries, in the Richmond, VA metropolitan area. A total of 221 Arab Americans participated in this study. Results: In this sample, higher rates of waterpipe use were found among male subjects (66.6%) than females (31.4%).Our results indicated no significant association between the type of tobacco used (exclusive versus dual) and desire or future intentions to quit waterpipe use. Upon examining the proxy indicators of acculturation, none of them was significant for the entire sample. However, upon stratifying the results by group (exclusive vs. dual), exclusive waterpipe use was significantly correlated with proportion of life lived in the US as r(16)=0.56, p=0.02 but the correlation remained not significant among dual smokers r( 23)= 0.08, p=0.6. Conclusion: Further studies are needed to confirm the relatively high prevalence of waterpipe use among Arab Americans. There is a need to develop effective prevention strategies that will consider the acculturation process when trying to control the spread of waterpipe use among minority groups in the U.S.

Collision of waterpipe and cigarette smoking epidemics among youth in Arab countries

Abstract Background: Waterpipe tobacco smoking (WTS) emerges as a new component of the global tobacco epidemic. Adolescents smoking waterpipe are susceptible to cigarette smoking, but limited research has characterized dual (cigarette plus waterpipe) users. The study objective is to determine the prevalence estimates of dual users to understand how “collision” of the two epidemics is evolving in the Arab countries.Methods: Data (n = 31,359; N = 6,109,572) were obtained from nationally representative Global Youth Tobacco Surveys (GYTSs) from 17 Arab countries. Current tobacco use was categorized into four groups—cigarette smoking only, WTS only, dual use, and never use. Weighted age-, sex-, and country-specific prevalence estimates along with 95% confidence intervals were reported.Results: Overall 3.0%, 6.1%, and 3.8% of youth were cigarette smokers only, WTS only, and dual users. Boys reported high prevalence estimates of cigarette smoking only (5.1% vs 1.1%), WTS only (7.4% vs 4.6%), and dual use (3.7% vs 2.1%) than girls. Dual-use estimates ranged from 0.7% in Oman to 15.0% in West Bank and WTS only ranged from 0.9% in Oman to 6.6% in United Arab Emirates.Conclusion: Dual use and WTS is well established among Arab youth and represents a new dimension to the global tobacco epidemic that may not respond to traditional tobacco control interventions.

Anthropometric measurements of newborns of women who smoke waterpipe during pregnancy: a comparative retrospective design

Abstract Waterpipe tobacco smoking carries adverse health consequences due to high level of chemical toxicants. This study investigated the anthropometric measurements of singleton newborns of Jordanian women with no known chronic diseases who smoked waterpipe during pregnancy, and the difference in these measurements in newborns of pregnant women who smoked waterpipe, cigarettes, both types, and none during pregnancy. The study also investigated the pattern of different types of tobacco smoking as a function of pregnancy trimester. A descriptive, comparative, retrospective, cross-sectional design was used. Two hundred and eight-five women (74 waterpipe, 84 cigarettes, 26 dual, 101 none) and their newborns were recruited from three hospitals. A questionnaire was used while interviewing mothers to assess tobacco smoking pattern. The results showed that compared with non-smokers, mean birth weight was 0.47 kg (95%CI = −0.70 to −0.35) lower for waterpipe-only smokers, 0.23 kg (95%CI = −0.41 to −0.8) lower for cigarette-only users, and 0.59 kg (95%CI = −0.81 to −0.31) lower for dual users. Compared to non-smokers, mean newborn length was 2.7 cm (95%CI = −3.80 to −1.42) lower for dual smokers, 2.2 cm (95%CI = −3.28 to −1.58) lower for waterpipe smokers, and 1.2 cm (95%CI = −2.01 to −0.45) lower for cigarette smokers. Compared with non-smokers, mean newborn head circumference was 1.9 cm (95%CI = −2.72 to −1.65) lower for waterpipe smokers, 1.7 cm (95%CI = −2.65 to −1.16) lower for dual smokers, and 0.8 cm (95%CI= −1.34 to −0.36) lower for cigarette smokers. From these results, we may conclude that waterpipe tobacco smoking during pregnancy can contribute to a reduction in newborns anthropometric measurements. Increasing awareness of waterpipe tobacco smoking adverse effects and developing cessation interventions in pregnancy is needed.

Waterpipe Tobacco Smoking among Arab Youth; a Cross-Country Study.

OBJECTIVE Waterpipe tobacco smoking (WTS) is considered a global epidemic that is spreading among youth. Our analysis was conducted to compare the national baseline prevalence rate estimates of WTS among Arab boys and girls. DESIGN SETTING AND PARTICIPANTS The Global Youth Tobacco Survey (GYTS) is a school-based survey using standardized self-administered questionnaires; it employs a two-stage cluster sampling technique to obtain a representative sample of youth (13-15 years of age). We conducted a secondary data analysis of nationally representative GYTSs available from 16 Arab countries. MAIN MEASURES Youth who self-reported smoking waterpipe at least once in the past 30 days were considered to be current waterpipe tobacco smokers. National weighted WTS prevalence rate estimates along with respective 95% confidence intervals were reported for boys and girls. RESULTS Pooled GYTS data from 16 Arab countries yielded a total of 31,359 youth. Overall, 10.6% of the respondents were current waterpipe tobacco smokers, with boys (13.7%) having significantly higher estimates than girls (7.2%). Overall, current WTS prevalence rate estimates ranged from .9% in Oman to 34.2%, in Lebanon. The WTS epidemic was more predominant among boys and girls, respectively, in the West Bank (42.8% and 24.2%), Lebanon (38.6% and 30.5%) and Jordan (25.7% and 14.5%). CONCLUSION Among Arab boys and girls, WTS represents a growing strain of the tobacco epidemic that requires immediate attention.