Mary P. Martinasek

Waterpipe (Hookah) Tobacco Smoking Among Youth

Waterpipe tobacco smoking is a centuries old practice, influenced by cultural tradition in Eastern Mediterranean countries, the Middle East, and parts of Asia. It historically has been an activity enjoyed primarily by men. In the past 2 decades, however, this method of tobacco smoking has increased in popularity in other parts of the world, including the USA. Growing interest in this form of smoking can be traced, in part, to the advent of a flavored tobacco, called maassel. The combination of flavoring agents and the paraphernalia itself used in the smoking process, along with its mystic appeal, novelty, affordability, and the social atmosphere in which smoking often occurs, has made waterpipe smoking attractive to women as well as men, cigarette smokers and nonsmokers alike, and particular groups, including persons of college age and younger adolescents. Although waterpipe smoking is perceived by its new generation of users to be less addictive and hazardous to health than cigarette smoking, researchers draw diametrically opposed conclusions. Research demonstrates that numerous toxic agents, including carcinogens, heavy metals, other particulate matter, and high levels of nicotine, are efficiently delivered through waterpipes. Moreover, sidestream smoke exposes others in the vicinity of waterpipe smokers to the risk of respiratory diseases and other conditions. In addition, persons sharing waterpipe mouthpieces may share infectious agents as well. Waterpipe tobacco smoking has been declared a public health problem by the World Health Organization and other authorities. Recognition of the deleterious effects of waterpipe smoking has led to initial attempts to expand regulatory control. Because waterpipe tobacco is not directly burned in the smoking process, many existing control measures do not apply. Public health authorities should monitor waterpipe tobacco use carefully. Finally, pediatricians and other healthcare providers should discourage experimentation and continued use among their adolescent patients.

Mobile Phone-Based Behavioural Interventions for Health: A Systematic Review.

Objective: To perform a systematic review of the literature concerning behavioural mobile health (mHealth) and summarize points related to heath topic, use of theory, audience, purpose, design, intervention components, and principal results that can inform future health education applications. Design: A systematic review of the literature. Method: Thirty-four interventions published in peer-reviewed journals before July 2010, employing a short message service (SMS) and/or multimedia message service to address health-related behavioural change, were reviewed. Results: Five interventions utilized SMS alone, 18 employed SMS/Internet, and 11 utilized SMS, Internet, and other strategies. Intervention length ranged from four weeks to one year. Twenty interventions (59%) were evaluated using experimental designs, and most resulted in statistically significant health behavioural changes. Conclusion: Surveillance of mHealth interventions’ role in facilitating behavioural change is a judicious parallel activity for health education and health behaviour authorities.

A Systematic Review of the Respiratory Effects of Inhalational Marijuana

This systematic review focuses on respiratory effects of inhalational marijuana. The systematic review of the literature was conducted using a comparative method between 2 researchers. Abstracts were reviewed for inclusion of respiratory effects related to inhalational marijuana. Relevant abstracts were collected, and full text articles were retrieved for review. Articles were removed if they did not contain burning marijuana; were animal studies; or were editorials, systematic reviews, commentaries, non-English language, or non-respiratory-related articles. Forty-eight articles were collected and categorized by respiratory effects. In particular, lung cancer, bullous emphysema/COPD, and other respiratory symptoms were the primary categories. Articles were noted by study population country, sample size, age distribution, and findings that were pertinent to respiratory health. The research indicates that there is a risk of lung cancer from inhalational marijuana as well as an association between inhalational marijuana and spontaneous pneumothorax, bullous emphysema, or COPD. A variety of symptoms have been reported by inhalational marijuana smokers, including wheezing, shortness of breath, altered pulmonary function tests, cough, phlegm production, bronchodilation, and other symptoms. It is important to stay current with research findings to educate patients on this smoking behavior.

Adolescent Asthma Self-Management: Patient and Parent-Caregiver Perspectives on Using Social Media to Improve Care.

BACKGROUND Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. METHODS Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. RESULTS Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. CONCLUSIONS A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism.

Hookah Smoking and Harm Perception Among Asthmatic Adolescents: Findings From the Florida Youth Tobacco Survey

BACKGROUND Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by asthma status. METHODS The Florida Youth Tobacco Survey was conducted in 2012 among 36,578 high school students. Secondary data analysis was conducted to compare the rates of hookah use among asthmatic youth to their nonasthmatic counterparts. Risk perception of hookah use compared to cigarette smoking was also assessed among asthmatic and nonasthmatic adolescents. RESULTS One in 5 high school students reported lifetime asthma. These asthmatic students have a significantly higher prevalence of hookah smoking and greater perception of hookah use as being less harmful than cigarette smoking, than their nonasthmatic counterparts. Among asthmatics, 12th graders and Hispanic students had the highest prevalence of hookah smoking. CONCLUSION Common misperceptions of hookah smoking as being less harmful than cigarette smoking are prominent among high school students in Florida and are greater among students with asthma than those students who do not have asthma. Efforts to increase education to dispel the myths surrounding hookah smoking as a safer alternative to cigarette smoking needs to exist at the high school level for both students with and without asthma.

Change in Carbon Monoxide Exposure Among Waterpipe Bar Patrons

INTRODUCTION Waterpipe (also known as hookah) smoking is increasing around the world, including the United States, where waterpipe bars have sprung up rapidly around college campuses. Users are exposed to several toxicants, including carbon monoxide (CO). We evaluated change in exhaled CO and estimated carboxyhemoglobin levels among waterpipe bar patrons in Tampa, FL. METHODS Exhaled breath samples were obtained immediately before entering and after leaving 6 waterpipe bars in Tampa, FL to measure CO boost and factors affecting CO change. Demographics, cigarette use status, and characteristics of waterpipe use during the bar visit also were assessed. RESULTS Among the sample of 166 participants, mean CO increased from 6.5 parts per million (ppm) to 58.2 ppm (a 795% relative boost; p < .001). CO change was higher for patrons who were dual (waterpipe plus cigarette) smokers compared with waterpipe-only smokers, and significant factors of CO change were frequency of waterpipe use, number of charcoals, number of tobacco bowls, and time spent in the bar (all p values < .05). CONCLUSION U.S. waterpipe bar patrons are exposed to considerable amounts of CO, which could put them at risk of acute illness and chronic heart and lung diseases. Environmental and policy controls are needed to curb this increasingly popular tobacco use method in the United States.

Are Students with Asthma at Increased Risk for Being a Victim of Bullying in School or Cyberspace? Findings from the 2011 Florida Youth Risk Behavior Survey.

BACKGROUND Adolescents with asthma are at risk for psychological and behavioral problems. The aim of this study was to determine whether high school students with asthma are at increased risk for bullying in school and cyberspace, and to explore the role of depressive symptoms in moderating this association. METHODS A secondary data analysis was completed with the 2011 Florida Youth Risk Behavior Survey. Participant included a random sample of adolescents in grades 9 through 12 who attended public high schools in Florida. Descriptive and inferential statistics were conducted using SPSS software. RESULTS We examined data from 6212 high school adolescents and found a significant relationship between current asthma and cyberbullying in adolescents. Of the sample diagnosed with asthma, 15.6% reported bullying and 17% cyberbullying (versus 10.2% and 11% of nonasthmatics). We further examined data using depressive symptoms as a mediating and moderating variable and found significance on all accounts. CONCLUSIONS Adolescents with asthma are at increased risk for being victims of bullying in school and cyberspace. Our findings suggest that adolescents with asthma who also report depressive symptoms are particularly at high risk for bullying than adolescents with asthma who did not report depressive symptoms. Efforts to increase education and decrease all types of bullying at the high school level for both students with and without asthma are warranted.

Beliefs and Attitudes Associated With Hookah Smoking Among a United States College Population

BACKGROUND: This study explores the differences among smokers of waterpipe tobacco in a college population to better inform campaigns to curb waterpipe use. METHODS: Participants included undergraduate and graduate students attending a liberal arts university in Florida. E-mail-based, cross-sectional surveys were collected in 2 sequential years. RESULTS: The majority of respondents (64%) reported having ever smoked a hookah, even if just 1–2 puffs. Of those who had ever smoked a hookah, 34% reported smoking a hookah within the previous 30 d. Constructs from the theory of reasoned action were all correlated with smoking behavior. The range of beliefs endorsed by smokers were more strongly associated with hookah-related attitudes compared with subjective norms. Concerns about health were stronger among never-smokers. CONCLUSIONS: Young adult college students continue to engage in waterpipe tobacco smoking at high rates. Campaigns need to focus on subsets of smokers and nonsmokers, independently.

Physicians’ perceptions of mobile technology for enhancing asthma care for youth:

This study assessed physicians’ receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians’ perceived barriers and benefits of integrating mobile technology in adolescents’ asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation.

waterpipe tobacco smoking impact on public health: implications for policy

Background Given the increasing evidence of its negative health effects, including contributions to both infectious and chronic diseases, waterpipe tobacco smoking raises public health concerns beyond even those presented by traditional smoking. Methods Identification of Clean Indoor Air Acts (CIAAs) from each of the 50 United States and District of Columbia were retrieved and examined for inclusion of regulatory measures where waterpipe tobacco smoking is concerned. Several instances of exemption to current CIAAs policies were identified. The cumulative policy lens is presented in this study. Results States vary in their inclusion of explicit wording regarding CIAAs to the point where waterpipe tobacco smoking, unlike traditional smoking products, is excluded from some legislation, thereby limiting authorities’ ability to carry out enforcement. Conclusion Consistent, comprehensive, and unambiguous legislative language is necessary to prevent establishments where waterpipe tobacco smoking occurs from skirting legislation and other forms of regulatory control. Stricter laws are needed due to the increasing negative health impact on both the smoker and the bystander. Actions at both the federal and state levels may be needed to control health risks, particularly among youth and young adult populations.