The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review.

This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.

The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms.

Recent evidence demonstrates that tobacco smoking causes an imbalance in bone turnover, leading to lower bone mass and making bone vulnerable to osteoporosis and fracture. Tobacco smoke influences bone mass indirectly through alteration of body weight, parathyroid hormone-vitamin D axis, adrenal hormones, sex hormones, and increased oxidative stress on bony tissues. Also, tobacco smoke influences bone mass through a direct effect on osteogenesis and angiogenesis of bone. A RANKL-RANK-OPG pathway is an essential regulatory pathway for bone metabolism and its importance lies in its interaction with most of the pathophysiologic mechanisms by which smoking influences bone mass. Both first- and secondhand smoke adversely affect bone mass; smoking cessation seems to reverse the effect of smoking and improve bone health. Recent advances in research on bone turnover markers could advance scientific knowledge regarding the mechanisms by which smoking may influence bone mass.

Effectiveness of a Culturally-Tailored Smoking Cessation Intervention for Arab-American Men.

To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack-a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking "very much". For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = -6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population.

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.

Screening for domestic violence in Jordan: validation of an Arabic version of a domestic violence against women questionnaire.

OBJECTIVES: Abuse against women causes a great deal of suffering for the victims and is a major public health problem. Measuring lifetime abuse is a complicated task; the various methods that are used to measure abuse can cause wide variations in the reported occurrences of abuse. Furthermore, the estimated prevalence of abuse also depends on how abuse is culturally defined. Researchers currently lack a validated Arabic language instrument that is also culturally tailored to Arab and Middle Eastern populations. Therefore, it is important to develop and evaluate psychometric properties of an Arabic language version of the newly developed NorVold Domestic Abuse Questionnaire (NORAQ). DESIGN AND METHODS: The five core elements of the NORAQ (emotional abuse, physical abuse, sexual abuse, current suffering of the abuse, and communication of the history of abuse to the general practitioner) were translated into Arabic, translated back into English, and pilot tested to ensure cultural sensitivity and appropriateness for adult women in the Eastern Mediterranean region. Participants were recruited from the Jordanian Ministry of Health-Maternal and Child Health Care Centers in two large cities in Jordan. RESULTS: A self administered NORAQ was completed by 175 women who had attended the centers. The order of factors was almost identical to the original English and Swedish languages questionnaire constructs. The forced 3-factor solution explained 64.25% of the variance in the measure. The alpha reliability coefficients were 0.75 for the total scale and ranged from 0.75 to 0.77 for the subscales. In terms of the prevalence of lifetime abuse, 39% of women reported emotional abuse, 30% physical abuse, and 6% sexual abuse. CONCLUSION: The Arabic version of the NORAQ has demonstrated initial reliability and validity. It is a cost-effective means for screening incidence and prevalence of lifetime domestic abuse against women in Jordan, and it may be applicable to other Middle East countries.

Wellness appraisal among adolescents in Jordan: a model from a developing country: a cross-sectional questionnaire survey.

The demographic and economic transition that many developing countries, including Jordan, are undergoing is producing important changes in diet and lifestyle that greatly impact the development of chronic illness. The health behavior of adolescents in developing countries constitutes one of the most serious global challenges we face. The purpose of this study was to explore the wellness appraisal of Jordanian adolescents. It specifically describes the (i) self-care and health history pattern, (ii) to assess physical activity and nutrition appraisal, (iii) quality of life appraisal and (iv) school and outside activities appraisal. A self-administrated questionnaire collected the data from adolescent groups (boys and girls.). A multi-stage stratified random sample was obtained from six public schools by first selecting the educational directorate located in the city of Irbid, which is located in the north of Jordan. A random sub sample of six individual schools was then selected. Individual classes were then selected. A total of 269 boys and 261 girls (12-17-year old) were included in the analysis. The results showed that the students engaged in risky health behaviors which could lead to short- and long-term health problems. The most alarming finding of this study was students' nutritional habits, including less than the daily requirements of fruits, vegetables, milk and meat, while the intake of fast food, soft drinks and sweets were higher than recommended. School-based health promotion and wellness programs should be established in Jordan to influence the health behaviors of adolescents and parents and to avoid further deterioration of their health. Jordanian school curriculum needs to integrate more precise health education programs about diet, exercise, self care and other life style behaviors. More detailed studies are needed with more elaborate instruments about food habits, physical activities and psycho social life.

Preconception health status of Iraqi women after trade embargo.

OBJECTIVES: To describe the preconception health status of Iraqi women in 2001 following the trade embargo imposed on Iraq beginning in 1991 and only partially removed in 1996. DESIGN: A descriptive cross-sectional prevalence study. SAMPLE: 500 Iraqi women at a premarital clinic in Baghdad in 2001. MEASUREMENTS: Women were surveyed for age, area of residence, menstrual history, household crowding, consanguinity, and a family history of congenital problems. Clinical findings regarding height, weight, and hemoglobin level were included in the data. RESULTS: Almost one third of the women were below the age of 20 and the majority were between 20 and 25 years of age. More than half of the women in this study had an intermediate-level education or less and lived in very crowded housing. Most of the women were anemic and reported a delay in menarche, suggesting malnutrition. Most of the women were planning consanguineous unions even though many reported congenital conditions in their family of origin. CONCLUSIONS: Young Iraqi women who endured embargo needed, and continue to need, aggressive preventive health services to recoup health gains lost during the 1990s and to address prevention of common congenital disorders.

Predictors of intention to quit smoking among Jordanian university students.

PURPOSE: To identify predictors that influence tobacco smoking cessation among Jordanian college students and to test the utility of the Trans-Theoretical Model for future cessation programs in this population. METHOD: A cross-sectional survey of randomly selected college students (18 to 22 years of age) who were smokers was conducted at two Jordanian universities. The surveys included the: Tobacco Use Questionnaire; Tobacco Use Self-Efficacy; Rosenberg Self-Esteem Scale; Barriers to Cessation; and the Fagerstrom Tobacco Nicotine Dependency Scale. Due to the complex nature of the contextual and individual factors related to smoking behaviour, a structural equation modeling approach was used to identify variables that may influence participation in tobacco smoking cessation programs. RESULTS: There was a 75% response rate with a total of 800 students (90% male) completing the survey. Three factors were identified as major contributors toward quitting smoking: a) a high stage of readiness, b) previous experience with barriers to smoking cessation, and c) past experience with quitting. CONCLUSIONS: The findings suggest that the value of smoking cessation programs should not be measured on recidivism rates alone. The implications are that such programs should make return to treatment easy and as guilt free as possible to improve ultimate long-term smoking abstinence.

Perceptions of lung cancer and smoking among college students in Jordan.

A descriptive, cross-sectional design was adopted to identify college students' knowledge and perceptions of lung cancer and smoking. A random sample of 400 students at the Jordan University of Science and Technology in northern Jordan was subjected to the Lung Cancer and Smoking Survey, which is based on the Health Belief Model. The results show that the prevalence of current smoking is 16.5% and that the prevalence of former smoking is 10.0%. Most (75.3%) of the respondents were aware of the prevalence of lung cancer. Almost all (90.3%) were aware of the cancer risk from air pollution, but fewer (57.5%) were concerned about the risk caused by side-stream smoke. Most disagreed that lung cancer could be easily cured. Former smokers were more knowledgeable than current smokers about the health hazards of smoking, and those who never smoked were more knowledgeable than both. Engineering students were more likely to agree with the benefits of quitting smoking than were medical or science students. Addiction and friends were the reasons most frequently given for not quitting smoking.

The effect of the health belief model in explaining exercise participation among Jordanian myocardial infarction patients.

This study describes the effect of health belief model (HBM) in explaining exercise participation among Jordanian myocardial infarction (MI) patients. A convenient sample of 98 MI patients was recruited from four governmental hospitals in northern Jordan. A self-reported questionnaire and structured interview were designed to obtain the needed information. Study results indicated that Jordanian MI patients had a high score in perceived severity and a low score in perceived barriers. Results also showed a significant correlation between exercise participation and health belief variables and sociodemographics such as age, annual income, level of education, and physician recommendation. These findings have implications for designing intervention programs aimed at improving physical activity by all MI patients. These programs should consider culture, socioeconomic status, personal system, and demographics. Further research is needed to develop a culturally sensitive instrument that takes into consideration the cultural variation and the specific needs of MI patients.

Smoking habits and attitudes towards smoking among university students in Jordan.

The aim of this study was to estimate the prevalence of smoking and to describe the habits, attitudes, and practices related to smoking among students of Jordan University of Science and Technology (JUST), Irbid, Jordan. Students (n = 650) were recruited in randomly selected, cluster samples drawn from the medical and engineering colleges of JUST. They were made familiar with a modified Arabic version of the World Health Organisation Smoking Questionnaire and the Attitudes towards Smoking Questionnaire to study their habits, attitudes, and beliefs in relation to smoking. The study revealed that the prevalence of smoking was 28.6% (50.2% among males and 6.5% among females). Friends, not family, were the main source of the first smoking, and this most often occurred after 15 years of age (82.3%). Males preferred smoking in the cafeteria, females in the bathroom. The main advantage of smoking for males was calming down, while for females it was independence. Non-smokers chose not to smoke because of health and hatred of the habit. The non-smokers had more positive attitudes against smoking and were more aware of the adverse effects of smoking. The reasons smokers gave for starting smoking were pleasure, followed by stress and curiosity. Two-thirds of smokers intended to quit smoking in the future. Some smokers disagreed with some criticisms against smoking, and reasons why they did not want to quit included social attitudes, addiction, and not knowing how to quit. Results of this study may provide baseline data to develop an anti-smoking program in the university and encourage policy makers to limit smoking in the university by strengthening the policies against smoking.