The Associations of Physical Activity and Health-Risk Behaviors toward Depressive Symptoms among College Students: Gender and Obesity Disparities.

Engaging in health-risk behaviors (HRBs) may be correlated with depressive symptoms among college students, but these relationships require more research. The purpose of this study was to examine the associations of physical activity levels (i.e., light [LPA] and moderate-vigorous [MVPA]) and HRBs (i.e., sedentary behavior [screen-based and non-screen-based behavior] and cigarette and e-cigarette tobacco use) with depressive symptoms in a sample of college students. Physical activity levels and HRBs were assessed through validated questionnaires. In total, 366 students participated (Mage = 22.59 ± 3.54; 60.1% female; 52.9% normal weight). E-cigarette use in males (ß = 0.23, p < 0.05) and screen-based sedentary behavior in females (ß = 0.14, p < 0.05) showed significant predictive utility toward depressive symptoms. In the overweight/obese group, screen-based sedentary behaviors (ß = 0.19, p < 0.05) and e-cigarette use (ß = 0.23, p < 0.01) showed significant predictive utility toward depressive symptoms. Females reported higher levels of depressive symptoms (Mfemale = 18.23 vs. Mmale = 14.81; η2 = 0.03) and less MVPA (Mmale = 52.83 vs. Mfemale = 41.09; η2 = 0.06) than males. Enhancing mental health by improving physical activity and eliminating HRBs should be tailored toward at-risk demographics.

E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis.

INTRODUCTION: Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS: Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS: The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS: Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use.

Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review.

OBJECTIVE: A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES: PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION: Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS: Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS: LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.

Psychometric properties of Fagerström Tolerance Questionnaire among Turkmen Nass (Naswar) users.

BACKGROUND: Smokeless tobacco (SLT) products are gaining popularity around the globe, particularly in Asia, Africa, and the Middle East. Among these products, Nass (aka Naswar) is popular among the Turkmen ethnicity in Iran. Although several studies reported nicotine dependence (ND) among SLT users, psychometric instruments have never been utilized to specifically measure ND among Nass users. Therefore, in this study, we aimed to evaluate the reliability and validity of the Fagerström Tolerance Questionnaire (FTQ) among Turkmen Nass users. METHODS: A cross-sectional, descriptive study was conducted in June-December 2018 among 411 Turkmen adults who currently (past 30 days) used Nass. Two bilinguals (Persian English) individuals translated and back-translated the FTQ-SLT, which maintained both the questionnaire's accuracy and cultural sensitivity. Construct validity was assessed using exploratory and confirmatory factor analysis. RESULTS: The mean age and standard deviation for initiating Nass were 22.5 ± 11.81 years. Exploratory and confirmatory factor analysis indicated a single-factor solution with 8-items that captured several important ND components. Using Nass frequently, soon after waking, when sick, and experiencing a craving were some of the main components. Subgroups comparison revealed that higher scores occurred among those who were married, had Nass user(s) in their immediate family, and consumed bulk form of Turkmen Nass directly without using a tissue. CONCLUSION: Our findings show that the FTQ- SLT is a fairly reliable and valid scale to measure ND among Turkmen Nass users and warrants further testing to accommodate cross-cultural differences in other populations.

Predicting thrombotic cardiovascular outcomes induced by waterpipe-associated chemicals using comparative toxicogenomic database: Genes, phenotypes, and pathways.

Hookah, or waterpipe, is a tobacco smoking device that has gained popularity in the United States. A growing body of evidence demonstrates that waterpipe smoke (WPS) is associated with various adverse effects on human health, including infectious diseases, cancer, and cardiovascular diseases (CVDs), particularly thrombotic events. However, the molecular mechanisms through which WPS contributes to disease development remain unclear. In this study, we utilized an analytical approach based on the Comparative Toxicogenomics Database (CTD) to integrate chemical, gene, phenotype, and disease data to predict potential molecular mechanisms underlying the effects of WPS, based on its chemical and toxicant profile. Our analysis revealed that CVDs were among the top disease categories with regard to the number of curated interactions with WPS chemicals. We identified 5674 genes common between those modulated by WPS chemicals and traditional tobacco smoking. The CVDs with the most curated interactions with WPS chemicals were hypertension, atherosclerosis, and myocardial infarction, whereas "particulate matter", "heavy metals", and "nicotine" showed the highest number of curated interactions with CVDs. Our analysis predicted that the potential mechanisms underlying WPS-induced thrombotic diseases involve common phenotypes, such as inflammation, apoptosis, and cell proliferation, which are shared across all thrombotic diseases and the three aforementioned chemicals. In terms of enriched signaling pathways, we identified several, including chemokine and MAPK signaling, with particulate matter exhibiting the most statistically significant association with all 12 significant signaling pathways related to WPS chemicals. Collectively, our predictive comprehensive analysis provides evidence that WPS negatively impacts health and offers insights into the potential mechanisms through which it exerts these effects. This information should guide further research to explore and better understand the WPS and other tobacco product-related health consequences.

The Effects of Pictorial Health Warning Label on Waterpipe (Low- and High-Frequency) Smokers' Experiences, Toxicant Exposures, and Puffing Behavior.

BACKGROUND: Pictorial health warning label (PHWL) is an effective risk communication measure among cigarette smokers. However, there is a lack of knowledge regarding the effect of PHWL on low- and high-frequency waterpipe (WP) smokers. This study examined the effects of PHWL on puffing behavior, subjective experiences, and toxicant exposures among low- and high-frequency WP smokers in the United States (US). METHODS: Sixty current (past-month) WP smokers (low-frequency; n = 30 and high-frequency; n = 30) completed two 45-min ad libitum WP smoking sessions in a cross-over design study (WP with no-PHWL vs. WP with PHWL). We compared the mean differences of puff topography, expired carbon monoxide (eCO), plasma nicotine concentration, and subjective experiences between the two smoking groups. RESULTS: Mean age of low-frequency smokers was 21.5 years and high-frequency smokers was 21.3 years. Compared to high-frequency, low-frequency smokers had significant reduction in average total smoking time [mean difference (SD) = -7.6 (10.2) min vs. -2.6 (6.7) min, p = 0.03] and number of puffs [mean difference (SD) = -33.37 (70.7) vs. -0.70 (29.2), p = 0.02] following exposure to PHWL compared to no-PHWL condition. Post-session subjective experiences were lower among high-frequency smokers compared to low-frequency smokers following smoking WP with PHWL compared to the no-PHWL session (puff liking -1.2 vs. -0.5; puff satisfaction -1.0 vs. -0.3; craving reduction -0.5 vs. 1.2) (p < 0.05 for all). CONCLUSION: Our findings indicate that placing PHWL on the WP device may be a promising strategy with differential effectiveness among WP smokers: low-frequency (reduce puffing behaviors) and high-frequency (reduce smoking experience).

Locked, Loaded, and Ready for School: The Association of Safety Concerns With Weapon-carrying Behavior Among Adolescents in the United States.

There is limited, if any, prior research exploring the potential link between adolescents' safety concerns and their predisposition to possess weapons has been limited. This study aimed to examine the relationship between high school students' perceived lack of safety and their weapons carrying behavior in a multiyear nationally representative sample of high school students. Information on self-reported weapons carrying in past month and gun carrying in past year, perceived lack of safety at school or during commute, being bullied and/or threatened, involvement in physical fights, and demographic characteristics were retrieved from Youth Risk Behavior Surveillance Survey data for 1991-2017. Generalized linear mixed models were used to address data clustering by survey year. Sampling design and sample weights were accounted for. Of a total number of 195,280 respondents with valid responses during 1991-2017, 18%, 7%, and 5%, respectively, carried weapon(s) in general, weapon(s) to school, and gun. On an average, 5% skipped school due to safety concerns. Missing ≥2 school days was associated with weapon (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.94 -2.61) and gun (AOR: 3.18; 95% CI: 1.81 -5.58) possessions, as well as weapons possession in school (AOR: 2.47; 95% CI: 1.96 -3.12). Experiences of weapons-induced injury(ies) or threat(s), and involvement in physical fights were other significant covariates in adjusted analyses. Compared with non-Hispanic whites, students of other racial/ethnic groups had significantly lower odds of possessing weapons. Perceived lack of safety emerged as a potential determinant of weapon carrying, a behavior with far-reaching public health concerns. While future research looking into the psychological motivations of possessing weapons is recommended, our findings offer a unique opportunity to address the crucial problems of school absenteeism induced by experiences of aggression and fears for safety as well as preempt the consequences of weapons-possession by adolescents.

COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran.

There is mixed evidence surrounding the relationship between tobacco use and COVID-19 infection/progression. The current study investigates beliefs and tobacco use behaviors and COVID-19 infection among a sample of smokers and never-smokers. Data were collected using an online survey distributed through Telegram, a cloud-based social media networking application in Iran from April 1 to May 31, 2020. The study participants included never-smokers (n = 511), current (past-month) waterpipe smokers (n = 89), current cigarette smokers (n = 158), and ex-smokers (n = 172). Multinomial logistic regression was used to compare tobacco use groups with never- smokers on beliefs, controlling for potential confounders. The study participants (n = 944) was mostly male (64%), had > high school education (76%), and lived in an urban area (91%), with mean ± SD age of 35.3 ± 10.8. Key findings of this study are that compared with never-smokers: (1) cigarette smokers were less likely to believe that smoking cigarette can lead to spreading COVID-19; (2) waterpipe smokers were more likely to believe that smoking waterpipe at home was a safe practice, that waterpipe protects against COVID-19, and smoking waterpipe may lead to a more rapid recovery from COVID-19; (3) both waterpipe and cigarette smokers believed that using e-cigarettes in public places was a safe practice during the COVID-19 pandemic; and (4) more than half of the ex-smokers stopped smoking due to COVID-19 and most of them planned to continue abstaining from smoking after the pandemic. Our findings underscore the need to raise awareness about the unsupported claims of a lower hazard of using tobacco products or possible protective effects against COVID-19 and to promote cessation programs.

The JUUL E-Cigarette Elevates the Risk of Thrombosis and Potentiates Platelet Activation.

BACKGROUND: Smoking is the main preventable cause of death in the United States and worldwide and is associated with serious cardiovascular health consequences, including thrombotic diseases. Recently, electronic cigarettes (e-cigarettes) and, in particular JUUL, have attained wide popularity among smokers, nonsmokers, pregnant females, and even the youth, which is alarming. Interestingly, there is/are no information/studies regarding the effect of JUUL on cardiovascular diseases, specifically in the context of modulation of platelet activation. Thus, it is important to discern the cardiovascular disease health risks associated with JUUL. METHODS AND RESULTS: We used a passive e-vape vapor inhalation system where C57BL/6J mice (10-12 weeks old) were exposed to JUUL e-cigarette vape. Menthol flavored JUUL pods containing 5% nicotine by weight were used as the e-liquid. Mice were exposed to a total of 70 puffs daily for 2 weeks; 3-second puff duration, and 25-second puff interval. The effects of JUUL relative to clean air were analyzed, on mouse platelet function in vitro (eg, aggregation) and in vivo (eg, FeCl3-induced carotid artery injury thrombosis model). Our results indicate that short-term exposure to JUUL e-cigarette causes hyperactivation of platelets and shortens the thrombus occlusion as well as hemostasis/bleeding times, relative to clean air (medians of 14 vs. 200 seconds, P < .01 and 35 vs. 295 seconds, P < .001, respectively). CONCLUSION: Our findings document-for the first time-that short-term exposure to the JUUL e-cigarette increases the risk of thrombotic events, in part by modulating platelet function, such as aggregation and secretion, in mice.

Correlates of poly-tobacco use among youth and young adults: Findings from the Population Assessment of Tobacco and Health study, 2013-2014.

INTRODUCTION: Poly-tobacco use is common among youth and young adults. This study examined sociodemographic, tobacco-related, and substance use characteristics of poly-tobacco use compared to mono-tobacco use among youth and young adults (12-34 years) in the United States. METHODS: We conducted a descriptive analysis by age-group of 12898 youth (12-17 years), 8843 younger young adults (18-24 years), and 6081 older young adults (24-34 years) from the 2013-2014 Population Assessment of Tobacco and Health study. Multiple logistic regression modeling was conducted to assess the sociodemographic, tobacco-related, and substance use associations with current (past 30 days) tobacco use on a binary scale (poly- versus mono-tobacco use) among tobacco users. RESULTS: Between 2013 and 2014, 3.6% of youth, 21.7% of younger young adults, and 15.8% of older young adults were current poly-tobacco users in the general population. In the regression analyses, among youth tobacco users, heavy drinking was the only factor associated with higher odds of poly-tobacco use. Factors associated with higher odds of poly-tobacco use among younger young adults included being male, having less than high school diploma or GED, residing in the South, having 2 and ≥3 quit attempts, heavy drinking, and marijuana use. Residing in the South, older ages of exposure to tobacco use, and marijuana use were associated with higher odds of poly-tobacco use among older young adults. CONCLUSIONS: Regardless of tobacco product type, poly-tobacco use was common among youth and young adults. Interventions designed to address factors associated with poly-tobacco use among youth and young adults are warranted.

Does education modify the effect of ethnicity in the expression of ideal cardiovascular health? The Baptist Health South Florida Employee Study.

BACKGROUND: Despite the progress made to decrease risk factors for cardiovascular diseases, disparities still exist. We examined how education and ethnicity interact to determine disparities in cardiovascular health (CVH) as defined by the American Heart Association. HYPOTHESIS: Education modifies the effect of ethnicity on CVH. METHODS: Individual CVH metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose) were defined as ideal, intermediate, or poor. Combined scores were categorized as inadequate, average, or optimal CVH. Education was categorized as postgraduate, college, some college, and high school or less; ethnicity was categorized as white, Hispanic, black, and other. Main and interactive associations between education, ethnicity, and the measures of CVH were calculated with multinomial logistic regression. RESULTS: Of 9056 study participants, 74% were women, and mean age was 43 (±12) years. Over half were Hispanic, and two-thirds had at least a college education. With postgraduate education category as the reference, participants with less than a college education were less likely to achieve ideal status for most of the individual CVH metrics, and also less likely to achieve 6 to 7 ideal metrics, and optimal CVH scores. In most of the educational categories, Hispanic participants had the highest proportion with optimal CVH scores and 6 to 7 ideal metrics, whereas black participants had the lowest proportion. However, there were no statistically significant interactions of education and ethnicity for ideal CVH measures. CONCLUSIONS: Higher educational attainment had variable associations with achieved levels of ideal CVH across race/ethnic groups. Interventions to improve CVH should be tailored to meet the needs of target communities.

Waterpipe smoking patterns and symptoms of nicotine dependence: The Waterpipe Dependence in Lebanese Youth Study.

INTRODUCTION: Waterpipe typically is smoked intermittently over long smoking sessions. Waterpipe is addictive and its users show symptoms of nicotine dependence (ND). This study examined the risk of developing ND symptoms across waterpipe use patterns among Lebanese youth. METHODS: Waterpipe use patterns (length of smoking session, smoking a whole waterpipe without sharing, past-30day use frequency, number of waterpipes smoked) were assessed. Symptoms of ND were assessed using the 10-item Hooked on Nicotine Checklist (HONC; endorsement of ≥1 symptom) and the 6 criteria of the International Classification of Diseases-10th revision (ICD-10 ND; presence of ≥3 criteria during 12months). RESULTS: Both the proportion of participants endorsing ND symptoms and the average number of endorsed ND symptoms increased with increasing waterpipe use frequency, number of waterpipes smoked, and length of smoking session. The risk of endorsing≥1 HONC symptom increased with increasing number of waterpipes smoked in the past 30-days (≥10 vs. <4 waterpipes; Hazard ratio (HR)=2.05, 95% CI: 1.52-2.58, p=0.007), and session length (>60min vs. <30min; HR=2.87, 95% CI: 2.83-2.91, p=0.001). The risk of attaining ICD-10 ND increased with increasing number of waterpipes used in the past 30-days (≥10 vs. <4 waterpipes; HR=2.56, 95% CI: 1.89-3.22, p=0.006), and smoking every day/almost every day vs. less than once weekly (HR=2.86, 95% CI: 2.12-3.60, p=0.007). CONCLUSIONS: Increasing use frequency, number of waterpipes smoked, and longer smoking sessions were associated with higher risk of ND. The length of smoking session emerged as a novel indicator of ND among waterpipe smokers.

The global epidemiology of waterpipe smoking.

OBJECTIVES: In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally. DATA SOURCES: Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used. STUDY SELECTION: The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking. DATA EXTRACTION: Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review. DATA SYNTHESIS: Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns. CONCLUSIONS: Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority.

Viewpoint: methanol poisoning outbreak in Libya: a need for policy reforms.

We address the controversies surrounding a 2013 outbreak of methanol poisoning in Tripoli, Libya. We critically examine and systematically analyze the outbreak to highlight the lessons learned from this disaster and how to act properly to prevent similar outbreaks in future. Many health problems have been directly attributed to drinking alcohol; the type and quality of alcohol determines the detrimental effects. An unregulated and flourishing black market in alcohol is among the factors behind the Libyan tragedy, where approximately 90 deaths and about 1000 hospital admissions were reported. We reviewed gaps in local and regional alcohol policy, and highlighted the issue of illegally produced and home-made alcohol. Collaboration between countries in the region plus critical health and policy reforms in Libya, with emphasis on public health preparedness, can dramatically decrease morbidity and mortality associated with such outbreaks.