Respiratory health and quality of life in young exclusive, habitual smokers - a comparison of waterpipe smokers, cigarette smokers and non-smokers

Abstract

Purpose

Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults’ respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups.

Method

We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured.

Result

The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS.

Conclusion

Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Keywords:

• tobacco
• hookah
• cough
• phlegm
• lung diseases
• early onset

Acknowledgment

This research was supported by funds from the Intramural Research Grant Program at King Hussein Cancer Center. The authors gratefully acknowledge the data collection efforts of Ahmad Abdallah, Nida AbdelAziz, Firas Al Amri, Ibrahim Al Shezawi, Mohammad AlZoubaidi, Mariam Atassi, Osama Bassah, Issa Deir, Sarah Ibrahiem, Hala Lobani, Raghad Maraghi, Omar Yehia Mansour, Mahmoud Morsy, Asal Nakhleh, Osama Oudat, Rawan Qawasmeh, Diala Zraikat, and Jamil Zraikat. The authors also thank Professor Omar Al-Rawas from the Department of Medicine at Sultan Qaboos University, and Dr. Gihan ElNahas from the Department of Neurology and Psychiatry (Faculty of Medicine at Ain Shams University) for their general administrative support.

Disclosure

The authors report no conflicts of interest in this work.