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Adolescent tobacco consumption continues to be a public health problem 1. In Jordan, for example, tobacco smoking among boys is one of the highest in the world 2 , while waterpipe and dual smoking combined use of cigarettes and waterpipe have exceeded that of cigarettes 3. In , waterpipe-only smoking was A large recent cross-sectional study with Jordanian adolescents found that Further analyses of the same population found that waterpipe smoking is associated with greater obesity, BMI and body weight among Jordanian adolescents 5. In parallel, eating habits and practices of Arab countries have become more Westernized 6. Previous studies of Arab adolescent lifestyle practices, including Jordanians, revealed that unhealthy food practices have become more prevalent recently 7 , 8. Similarly, a region-wide study found that only few adolescents consumed fruits and vegetables as frequently as guidelines recommend Additionally, several barriers to adopting healthy eating and adequate physical activity behaviors by Arab adolescents, including Jordanians 8 , were identified. Although there is some research on clustering of lifestyle risk factors, there is still gaps in research on the youth population. To our knowledge, no studies have examined the relationship of waterpipe smoking with eating habits among Jordanian adolescents. Given the marked increase of waterpipe smoking and poor eating habits among adolescents, and their potential adverse health effects when combined, it is vital to investigate the associations between waterpipe smoking and eating habits among adolescents. Therefore, the aim of the current study was to compare eating habits among adolescent cigarette-only, waterpipe-only and dual smokers, versus non-smokers. We hypothesize that adolescent smokers practice unhealthy eating habits with worse habits among waterpipe smokers and dual smokers. The current study used a cross-sectional design to examine the relationship between waterpipe smoking and eating habits among adolescent students, enrolled in Irbid-TRY, versus other types of tobacco smoking. A simple random selection technique was used to randomly select 8 public high schools from two major educational districts in northern Jordan; Irbid 1st and Arramtha, which are a representative sample of school populations in northern Jordan. Schools were stratified by gender to ensure equal representation of both sexes as public high schools in Jordan are single-sex. A two-stage cluster sampling design, in which the school and the class were the unit of cluster, was conducted as schools are considered a good venue to recruit students for research purposes. In each of the participating schools, an average of 4 classes of each grade with an average of 30 students within each class were randomly selected using a simple random technique. Within each of the selected classes, all healthy adolescents in the 7th to10th grades were invited to participate. The final response rate of participating students was Tobacco use patterns were obtained by a validated self-reporting survey in Arabic, adapted from the Youth Risk Behavior Survey The response options were: a never used, b have used, but not in the past 30 days, c 1—2 days, d 3—5 days, e 6—9 days, f 10—19 days, g 20—29 days, and h all 30 days. To assess frequency of use, 4-level indicator variables were created. For cigarette use frequency, the levels were: never smokers never smoked either cigarettes or waterpipe ; smoked cigarettes but not in the past month; smoked cigarettes in the last month but less than weekly; and smoked cigarettes weekly during the past month. Similar 4-level indicator variables were created to indicate the frequency of waterpipe smoking and dual smoking frequency. Current dual smoking was classified for those who reported smoking both waterpipe and cigarettes in the past month. The survey had 58 items to obtain information about a variety of adolescent health aspects. It is a self-administered classroom activity that usually takes the students about 15 minutes to complete. The survey was facilitated by two research assistants and a volunteer school teacher. The items concerning eating habits are used in the current study. These items include frequency of weekly consumption of fruit and vegetables; daily intake of fruit juice, water, soda and soft drinks; weekly consumption of junk food and fast food; and weekly frequency of having breakfast. The research team undertook internal consistency reliability and validity analyses to obtain preliminary reliability and validity data about the questionnaire in an Arabic-speaking population data are not yet published. SPSS software for Windows version Subsequently, LSD post hoc comparisons were used to verify specific differences between groups. Thereafter, a series of standard linear regressions were used to determine the individual relationship of smoking status i. Additional stepwise regression that included the significant predictors found in the standard linear regressions was used. A total of adolescents participated in the study, however only Table 1 shows mean age, weight, height, BMI and school grade. As presented in Table 2 , about Additionally, Table 2 shows that about About half of the sample reported eating vegetables One the other hand, about half of the sample reported eating fried potatoes Table 3 shows average weakly dietary consumption among different smoking status categories, including none, cigarette, waterpipe and dual smoking. About adolescent students provided both sufficient smoking and diet data. Also, subsequent post hoc comparisons revealed the following: mean weekly breakfast consumption was less in waterpipe-only 3. Mean vegetable consumption during the week was less in waterpipe-only 4. Weekly fast food consumption was higher in dual smokers 2. Mean chocolate and candy weekly consumption was higher in dual smokers 4. Mean consumption of energy drinks during the week was highest among dual smokers 1. Mean soda consumption frequency was higher in waterpipe-only 4. A series of standard linear regression analyses showed that smoking status predicted 6. A stepwise regression that included the 4 significant factors, showed that smoking status predicted 6. The present study examined eating habits among adolescent tobacco smokers, including waterpipe. Overall, the study found that unhealthy dietary habits are often practiced by waterpipe-only and dual smokers compared to cigarette-only smokers and non-smokers. Differences in eating habits were found in consumption of breakfast, soda and energy drinks, vegetables, candy and chocolate. These findings are important and suggest that adolescent waterpipe smoking is associated with unhealthy eating habits. Our findings show that, among participating students, dual smoking was reported the highest, followed by waterpipe-only smoking, then cigarette-only smoking. More so, participating adolescents reported relatively high consumption of unhealthy food and beverages, such as fried potatoes, candy and chocolate, soda, as well as skipping breakfast. These findings are very important and are congruent with the literature reporting that adolescent cigarette smokers are more likely to adopt an unhealthy dietary intake The current study, however, is the first to examine the relationship between waterpipe and dual smoking with eating behavior in adolescents. Similar to cigarette smoking 14 , our findings indicate that smoking waterpipe either alone or combined with cigarettes seems to be associated with unhealthy eating behaviors. This association between unhealthy eating habits and waterpipe smoking is very alarming, especially in view that waterpipe smoking is spreading rapidly among adolescents. Studies have shown that waterpipe smoking is increasing in many countries worldwide, including Western countries 15 , Similarly, in Jordan, waterpipe smoking surpasses cigarette and dual smoking, which is also high 3. In parallel to the increase in waterpipe and dual smoking among adolescents, Arab people, including youth, have adopted unhealthy eating habits 6 - 8. Combined, a large cross-sectional study found that waterpipe smoking is associated with greater obesity, BMI and body weight among Jordanian adolescents 5. Waterpipe smoking is associated with adverse health consequences 17 , 18 , including an increase in oxidative stress and inflammation All these harmful effects are more likely to worsen if combined with unhealthy eating habits In particular, the current findings might also support evidence that adolescents who smoke cigarettes are more likely to be obese, which continues into adulthood Other evidence on adults found that waterpipe smokers tend to have higher abdominal obesity compared to non-smokers Furthermore, tobacco smoking was found to be associated with more physical inactivity 23 , and this could partially explain the clustering of unhealthy behaviors and the risk of obesity among waterpipe smokers in the current study. Engaging in tobacco smoking has been attributed to a dampened appetite for healthy food 24 and little concern about weight gain One important reason that could explain the prevalence of an unhealthy diet among adolescent smokers, especially those who smoke waterpipe, is the perceived appetite suppression effect of nicotine This may lead to weight control, which could be a main reason for continuing smoking and failure into relapses. The appetite-suppression effect of nicotine along with desire to control weight could also explain the habit of skipping breakfast among adolescents in the current study. However, published literature reported that people who smoke do not eat less than those who do not smoke Similarly, a reduction in weight can only be noticed temporarily among people who newly initiated smoking or smokers who experience relapses. Nonetheless, policies on cigarette and waterpipe smoking prevention are not fully endorsed in Jordan, and also not in compliance with the FCTC requirements with regards to Article 11, and lag behind regionally and worldwide Although the law requires health warnings on all tobacco products, health warnings in Jordan have been authorized only for cigarette packs Importantly, since waterpipe smoking has a strong social underpinning, community-based and peer-led interventions could be developed to renormalize this behavior in the region. Finally, the current study shows that adolescent smokers, particularly waterpipe and dual, are adapting unhealthy eating habits. Accordingly, smoking cessation programs should also consider eating behavior modifications. In fact, given that unhealthy behaviors tend to cluster, adolescent smokers should attend comprehensive behavior modification programs that target other unhealthy behaviors. The current study has some limitations. Tobacco smoking and eating patterns were self-reported, which might be associated with false reporting. However, the Arabic version of the Youth Risk Behavior Survey is found valid and a reliable measure for smoking behavior among adolescents Future studies need to use biological markers to assess smoking status to confirm the relationship of waterpipe smoking and dual smoking with eating habits. The current study used a cross-sectional design, and thus cannot draw any causal inferences. Therefore, longitudinal research is needed to confirm the current findings. Moreover, the current study was conducted in northern Jordan, thus limiting the generalizability of the findings to other countries. However, the pattern of waterpipe and dual smoking tend to be similar among adolescents, especially in the Middle East and North Africa MENA region Unhealthy eating habits are practiced among adolescent smokers, especially those reporting waterpipe-only and dual smoking, compared to cigarette-only smoking and non-smoking. Public health action as well as developing and enforcing relevant policies for waterpipe smoking and healthy food choices are urgently needed to reduce waterpipe smoking and increase awareness about the combined negative effects of waterpipe smoking and unhealthy dietary choices, especially among youth. This is particularly important because waterpipe smoking has become an epidemic, with waterpipe exceeding cigarette smoking, and dual smoking also being high, especially among girls. Recent manuscripts Archive About. Editorial Policies. Instructions to Authors. Recent manuscripts. Nihaya A. Al-sheyab 1. Mahmoud A. Alomari 2. Introduction: The relationship between waterpipe smoking and eating habits among adolescents has not been investigated, thus the aim of the current study was to compare eating habits among adolescent cigarette-only, waterpipe-only, dual smokers versus non-smokers. Methods: Using a descriptive, cross-sectional design, self-reporting patterns of waterpipe, cigarette smoking and eating habits were collected from a random representative sample of boys and girls in grades 7—10 in Northern Jordan. Results: A total of 6. Given the growing epidemic of tobacco smoking in the Eastern Mediterranean Region, especially adolescent waterpipe smoking, and its association with unhealthy eating habits, public health actions and enforcing policies to decrease uptake of waterpipe smoking as well as improving food choices in schools among youth are urgently needed. Smoking status Tobacco use patterns were obtained by a validated self-reporting survey in Arabic, adapted from the Youth Risk Behavior Survey Table 2 Smoking status and dietary consumption among participants. Relationship of tobacco smoking with eating habits Comparisons Table 3 shows average weakly dietary consumption among different smoking status categories, including none, cigarette, waterpipe and dual smoking. Regression A series of standard linear regression analyses showed that smoking status predicted 6. Limitations The current study has some limitations. World Health Organization. WHO urges more countries to require large, graphic health warnings on tobacco packaging: the WHO report on the global tobacco epidemic, examines anti-tobacco mass-media campaigns. Cent Eur J Public Health. Google Scholar. Nicotine Tob Res. Prevalence, patterns and correlates of cigarette smoking in male adolescents in northern Jordan, and the influence of waterpipe use and asthma diagnosis: a descriptive cross-sectional study. Journal of Substance Use. Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Perceived barriers to healthy eating and physical activity among adolescents in seven Arab countries: a cross-cultural study. Scientific World Journal. Eating habits, physical activity, and sedentary behaviors of Jordanian adolescents' residents of Amman. Mediterranean Journal of Nutrition and Metabolism. Relative contribution of physical activity, sedentary behaviors, and dietary habits to the prevalence of obesity among Kuwaiti adolescents. Food and Nutrition Bulletin. Consumption of fruits and vegetables among adolescents: a multi-national comparison of eleven countries in the Eastern Mediterranean Region. The British Journal of Nutrition. Methodology of the youth risk behavior surveillance system A partnership for health - working with schools to promote healthy lifestyle. Aust Fam Physician. A snapshot of year 10 salsa peer leaders' lifestyle behaviours. Differences in food intake and exercise by smoking status in adolescents. Preventive Medicine. Water-pipe tobacco smoking among middle and high school students in Arizona. Determinants of hookah use among high school students. Maziak W. Rise of waterpipe smoking. Tobacco use among middle and high school students-United States, Exposure to waterpipe smoke induces renal functional and oxidative biomarkers variations in mice. Inhal Toxicol. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. The American Journal of Clinical Nutrition. Association between adolescent substance use and obesity in young adulthood: a group-based dual trajectory analysis. Addict Behav. The relationship between waterpipe smoking and body weight: population-based findings from Syria. Effects of smoking status on content of caloric intake and energy expenditure. International Journal of Eating Disorders. White MA. Smoking for weight control and its associations with eating disorder symptomatology. Comprehensive Psychiatry. Am J Public Health. Generalized additive models. CRC Press; Acute effects of nicotine on hunger and caloric intake in smokers and nonsmokers. WHO report on the global tobacco epidemic raising taxes on tobacco. World Health Organization; Collision of waterpipe and cigarette smoking epidemics among youth in Arab countries. Risky behaviors, substance use, and other lifestyle correlates of energy drink consumption in children and adolescents: a systematic review Michela Marinoni, Maria Parpinel, Alessio Gasparini, Monica Ferraroni, Valeria Edefonti European Journal of Pediatrics. Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes C. Ajibo, A. Van Griethuysen, S. Visram, A. Lake Public Health. Gender-specific differences in plasma ferritin in adolescents smoking cigarettes versus waterpipe smoking: the Irbid-TRY Project Mahmoud A. Alomari, Nihaya A. Al-sheyab, Khulood K. Shattnawi, Omar F. Khabour Archives of Medical Science. Send by email. Trends in socioeconomic inequality in e-cigarette use among adolescents in South Korea. Comparison of smoking conventional cigarettes and using heated tobacco products on the olfactory and gustatory function in healthy young adults: A cross-sectional study. Associations of weight control related behaviors with current cigarette smoking among Chinese adolescents: Results from an ongoing school-based survey in Zhejiang province. Sociodemographic inequalities in cigarette, smokeless tobacco, waterpipe tobacco, and electronic cigarette use among adolescents aged 12—16 years in countries: A cross-sectional analysis. Association of smoking cessation with dynapenia among older lifetime smokers in Korea. Keywords index. Topics index. Table of contents. All articles are published however under a creative common license. The views and opinions expressed in the published articles are strictly those of the author s. We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool more. You can change cookies settings in your browser. 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