Buying Ecstasy online in Isfahan
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Buying Ecstasy online in Isfahan
Official websites use. Share sensitive information only on official, secure websites. To provide prevention programs and educate drug users DUs , the estimation of their population is necessary. This cross-sectional study was performed in summer on people selected through a multistage sampling method based on 14 region of the municipality of Isfahan. The data collection tool was a questionnaire that was previously used in Dr. Banshi's national plan without any changes. The Cronbach's alpha value of the questionnaire was 0. Using correction factors such as transparency of response and the ratio of social network size used in previous national studies, the number of people with high-risk behaviors was estimated. The results were analyzed through NSUM based on survey analysis. Among all kinds of DUs, men were the largest consumers. In both sexes, the prevalence of using opium and its nectar and illegal treatment with methadone and buprenorphine was higher in people of over 30 years of age, while the prevalence of consuming cannabis, ecstasy, tramadol, tobacco products, and stimulants was higher in the age group of 18 to 30 years. The results indicated that the prevalence of different DUs in Isfahan city, especially among men was higher than the reported average especially in young men of years of age. Since the prevalence of drug use varies based on the type of substance used among age groups, targeted preventive planning based on the type of drug used and age group is recommended. To estimate the population size of hidden groups such as drug users DUs is a challenge for researchers and health care practitioners as well as society. The amount and type of drug use differ throughout the world. In a review in , the prevalence of drug injection was estimated to be 0. Despite frequent efforts, for many reasons such as legal prohibition, stigma and discrimination, and lack of social acceptance in many countries of the world including Iran, these groups remain hidden and inaccessible, which makes it difficult to estimate their population size. There are 2 methods for estimating the population size of hidden groups, direct and indirect. Then, considering the social network size in the general population and some other indicators, the size of the hidden population is estimated. This method was used for the first time in to estimate the population size of people lost in the Mexican earthquake. The results of this study can be helpful to provincial policymakers and experts in estimating the extent, direction, and type of preventive activities required, the costs, and required manpower as well as to obtain economic and executive support. The sample size was estimated at about people considering the drug use prevalence of 0. Sampling was performed using non-random multistage sampling; 14 districts of Isfahan municipality were considered as stratified and, based on information obtained from the Health Deputy of Isfahan University of Medical Sciences, the sample size was determined proportionate to the size of each of these districts. Then, a list of crowded areas of the city as clusters was prepared and two clusters were randomly selected from within each district cluster. Within the clusters in the regular days of the week and at busy hours and , a passer-by was randomly selected once every 15 minutes. The study inclusion criteria included residing in Isfahan for at least 2 years, being 18 years of age and older, and having the mental ability to answer the questions. The exclusion criteria included completion of the questionnaire in the previous days and not willing to participate in the study. A standard questionnaire was used for data collection; its validity was evaluated by the experts in the Ministry of Health's Mental Health Bureau and its Cronbach's alpha was 0. Its reliability was evaluated in a pilot study and the kappa coefficient was estimated at 0. Each question is divided into 2 parts based on gender, male and female, and has three age groups: under 18, 18 to 30, and over In each section, if the respondents knew someone, they would report the number of people. The last part included demographic questions i. Four interviewers 2 women and 2 men were selected and trained through a roleplaying method Mr. Tavasoli, Mr. Torkan, Ms. Rezaei, and Ms. Talebi Por. The interviewers were assigned to different districts according to the timetable and based on the age-sex sampling table; they selected the passers-by and asked them for an informed consent. Ethical considerations: All questionnaires were completed anonymously and all information remained confidential. In order to persuade people to answer the questions, the interviewers tried to find a relatively secluded place. Due to the possibility of increasing unwillingness to take part in the study, verbal consent was obtained rather than a written one. In this study, the transparency coefficient varied from 0. The indicators of mean, standard deviation, frequency, and frequency percentage were used to data analysis and independent t-test and chi-squared test were used for data analysis. Thus, participants from each of the 14 regions were weighted based on the population of that area probability weight. The selected clusters from each area were also coded 1 to 4 as primary sampling units. The sex variable was considered as a stratum. A Finite population correlation was used to determine the odds equivalent in selecting the samples. The age of the participants ranged from 18 to 73 years. The mean age SD of the participants was In both genders, most of the participants had a diploma. Most of the participants were married. In all types of drugs, the prevalence of drug use was higher in men than women. Among men, cannabis was the third most used drug after tobacco, and opium and its nectar, while it was the second most used drug among women. In both sexes, the prevalence of opium and Shireh use and illegal treatment with methadone and buprenorphine among people over 30 years of age was higher than that in other age groups. Likewise, the prevalence of cannabis, ecstasy, hallucinogens, tramadol, tobacco, stimulants, and zolpidem among men of years of age was higher than that among the older and younger age groups. In addition, the prevalence of cannabis, stimulants, ecstasy, tramadol, zolpidem, and tobacco, legal treatment with methadone and buprenorphine, and injecting drug use was higher in women of 18 to 30 years of age. Furthermore, the prevalence of injecting drug use and legal treatment with methadone and buprenorphine was 0 in women under 18 years of age Table 2. The results indicated a high prevalence of use of different types of drugs in Isfahan. Tobacco use was had the highest prevalence, followed by opium and cannabis in men, and cannabis and opium among women, respectively. The highest prevalence of drug use in Isfahan was related to tobacco. In a study by Meysamie et al. Evidently, easy and low-cost access to different drug compounds and purity rates are other reasons for increase in drug use. The highest prevalence of the use of ecstasy pills in the city of Isfahan, which was first estimated by the NSUM, was in the sexually active age group of years. Prolonged duration of ejaculation may be one of the reasons for the use of ecstasy pills. The present study estimated the prevalence of zolpidem in Isfahan through NSUM for the first time, and the results indicated that the use of this hypnotic drug was much higher than the expected medical consumption, especially in people of 18 to 30 years of age. There have been reports of zolpidem addiction in athletes, physicians, and students, necessitating attention to this modern addiction and examination of the causes of young people's tendency to take this drug. The prevalence of injecting drug use in Isfahan was lower than estimations in the studies by Baneshi , 2 and Nikfarjam et al. Female sex workers, homosexual men, and injecting drug users IDUs are the 3 most vulnerable groups of a society at risk of developing HIV. In the present study, it was estimated that more than one-third of men who inject drugs had a constant behavioral addiction, while the prevalence of injecting drugs in women was 0. The results of this study indicated that the prevalence of different drug abuse types among men is more likely than women. According to the results of the present study, the highest prevalence of drug use among men and women was observed in the age groups of 18 to 30 and over 30 years, which is in line with the study by Nikfarjam et al. Evidently, it is also important to pay attention to children of less than 18 years of age. A study by Ranjbaran et al. One of the limitations of the present study was the impossibility of household-based random sampling due to the sensitivity of the considered subject, i. Therefore, through multistage sampling and random selection of people at specified intervals, we attempted to approach the sampling systematically. Second, there is likely reporting bias because some refusing people to participate in the study may recognize many DUs in their social network. However, due to the inability to track people, it was not possible to check and compare the characteristics of DUs with those participating in the study. Third, the size of the social network of DUs is smaller than that of the general population, 7 which will cause underestimation. Moreover, the size of the social network of the general population may vary by gender and age, and even by various regions of the country. However, due to the lack of accurate information in this regard, it was decided to use the indices used in earlier studies in Iran. The results of the present study showed that the prevalence of drug use in Isfahan city, especially in men, is significant and in some cases even higher than the average reported in other studies in the country. Since the prevalence of drug use varies by the type of substance used in the age groups of and over 30 years, targeted preventive planning by type of drug and age group is recommended. The authors would like to thank all those who helped us with this project, including the interviewers. They would also like to thank the Social Deputy of the Police Command of Isfahan who assisted in the performance of our citywide survey, Ayandeh Pazhouhi Center associated with Kerman University of Medical Sciences for providing the questionnaires and scientific advice, and Dr. Marjan Meshkati and Dr. Ramin Radfar for their scientific and practical advice. Collected data, analysis, and wrote the original draft: MAJ; statistics advisor- contributed to analysis: MB; contributed to analysis, review, and editing: MN. As a library, NLM provides access to scientific literature. Addict Health. Find articles by Meysam Abshenas-Jami. Find articles by Mohamadreza Baneshi. Find articles by Maryam Nasirian. Received May 17; Accepted Jul Open in a new tab. Conflicts of Interest The Authors have no conflict of interest. Similar articles. Add to Collections. Create a new collection. 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Substance Abuse among Iranian High School Students
Buying Ecstasy online in Isfahan
Metrics details. Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system. Even though hookah use in the western world is a recent trend, it has existed for a millennium, emerging in the North Western provinces of India, spreading to Iran, the Arab world, and Turkey and now gaining popularity in the USA and Europe \[ 2 \]. PubMed search results for different names of hookah used in the literatures. Hookah is the most common used term followed by waterpipe and shisha. The hookah or hookah apparatus is composed of an upper and lower compartment connected by a pipe Fig. Briefly, the top consists of a bowl where tobacco or molasses are placed then covered with perforated aluminum foil above which burning charcoal is placed. On the bottom of the apparatus resides a water jar covered by a gasket, protruding a hose and a release valve used for clearing out stagnate smoke \[ 1 , 2 , 3 \]. A detailed description of hookah components is provided in Table 1. Indeed, one study reported that differences in pipe material affected the levels of carbon monoxide CO exposure, correlating the non-porous plastic hose with higher yields of CO compared to the more porous leather hose \[ 6 \]. The same theory could be applied to yields of other chemicals, especially nicotine. There are three commonly used types of hookah tobacco, Mouassal, Jurak, and Tumbak, each contains different ingredients. Hadidi and Mohammed \[ 8 \] estimated that the nicotine contents of Mouassal is about 3. Jurak is commonly used in the Middle East and Gulf region. Finally, Tumbak, which is used mainly in Asia, is a pure form of unflavored tobacco leaves Ajami smoked with charcoal. In the USA, there are different flavors used in the hookah tobacco with the most popular being the fruit flavors \[ 9 \]. Similarly, among university students, fruit flavored tobacco was preferred to unflavored ones \[ 10 \]. The user or the person preparing the hookah Fig. During inhalation, charcoal-heated air passes through the pierced aluminum foil and through the tobacco down the pipe and towards the water. Taken together, hookah smoking seems to have a complex puffing behavior when compared to conventional cigarette smoking. Both cigarette- and hookah-smoking topography serves as an indirect measure of smoke and chemical exposure \[ 12 , 14 \]. In comparison to cigarettes, hookah puffing is more variable including total puffing time, number of puffs, and total smoke inhaled, all being affected by the nicotine content of tobacco, the presence of flavors, the personal preferences, and the social setting of the vaping session \[ 12 , 15 , 16 \]. Furthermore, number of puffs, mean puff duration, puff volume, and inter-puff intervals were higher in hookah \[ 22 , 23 , 24 \], in contrast to conventional smoking \[ 25 , 26 \]. Importantly, this higher humidity of the smoke and its cooled down nature facilitates deeper inhalation potentially increasing the side effects of using hookah \[ 2 \]. As mentioned before, hookah became widely popular, with its use accelerating rapidly especially among youth and women \[ 28 , 29 \]. Although there are ample justifications in the literature for hookah use, in this section, we will include the most commonly reported, in addition to the prevalence of hookah. One factor that drastically contributed to the increased hookah use similarly to e-cigarette use is the misperception about the health risks. However, nicotine could be easily absorbed through the mucosal lining of oral cavity \[ 2 \]. To this end, a recent study conducted on social media Twitter found that social events and flavors were among the common contexts and experiences associated with Twitter discussions about hookah — \[ 39 \]. Thus, clearly, there should be more emphasis on research studies that examine hookah health risks, which would inform campaigns for educating the public on the myths and the negative health effects associated with hookah use. Worldwide, it is estimated that million people use hookah on a daily bases \[ 40 \]. Furthermore, while the majority of US hookah users are also tobacco smokers, a significant portion of hookah users are non-smokers \[ 35 , 38 \]. In this connection, differences between rural and urban US in smoking hookah were also examined, and the results illustrated more prevalence of hookah use in urban areas in comparison to rural areas \[ 46 \]. This difference could be attributed to the sociocultural and economic factors linked to living in urban areas. It is difficult to determine what might be the cause behind this increase in the west, but potentially, it might derive—in part—from the higher population of Arab Americans within these regions. Regardless, conducting research on hookah environment characteristics such as the number of hookah bars, methods of advertising, and social behaviors could serve as the first step in further understanding the increasing prevalence and popularity of hookah. Hookah use among US youth population in schools was under scrutiny in many studies. For instance, one study surveyed a representative sample of 6th—12th grade students for hookah use, and the results showed that These results are remarkable as they show that as young as sixth grade vulnerable population can be a user of hookah, and potentially exposed to all associated health risks. According to the same study, household hookah users and easy access are the main motivation to use hookah in such young age \[ 48 \]. Notably, this belief is the major reason many adults use hookah, in addition to viewing it as a good way of socializing, and the belief that it helps quitting cigarettes, as well as being relatively cheaper than smoking cigarettes \[ 34 \]. Another drastic and more concerning increase of 5. This is especially troublesome as adolescents continue to be exposed to harmful tobacco product constituents, in particular nicotine that might interfere with brain development, cause addiction, and might lead to sustained future tobacco use \[ 53 \]. This increase in use could be attributed to the perception of fewer negative consequences of hookah smoking compared with cigarette smoking and the social norms regarding its acceptability among this population \[ 55 , 56 , 57 \]. Regardless of the variability in hookah prevalence among the various populations, clearly, there is an overall drastic increase in its use over a short period. Consequently, it is important to evaluate the major compounds expelled from hookah vape, in order to aid in evaluating both acute and chronic health outcomes. Several toxicants have been found in mainstream hookah smoke including nicotine \[ 27 , 61 , 62 , 63 , 64 \], carbon monoxide \[ 27 , 63 \], carcinogenic polycyclic aromatic hydrocarbons PAHs \[ 27 , 61 , 63 , 64 , 65 \], aromatic amines \[ 63 \], aldehydes \[ 64 , 66 \], furanic and phenolic compounds \[ 67 , 68 \], tar \[ 19 , 61 \], particulate matter \[ 69 \], heavy metals \[ 19 \], and ammonia \[ 70 \]. Comparison of the levels of some toxicant expelled in both hookah and tobacco smoke. Levels of the toxicants a tar, CO, b carbonyl compounds formaldehyde and acetaldehyde , and c certain PAHs are indicated. Nicotine—the major source of tobacco addiction—content in hookah is extremely variable as it depends on the type of tobacco used. Consequently, the amount uptaken by the user depends on hookah use characteristics that are adjusted depending on nicotine levels in tobacco used in order to deliver desired doses \[ 62 \]. Similar to cigarette smoking, plasma nicotine levels were found to be increased in hookah users, indicating systematic delivery of nicotine. This is because CO displaces O 2 from hemoglobin forming carboxyhemoglobin CO affinity for hemoglobin is times that of O 2 and shifting the oxygen dissociation curve to the left, thereby causing hypoxia and impairment of cellular respiration \[ 76 \]. Notably, hookah use was linked to several cases of CO poisoning \[ 77 , 78 , 79 , 80 , 81 \]. Furthermore, NNAL—a metabolite formed after 4- methylnitrosamino 3-pyridyl butanone NNK enters the body and a well known carcinogen—urinary levels increased markedly after hookah use, indicating the presence of tobacco-specific nitrosamines in hookah smoke \[ 63 , 82 \]. Of note, levels of tar delivered vary from session to session, reaching up to folds in some cases of longer hookah smoking sessions \[ 84 \]. For instance, aldehydes, such as acrolein, induce cardiopulmonary toxicity \[ 85 , 86 \], are potentially carcinogenic \[ 87 , 88 \], and are prothrombotic \[ 89 \]. Furthermore, the PAHs are carcinogenic \[ 90 \], whereas carbon monoxide induces cardiovascular disease \[ 91 \], and nicotine is known for its addictive nature \[ 92 \]. As for ammonia, which is a strong respiratory irritant, its levels should be measured as part of the assessment of the hookah toxicant profile, and this could be achieved using a simple colorimetric method as was recently described for determining ammonia levels in tobacco fillers and sidestream smoke in different tobacco brands \[ 93 \]. Based on the aforementioned considerations, hookah use poses as many or even higher risks for the smoker as cigarette smoking. Ambient concentrations of particulate matter are often used to assess pollution levels from tobacco smoke \[ 94 \]. Cigarette smoking expels high levels of particulate matter in bars, exposing both customers and employees passively to hazardous levels of pollutants \[ 95 \]. Nonetheless, such low air quality exposes non-users within the household to hazardous materials and puts them under increased risk of disease, especially if they are highly vulnerable with chronic disease, children, and pregnant women. Consequently, there is a marked need for further research, policies, and better air quality monitoring to improve the indoor air quality in order to reduce passive exposure and its negative health consequences. Comparison between PM2. While hookah users and those in close proximity are exposed to many of the potentially dangerous toxicants at one time, the health risks associated with its use continue to be under debate. This is—in part—attributed to the fact that the composition of tobacco smoke in hookah and its puffing patterns are variable and not well standardized. Nonetheless, several studies have provided evidence of health impairments that are associated with hookah use. Theoretically, sharing the mouthpiece during hookah group smoking can be a probable source of transmission of pathogens such as viruses, bacteria, and fungi. For instance, a study reported a potential risk for transmission of communicable diseases such as hepatitis C when sharing the mouthpiece between users with bleeding gum \[ 99 \]. Other studies have also linked hookah to transmission of Helicobacter pylori main cause of peptic ulcer and Aspergillus spores cause of pneumonia in immunocompromised patients \[ , \]. Moreover, 48 bacterial isolates were detected from hookah hoses, and among them were virulent as well as antibiotic-resistant strains \[ \]. Furthermore, using hookah was linked to developing periodontal diseases in similar magnitude to cigarettes \[ \] as well as documented alteration in oral microbial flora \[ \]. Similar to cigarette smoking, hookah use is also linked to a harmful impact on the pulmonary system. Thus, hookah users complain of symptoms such as wheezing, cough, sputum, and shortness of breath \[ , , \]. FeNO is an essential marker of eosinophilic airway inflammation, and reduction in its levels may be due to rapid conversion of nitric oxide to peroxynitrite by reactive oxygen and nitrogen species or downregulation of nitric oxide synthase \[ , \]. Also, hookah users had lower lung diffusing capacity and elevated levels of apoptotic endothelial cell microparticles \[ \]. Hookah exposure induced a significant elevation of macrophages, lymphocytes, and neutrophils in broncho-alveolar lavage fluid and altered the levels of several cytokines. It also increased catalase activity in the lung and resulted in changes in the level and mRNA of major matrix metalloproteinases MMP-1, MMP-9, and MMP , confirming pulmonary damage associated with hookah use \[ , \]. To this end, in a population-based study, hookah use was associated with metabolic syndrome development. Thus, hookah users had significantly higher incidence of hypertriglyceridemia and hyperglycemia, as well as hypertension and abdominal obesity, which was observed after controlling for age, sex, social class, and area of residence \[ \]. Unfortunately and as stated before, the number of hookah users among the vulnerable populations of pregnant females and adolescents is increasing. In fact, pregnant females still use hookah during pregnancy, regardless of its reported hazards. Moreover, the risk of delivering low birth babies tripled, in addition to reported neonatal respiratory distress that is linked to hookah use during the first trimester \[ , \]. In a rat exposure model, hookah smoke exposure was shown to be associated with low birth weight, increased neonatal death rate, and lower growth rate among offspring \[ \]. Additionally, prenatal exposure to hookah smoke in a murine model of asthma in adult mice offspring also induced airway inflammation and adversely affected lung function \[ \]. In utero exposure to hookah tobacco smoke in rats resulted in impaired memory and decreased brain-derived neurotrophic factor in hippocampus of adult male offspring rats \[ \]. A study of hookah use among 7th—10th grade students indicated that it may impair adolescent brain development, given that it reduces the levels of the brain-derived neutrophic factor BDNF \[ \], which is essential for cognition and behavior \[ \]. A relatively recent study also reported a reduction in BDNF serum levels in students reflecting a possibility of systematic adverse health alterations in adolescence, coupled with behavioral changes low attention and aggression \[ \]. Moreover, hookah tobacco smoke exposure in rats induced short- and long-term spatial memory impairment \[ \], which was associated with reduced hippocampal levels of major oxidative stress biomarkers and oxidative capacity enzymes \[ , \]. With respect to carcinogenicity of hookah, it was reported that carcinoembryonic antigen CEA levels were higher in hookah smokers, in comparison to non-smokers, yet not as high as in cigarette smokers \[ \]. Furthermore, three case-control studies reported a link between the risk of esophageal cancer and hookah use, with the risk increasing with cumulative use, higher frequency, and the duration of use \[ , , \]. Additionally, using hookah was linked to an average of six folds higher risk of lung cancer \[ , , , \]. Moreover, it was reported that hookah use may increase the risk of gastric cancer by threefold, albeit the mechanism remains unknown \[ \]. In addition, hookah smoking was shown to be genotoxic, leading to DNA damage in lymphocytes, where the magnitude of its genotoxicity was higher than that induced by cigarette smoking \[ , \]. Exposure to hookah smoking resulted in elevated plasma and saliva levels of toxic metals, namely cadmium, copper, and zinc \[ \], which could contribute to its long-term carcinogenicity. It is noteworthy that many of the aforementioned studies had limitations, for example, no control over use of other forms of tobacco and lack adjustments of the cofounding factors in some case studies, as well as limited assessment of gender and age as cofounders. Nonetheless and taken together, there is sufficient evidence in support of the association of hookah use with negative human health outcomes. Cardiovascular effects and their underlying mechanisms. These data are compiled from what is reported in clinical studies. The detrimental acute and chronic effects of tobacco smoking on the cardiovascular system are well established \[ , , , , , \]. In light of that, it has been shown that hookah smoke effects on the cardiovascular system are comparable to those of conventional cigarettes. It is noteworthy that a recent meta-analysis reported an odds ratio of association between hookah tobacco smoking and heart disease of 1. Acute effects of conventional smoking, such as increased blood pressure, heart rate, and vascular resistance, have been known for decades \[ , , , , , \]. As with tobacco smoking, the instantaneous effects of hookah use include higher systolic and mean arterial blood pressure, as well as elevated heart rate HR \[ 17 , 23 , , , , , , \]. These effects have been attributed, in part, to the baroreflex mechanism impairment \[ \] or to elevated nicotine plasma level. The latter exhibits adrenergic effects that will enhance local and systemic catecholamine release \[ 15 , 18 , , , , \]. Supporting the latter notion, mean post-hookah-smoking HR elevation was doubled in participants using nicotine-containing hookah in comparison to nicotine-free hookah smokers \[ \]. Another study reported that changes in the cardiovascular central and peripheral components occur immediately after hookah smoking and include increases in HR, blood pressure, and after occlusion vascular resistance, whereas after occlusion blood flow and outflow were decreased \[ \]. The cardiovascular changes were shown to be exacerbated among individuals with low habitual physical activity and physical fitness levels \[ \]. More recently, it has been reported that adolescents smoking hookah had significantly lower vascular endothelium growth factor VEGF levels \[ \], which might adversely affect vascular growth and function in this population. Acute use of hookah also induced changes in the peripheral vascular system in similar fashion to cigarette smoking, such that it increased vascular resistance and reduced post-occlusion blood flow. In a manner comparable to cigarette smoking, short-term hookah use significantly impaired flow-mediated dilation FMD , which indicates endothelial dysfunction, but hookah was a weaker predictor for high risk profile \[ \]. Furthermore, it was reported that short-term hookah use both tobacco-based and tobacco-free products disrupts the autonomic nervous system regulation on the cardiac cycle, thereby causing a reduction in HRvariability, which—in turn—might aggravate the risk of coronary artery disease development \[ 18 \]. Moreover, a significant increase in TXB 2 levels, a metabolite of the biologically active TXA 2 , and an index of oxidative injury were reported after a single hookah smoking session \[ \]. This increase in TXB 2 levels would suggest an increase in platelet activity \[ \]. Importantly, it has been shown that an increase in platelet activity plays a major role in the pathogenesis of acute myocardial infarction MI \[ \] and acute stroke \[ , , \]. Therefore, it is not surprising to see a link between hookah smoking and acute MI in young adults \[ \], and among patient undergoing cardiac catheterization \[ \]. However, no data exist yet on the association between hookah smoking and acute stroke \[ \]. Interestingly, and contrary to the hypothesis that hookah decreases myocardial blood flow because of the charcoal combustion nanoparticles vasoconstrictor , a study found that hookah use acutely increased myocardial blood flow. In light of the aforementioned evidence, it is clear that even short-term use of hookah disrupts normal cardiovascular function, as repetitive short-term hookah exposure may be the triggering point of causal chain of reactions ultimately leading to the chronic effects. With regard to the adverse cardiovascular effects associated with longer-term of hookah use, they are comparable to those associated with cigarette smoking. In this connection, a link between chronic use of hookah and coronary artery disease CAD development has been shown, with the frequency and duration of exposure being critical risk factors to CAD. Additionally, cardiovascular disease development such as ischemic heart disease IHD and heart failure has been associated with heavy hookah smoking \[ \]. These outcomes could be explained by the continuous stress placed on the cardiovascular system as result of exposure to high amounts of CO \[ \]. Furthermore, death due to IHD was 1. In accordance with the latter data, dose-response relationship between hookah-years and percent stenosis was also established \[ \]. Furthermore, risk of MI and stroke death was significantly increased with hookah smoking. Notably and interestingly, a recent cross-sectional study aimed to examine the relationship between chronic hookah smoking and cardiovascular hemodynamics in adolescents found a reduction in both BP and HR of adolescent hookah smokers versus non-smokers, which is in contrast to previously reported results in adults. Nonetheless, the exact mechanism underlying such outcome is still unclear but warrants investigation \[ \]. Together, hookah use has been associated with many cardiovascular effects that influence or contribute to the decline of the overall health status of members of our communities. Unfortunately, despite studies documenting cardiovascular disease risks associated with hookah, people continue to assume that it is safer than cigarettes, mainly due to being unaware of its negative health effects. Acute and chronic exposures to hookah smoke resulted in significant changes in kidney function biomarkers such as creatinine and blood urea nitrogen, in mice. This was associated with reduction in antioxidant enzymes and biomarkers including superoxide dismutase for acute and chronic hookah smoke exposures, and catalase, glutathione peroxidase, and thiobarbituric acid reactive substances for chronic exposure \[ \]. Acute and chronic exposure of mice to hookah corroborates with the clinical findings that suggest cardiovascular dysfunction. Thus, short-term nose-only exposure to mainstream hookah for 5 consecutive days induced a significant decrease in platelet numbers and amplified in vitro platelet aggregation indicating a prothrombotic state \[ , \]. Furthermore, cardiac inflammation with an increase in reactive oxygen species ROS was observed, which consequently caused an elevation in heart glutathione GSH; an antioxidant concentrations. This seems to indicate that an initial adaptive response that counterbalances the potentially damaging activity of ROS \[ \] is triggered. The increased cardiac vulnerability may explain the increased systolic blood pressure reported after long-term use, which was not seen post-short-term exposure \[ , \]. In summary, both clinical and animal studies have provided substantial evidence of a link between cardiovascular disease development and hookah short- and long-term use. However, there remain some knowledge gaps; firstly, there is a lack of well-designed studies addressing the association between hookah use and cardiovascular diseases. Second, the pathophysiologic mechanisms underlying the cardiovascular adverse effect are not fully understood, and thus, studies to address these issues are not only warranted but also critical at this point. For instance, e-cigarette use has been linked to increased health risks, including increase thrombosis risk \[ \] as well as throat and mouth irritation, respiratory tract irritation, and behavioral changes among others \[ \]. As for the use of e-liquids in e-hookah, that would be expected to produce the same toxicity as e-cigarettes. The evolving nature of these devices supports the notion that investigating their use patterns, purpose, prevalence, and potential health effects is crucial. Meanwhile, the public health experts should educate the public about the possible yet unknown health hazards of these products, whereas policy makers should limit their access to youth. As mentioned before, hookah smoke may be associated with similar or even greater inhalation of toxicants in comparison to cigarettes. Since , the FDA finalized a rule extending their control of all tobacco products, including hookah tobacco. FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, and sale, as well as distribution of hookah tobacco and of all hookah apparatus parts except the accessories; lighters and tongs \[ \]. Unfortunately, youth represent a large portion of the hookah user population, and their accessibility is facilitated through online ordering. To control such means of access, major credit card companies should ban online payments for hookah, as they did with cigarettes \[ \]. Tobacco is a preventable cause of morbidity and mortality worldwide. Lately, as also noted by the American Heart Association statement \[ \], hookah has been considered a global threat—in part—due to the high increase of its use, in addition to the deleterious effects it has on human body such as frequent respiratory infections, persistent cough, oral and esophageal cancer, and induction of a pro-inflammatory state. In this connection, recent studies have shown that the levels of hookah-emitted chemicals vary depending on multiple factors such as topography, experience, session length, and type of tobacco used during each session. The widespread and increasing usage of hookah in the USA is concerning. Collectively, these findings can be used in educational campaigns for the public, as well as in shaping policies for further evidence-based hookah control. However, the corresponding authors will share the sources of the data upon request. The growing epidemic of water pipe smoking: health effects and future needs. Respir Med. Article PubMed Google Scholar. Waterpipe smoking: not necessarily less hazardous than cigarette smoking: possible consequences for cardiovascular disease. Neth Heart J. Nakkash R, Khalil J. Health warning labelling practices on narghile shisha, hookah waterpipe tobacco products and related accessories. Tob Control. Chaouachi K. Libyan J Med. Advisory Note: Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators. Saleh R, Shihadeh A. Elevated toxicant yields with narghile waterpipes smoked using a plastic hose. Food Chem Toxicol. Radiological hazards of Narghile hookah, shisha, goza smoking: activity concentrations and dose assessment. J Environ Radioact. Nicotine content in tobacco used in hubble-bubble smoking. Saudi Med J. PubMed Google Scholar. Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U. Nicotin Tob Res. Article Google Scholar. 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Water pipe hookah smoking and cardiovascular disease risk: a scientific statement from the American Heart Association. Hookah steam stones: smoking vapour expands from electronic cigarettes to waterpipes. Download references. Hanan Qasim, Ahmed B. Alarabi, Zubair A. Karim, Fatima Z. You can also search for this author in PubMed Google Scholar. HQ wrote the manuscript and prepared the figure. ABA wrote the manuscript and prepared the figures. KHA wrote the manuscript. ZAK conceptualized and edited the manuscript. FZA conceptualized and edited the manuscript. FTK conceptualized and edited the manuscript. All authors read and approved the final manuscript. Correspondence to Fatima Z. Alshbool or Fadi T. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions. Qasim, H. Environ Health Prev Med 24 , 58 Download citation. Received : 28 May Accepted : 22 August Published : 14 September Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Alarabi 1 , Karem H. Alzoubi 2 , Zubair A. Karim 1 , Fatima Z. Abstract Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. Full size image. A typical hookah apparatus. Table 1 Hookah apparatus components and their use Full size table. Reasons and prevalence of hookah use As mentioned before, hookah became widely popular, with its use accelerating rapidly especially among youth and women \[ 28 , 29 \]. Prevalence Worldwide, it is estimated that million people use hookah on a daily bases \[ 40 \]. Hookah health hazards While hookah users and those in close proximity are exposed to many of the potentially dangerous toxicants at one time, the health risks associated with its use continue to be under debate. Cardiovascular effects of hookah use The detrimental acute and chronic effects of tobacco smoking on the cardiovascular system are well established \[ , , , , , \]. Clinical studies Acute cardiovascular effects Acute effects of conventional smoking, such as increased blood pressure, heart rate, and vascular resistance, have been known for decades \[ , , , , , \]. Cardiovascular effects of chronic use With regard to the adverse cardiovascular effects associated with longer-term of hookah use, they are comparable to those associated with cigarette smoking. Animal studies Acute and chronic exposures to hookah smoke resulted in significant changes in kidney function biomarkers such as creatinine and blood urea nitrogen, in mice. Conclusion Tobacco is a preventable cause of morbidity and mortality worldwide. Article Google Scholar Noonan D. Acknowledgements None. Funding Not applicable. Alzoubi Authors Hanan Qasim View author publications. View author publications. Ethics declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. About this article. Cite this article Qasim, H. Copy to clipboard. Contact us General enquiries: info biomedcentral.
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