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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Thursday, July 13, 2006 - 12:00 PM

Waterpipe Smoking and Addiction: a Primary Dependence Scale

Rehab Abdel Rahman, MD, MPH, Public Health Deaprtment, Ain Shams University and Egyptian Smoking Research Institute (ESPRI), Public Health section,, Teviot place, EH8 9 AG, Edinburgh, United Kingdom, Christopher A. Loffredo, PhD, Department of Oncology, Georgetown University School of Medicine, Box 571472, 3800 Reservoir Rd, Washington, DC 20057-1472, Maged El-Setouhy, MD, Public Health, Egyptian Smoking Prevention Research Institute (ESPRI), Dept. Of Public Health. College of medicine. Ain Shams university. Abbasia., Cairo, Egypt, and Mostafa K. Mohamed, MD, PhD, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Abassia Square, Cairo, Egypt.

Objective: 1- assess evidence for addiction among waterpipe smokers 2-construct a primary dependency scale for waterpipe smoking

Methods: Exclusive waterpipe smokers were selected and interviewed from a rural male Egyptian cohort. A smoking intensity index was created by summing up scores of daily tobacco consumption and first smoking time after wake up. Subjects were then classified into highly, moderately, and slightly dependant according to this index. The resulting groups were compared to other dependency scale items.

Results: 150 waterpipe smokers were identified with mean age of 45 years. Most were married (93%) and had no school education (67%). The following evidence of addiction was observed: (a) of those who never tried to quit, 80% wanted to do so, compared to 94% of those who had tried to quite (p < 0.05); (b) the mean age of initiation was inversely correlated with most of the dependency index items (p<0.001); (c) the group of highly dependent waterpipe smokers had the highest scores for other items in the Fagerstrom scale (p<0.05) and were less likely to have tried quitting compared to slightly addicted smokers (41% vs. 88%, p<0.001).

Conclusion: waterpipe smoking shows clear evidence of being an addictive behavior. The smoking intensity index we developed provides a primary assessment tool to assess dependence among such smokers. Exclusive waterpipe smoking was also linked to many attributes (age, marital status, and education), which may provide useful information for prevention activities.