Waterpipe smoking is popular in many parts of the world. Micronuclei (MN) evaluation in the exfoliated oral cells of smokers is a non-invasive technique for evaluation of possible tobacco harm. We aimed to assess whether MN levels are higher in waterpipe smokers than in never smokers. We examined oral smears of 128 adult male waterpipe smokers and 78 males who never smoked tobacco in rural Egypt The total number of MN per 1000 cells per subject, and the number of MN-containing cells per individual were compared. We observed a higher level of total MN in waterpipe smokers (10 ± 4) than in never smokers (4 ± 2, p<0.001). A similar difference was found for the mean number of affected cells per individual (8 ± 3 vs. 4 ± 1.62, p < 0.001). MN levels were not significantly dose related. This study is among the first to assess the association between waterpipe smoking and a cytogenetic measure of tobacco harm. The two-fold increase in MN level is consistent with previous reports of MN in cigarette smokers. More research is needed to determine if such MN levels are predictive of future health consequences.

This study investigated behavioral and sociodemographic factors associated with tobacco use among female university students patronizing water pipe cafes in Cairo, Egypt. We interviewed two groups of female university student smokers (100 and 96 students from a public and a private university, respectively). The interviews took place in nine water pipe cafes near the two universities. A logistic regression model was developed to analyze the relationship between tobacco-related knowledge and beliefs and the choice between smoking water pipe or cigarettes. Among these smokers, 27% smoked cigarettes only, 37.8% smoked water pipe only, and 35.2% smoked both types of tobacco. Most of the water pipe smokers (74.1%) preferred this method because they believe it to be less harmful than smoking cigarettes. More than half of the subjects were encouraged to start smoking by other females (56.6%). Curiosity was a significant factor for initiation (OR = 2.8, 95% CI = 1.3-6.2, p<.01). We found no significant differences between water pipe and cigarette smokers regarding current age, age at initiation, quit attempts, knowledge about the hazards of smoking, wanting to be fashionable, or smoking with friends. About one in four (23.7%) attempted to quit, with health cited as a major reason. An urgent need exists for correction of the misperception among this study population that water pipe smoking is safe and less harmful than cigarette smoking.

introduction: Tobacco use in low-to middle-income countries is a major public health concern for both smokers and those exposed to environmental tobacco smoke (ETS). Egypt has made important strides in controlling tobacco use, but smoking and ETS remain highly prevalent. This randomized intervention sought to improve the target population's knowledge regarding the hazards of smoking and ETS and to change attitudes and smoking behaviors within the community and the household.

Introduction: The causal relationship between tobacco smoking and a variety of cancers is attributable to the carcinogens that smokers inhale, including tobacco-specifi c nitrosamines (TSNAs). We aimed to assess the exposure to TSNAs in waterpipe smokers (WPS), cigarette smokers (CS), and nonsmoking females exposed to tobacco smoke. Methods:We measured 2 metabolites , 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides (NNAl-Gluc) in the urine of males who were either current CS or WPS, and their wives exposed to either cigarette or waterpipe smoke in a sample of 46 subjects from rural Egypt.Results: Of the 24 current male smokers, 54.2% were exclusive CS and 45.8% were exclusive WPS. Among wives, 59.1% reported exposure to cigarette smoke and 40.9% to waterpipe smoke. The geometric mean of urinary NNAL was 0.19 ± 0.60 pmol/ml urine (range 0.005 -2.58) in the total sample. Signifi cantly higher levels of NNAL were observed among male smokers of either cigarettes or waterpipe (0.89 ± 0.53 pmol/ml, range 0.78 -2.58 in CS and 0.21 -1.71 in WPS) compared with nonsmoking wives (0.04 ± 0.18 pmol/ml, range 0.01 -0.60 in CS wives, 0.05 -0.23 in WPS wives, p = .000). Among males, CS had signifi cantly higher levels of NNAL compared with WPS (1.22 vs. 0.62; p = .007). However, no signifi cant difference was detected in NNAL levels between wives exposed to cigarette smoke or waterpipe smoke. Conclusions:Cigarette smokers levels of NNAL were higher than WPS levels in males. Exposure to tobacco smoke was evident in wives of both CS and WPS. Among WPS, NNAL tended to increase with increasing numbers of hagars smoked/day.

Summary Setting Waterpipe smoking is increasing worldwide. Nevertheless, little is known about nicotine dependence in tobacco smokers who use waterpipes. Objective To assess evidence of dependence among non-cigarette smoking waterpipe smokers in Egypt. Methods A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We adapted the Fagerström test for nicotine dependence and the Reasons for Smoking (RFS) scales and related these to smoking behavior. Results The mean age of the subjects was 47 ± 14 years, the mean age at smoking initiation was 22 ± 9 years, and average daily consumption was 4 ± 8 hagars (tobacco units). The time to the first smoke of the day (P < 0.001), smoking even when ill (P = 0.003), time to tobacco craving (P < 0.001), and hating to give up the first smoke of the day (P = 0.033) were each significantly associated with the number of hagars smoked per day. The RFS subscales of addictive smoking, smoking to relieve negative affect, and smoking for stimulation were also associated with these variables. Conclusion The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.