Waterpipe Nicotine Dependence and Depressive Symptoms among Adolescent Waterpipe and Dual Users

Abstract

Background. Waterpipe nicotine dependence and its association with depressive symptoms and dual usage among adolescents are currently not examined in the literature. Adolescents are a vulnerable population that is susceptible to depression and initiation of tobacco use. We aim, in this novel study, to assess the association between depressive symptoms and waterpipe nicotine dependence among adolescents in Jordan, evaluate the association between waterpipe smoking status (waterpipe smoker vs. dual user) and waterpipe nicotine dependence, and assess the internal validity of the Waterpipe Nicotine Dependence Scale (WNDS). Method. A cross-sectional study among adolescents of grade 9th to 12th in Jordan was conducted through multistage cluster random sampling. The self-reported Arabic Youth Tobacco Use Composite Measure Questionnaire (YTUCM) was used to collect the surveys that include demographic information, smoking status, and the WNDS to assess waterpipe nicotine dependence and depressive symptoms. Multiple linear regression and the t-test were used to analyze the data. Findings. One thousand three hundred and three surveys were collected, of which 1082 were included in the study (443 males and 639 females). 64.9% of the sample were nontobacco users, while 20.1% were waterpipe- (WTP-) only smokers, 11.4% were dual users, and 3.7% were cigarettes-only users. After adjusting for weights, 66.6% were nonsmokers, 19.2% were WTP-only smokers, 10.2% were dual users, and 3.9% were cigarettes-only smokers. Using multiple linear regression, depressive symptoms were significantly associated with WTP nicotine dependence (β 0.618), upon adjusting for confounders. Furthermore, dual users were associated with higher WTP nicotine dependence (β 12.034) compared to WTP-only smokers after adjusting for confounders. Cronbach’s alpha for the WNDS was 0.955. Conclusions. Our study shows that there is a statistically significant association between depressive symptoms and WTP nicotine dependence and higher dependence among dual users compared to WTP-only smokers. The WNDS can be a useful tool to assess WTP nicotine dependence with high internal consistency. However, a longitudinal study is needed to further understand the association and temporality between the depressive symptoms and WTP nicotine dependence. Additionally, research is needed to shorten the WNDS while maintaining high internal consistency and assess the external validity of the WNDS and the short- and long-term consequences of dual usage.

Prevalence of waterpipe smoking and its associated factors among adolescents aged 12–16 years in 73 countries/territories

“…The harmful effects of waterpipe smoking are not restricted to adults, with adverse health effects such as acute lung infection and injury, carbon monoxide poisoning, and subclinical consequences (e.g., lung function decline, oral and systemic genotoxicity, and the alteration of vascular and hemodynamic functions) found among adolescents ( 14 ). Abbadi et al found that waterpipe nicotine dependence was associated with depressive symptoms among adolescents ( 15 ). Alomari et al reported that waterpipe smoking could inhibit the brain-derived neutrophic factor (which is the pivotal for neuronal survival, migration, dendritic arborization, synaptogenesis and differentiation) among adolescents ( 16 ).…”

Waterpipe smoking: Results from a population-based study in Qatar

“…Dual usage may promote and reinforce nicotine addiction. For instance, in a study conducted in Jordan, dual users were associated with higher waterpipe nicotine dependence compared to only waterpipe smokers 41 , which may postpone tobacco cessation and lower chances of successful cessation 42 . Therefore, dual and poly-tobacco use is an emerging pattern 2 that is becoming a public health concern since their synergistic health effects remain mostly unknown.…”

Prevalence estimates of drug addiction among high-school students and its association with violence, and school behaviors: A cross-sectional study from Jordan

“…Our finding of male predominance among drug users is concordant with previous studies that showed males had a higher prevalence of substance use than females [ [ 35 , 38 , 39 ]]. Abbadi et al investigated tobacco usage among adolescents of grades 9th to 12th in Jordan and found that approximately one-third of students were cigarette and/or waterpipe smokers, and males had higher rates of nicotine dependence than females [ 23 ]. This gender difference could be attributed to such beliefs, and social acceptability about drug use and smoking differ between males and females [ [ 40 ]].…”

“…Jordan has one of the youngest populations globally, with 63% of its population under 30 years, increasing the risk of drug use [ [19] , [20] , [21] ]. Previous reports have indicated an increase in substance and tobacco use in the Jordanian population [ 20 , [22] , [23] , [24] , [25] ]. Al-Husseini et al reported excessive use for medicine use (anti-Parkinson's drugs, benzodiazepine sedative-hypnotics, and anticholinergics) in community pharmacies since 2006 [ 25 ].…”