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Is there a need for a GB shisha cessation service? Findings from cross-sectional surveys conducted in 2012 and 2013 Dr. Aimee Grant, Public Health Wales.

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Presentation on theme: "Is there a need for a GB shisha cessation service? Findings from cross-sectional surveys conducted in 2012 and 2013 Dr. Aimee Grant, Public Health Wales."— Presentation transcript:

1 Is there a need for a GB shisha cessation service? Findings from cross-sectional surveys conducted in 2012 and 2013 Dr. Aimee Grant, Public Health Wales NHS Trust, Rory Morrison, ASH Scotland, Martin Dockrell, ASH

2 Overview How harmful is shisha for health? Existing research: prevalence of shisha use Research design Findings How should we respond? Do we need a shisha cessation service?

3 How harmful is shisha for health? World Health Organisation (2005) CO poisoning (Clarke et al., 2012) Laboratory study 1 (Eissenberg and Shihadeh, 2009) – 45 mins shisha v 1 cigarette – High levels of exhaled CO (23.9ppm) – High puff volume (50 litres) – Similar peak nicotine levels Laboratory Study 2 (Daher et al., 2010) – Second hand smoke Ecological validity (Chaouachi, 2011)

4 Estimates of prevalence A ‘Global epidemic’? (Maziak, 2011) Large-population surveys – California Tobacco Survey – United Arab Emirates International survey evidence – Mostly students (5 peer reviewed published studies) – Some small samples (Al-Naggar and Saghir, 2011) – Opportunity sampling (Rehman et al., 2012) Evidence from the UK? – 2 student surveys (Jackson and Aveyard, 2008; Jawad et al., 2012)

5 Most articles from the UK focus on breaches of smoke- free legislation Three focus on an apparent rise in users Shisha in the news

6 Research design Research question: – What is the prevalence and frequency of shisha use among adults (aged 18+) in Great Britain? Design - repeated cross-sectional surveys: – Participants recruited from an online panel maintained by YouGov Plc using targeted quota sampling, surveys conducted online – Feb/March 2012 (n=12,436); Feb 2013 (n=12,171) – Results weighted to be representative of GB population by sex, age, social class, ethnicity, GB region, newspaper readership, voting intention

7 Findings: Prevalence & frequency of use, 2012 to 2013 Self-reported shisha use: 'How often, if at all, have you smoked using a “shisha” pipe? (Please note that shisha pipes are also known waterpipes or hookah pipes)' % (95% CI) % (95% CI) More than 3 to 4 times a month0.3 (0.2, 0.5) 0.3 (0.1, 0.4) Once or twice a month0.7 (0.4, 1.0) 0.7 (0.4, 0.9) Once or twice every 2 to 3 months0.5 (0.3, 0.6) 0.5 (0.3, 0.7) Once every 6 to 12 months1.5 (1.2, 1.8) Less often8.2 (7.6, 8.8) 9.0 (8.3, 9.6) Never68.9 (67.8, 70.0) 70.3 (69.3, 71.3) Don’t know/ can’t remember1.6 (1.3, 1.9) Not applicable – do not know what a shisha pipe is 18.2 (17.3,19.1) 16.2 (15.4, 17.0) Design-adjusted Chi-sq test for differences in shisha use between years: p-value = 0.13

8 % ‘ever’ & ‘frequent (at least once or twice a month)’ shisha use to 2013 Error bars represent 95% CI. No statistically significant difference between 2012 & 2013 surveys in ever shisha use (p=0.19), or frequent use (p=0.51)

9 % ‘ever’ shisha use, 2012 & 2013 combined, by: Gender Self- reported ever shisha use differs by gender (p<0.001)

10 % ‘ever’ shisha use, 2012 & 2013 combined, by: Age group Self- reported ever shisha use differs by age (p<0.001)

11 % ‘ever’ shisha use, 2012 & 2013 combined, by: Social Grade Self- reported ever shisha use differs by social grade (p<0.001)

12 % ‘ever’ shisha use, 2012 & 2013 combined, by: Ethnicity Self- reported ever shisha use differs by ethnicity (p<0.001)

13 % ‘ever’ shisha use, 2012 & 2013 combined, by: GB country of residence Self- reported ever shisha use differs by GB country of residence (p<0.001)

14 % ‘ever’ shisha use, 2012 & 2013 combined, by: Smoking status Self- reported ever shisha use differs by smoking status (p<0.001)

15 Multivariate analysis of predictors of ‘ever shisha use’ (1) Adjusting for covariates in a logistic regression model largely confirmed the results already presented Older adults were less likely to report ever use than younger Women less likely to report ever use than men Lower social grades less likely to report ever shisha use when compared to higher grades Increased odds of use for ‘mixed/multiple’ ethnic groups [OR 2.37 (95% CI 1.64 to 3.41)] and ‘Asian/Asian British’ [OR 1.84 (95% CI 1.39 to 2.45)] compared to white – but no difference detected for other groups

16 Multivariate analysis of predictors of ‘ever shisha use’ (2) Being a daily, non-daily, or ex-smoker raised odds compared to being a self-reported never smoker Compared to England, residing in Scotland reduced odds of reported ever use [OR 0.75 (95% CI 0.61 to 0.92) – no effect was found for Wales after adjustment for covariates A model based on the outcome of ‘frequent use’ gives similar results, and a range of sensitivity analyses did not materially alter the main conclusions

17 Strengths & limitations Strengths: – Large, recent survey, providing quite precise estimates of use Limitations: – Self-reported shisha use only – Survey conducted in English language, perhaps resulting in systematic exclusion of some groups – Probably, like many ‘opt-in’ survey methods, under-represents those from most disadvantaged areas who are harder to reach

18 The UK Public Health response to shisha Healthy Lives, Healthy People (2011) – Tower Hamlets and Coventry City Council Information and advice Tobacco Control Action Plan for Wales (2012) – SSS to develop a protocol to help users quit Reports of interventions in the media – NHS Hull and Hull City Council (Hull Daily Mail, ) ‘raise awareness’ – Leicester – Horn Concern (Leicester Mercury, ) raise awareness in young people

19 Should the public health response be expanded? Our survey provides little support for the notion of an ‘epidemic’ at the GB population level – but it does not preclude shisha being an issue in specific population sub- groups/local areas There is a need to enforce existing regulations – Violation of smokefree regulations – Use of illicit (tax free) products – Absence of health warnings on shisha – Age of users? – Lack of clarity regarding tobacco content of shisha Awareness raising activities for high risk groups Cessation support for regular users

20 Unanswered questions If a person smokes cigarettes every day and shisha once a month, which form of smoking should we be tackling? For ex-smokers, is “shisha prevention” vital relapse prevention? What is the right balance between shisha prevention/cessation and wider tobacco control? In a shisha strategy, what is the right balance between treatment and regulation?

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