Waterpipe Tobacco Dependence In UK Male Adult Residents: A Cross Sectional Study Ali Al-Bakri, Saba Kassim, Mustafa al’Absi, Ray Croucher,

Introduction Waterpipe tobacco smoking (WPTS) is getting popular in Europe (1) WPTS has common and unique dependency aspects (2) WPTS dependency can not be measured in traditional cigarette dependency tools (2,3) WPTS dependence amongst UK adults WPT smokers has not been assessed Few studies which lack validation and standardization (4)

Aims To assess, estimate and identify factors associated with waterpipe tobacco dependence syndrome amongst UK male adult resident waterpipe smokers To evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11), in measuring WPTS dependence amongst UK male adult resident WPT smokers

Methodology Cross sectional survey 7 shisha premises participated in central London Random time table,180 participants in 4 weeks Data were collected via face to face interview QMUL Research Ethics Committee approved the study Data analysis: descriptive, chi square, uni and multivariate and psychometric analysis.

Socio-demographic factors Waterpipe module of Global Adult Tobacco Survey (GATS) LWDS-11Questionnaire

Results Sample Background Socio-demographic factorsN (%) Age (Mean/SD 29.46/±9.41 years) 180 (100) Ethnicity Arab Asian White Black 106 (58.89) 27 (15.00) 26 (14.44) 21 (11.67) Level of education Above completed secondary education Completed secondary education Below completed secondary education 97 (53.89) 55 (30.56) 28 (15.55)

Sample background Sample background (continued) Aspects of WPTS N (%) Historic WPTS pattern Age/Yrs of WPTS initiation Smoked WPTS daily in the past Mean (SD ±8.1) 94 (52.2) Current WPTS pattern With others Alone Smoked flavored tobacco Did not Mix the water in the WP tank with other substances Duration 140 (77.8) 38 (21.1) 154 (85.6) 176 (97.8) Median (range) 1 ( ) hours

Level of WPTS Dependence in the sample The mean/SD LWDS-11 score is 10.05± % of participants were more likely WPTS dependent

Psychometric assessment of LWDS-11 The Cronbach’s alpha coefficient =0.74 Two domains were identified physiological dependence positive and negative reinforcement

Factors associated with WPTS dependency

Explanatory VariablesAdjusted OR (95%CI)P-value Ethnicity White Arab Asian Black ( )* 1.71 ( ) 1.79 ( ) Education Level High Intermediate low ( ) 1.26 ( ) Daily WPTS in the past No Yes ( )*0.003 Last WPTS variables Duration WPTS with others WPTS alone 1.15 ( )* ( ) Model of factors associated with WPTS Dependency

Discussion Of the participant 47% were WPT dependents confirming previous studies (5) Two domain of WPT dependence emerged, contradicting other studies (3) The association of being from Arab ethnicity and being daily WPT dependence in past with current WPT dependence confirmed current literature (6,7,8,9,10)

Future research Investigating the WPTS dependency among female population Conducting LWDS-11 in different population to improve validity Biomarker validation of WPTS dependency

Conclusion level of WPTS dependence was significant in this sample and was associated with socio-behavioural factors The LWDS-11 was found useful in assessing WPTS dependency Future research to address gaps identified

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Acknowledgmen t Special thanks for the BSTP for funding my participation The contribution of the owners of the shisha premises in the study is appreciated

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