1. Waterpipe Tobacco Dependence In UK Male Adult Residents: A Cross Sectional Study Ali Al-Bakri, ali.albakri777@gmail.com Saba Kassim, s.kassim@qmul.ac.uk Mustafa al’Absi, malabsi@umn.edu Ray Croucher, ray.e.croucher@gmail.com

2. 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)

3. 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

4. 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.

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

6. 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)

7. Sample background Sample background (continued) Aspects of WPTS N (%) Historic WPTS pattern Age/Yrs of WPTS initiation Smoked WPTS daily in the past Mean 21.28 (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 (0.15-10) hours

8. Level of WPTS Dependence in the sample The mean/SD LWDS-11 score is 10.05±5.68 47% of participants were more likely WPTS dependent

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

10. Factors associated with WPTS dependency

11. Explanatory VariablesAdjusted OR (95%CI)P-value Ethnicity White Arab Asian Black 1 2.63 (1.05-6.62)* 1.71 (0.56-5.28) 1.79 (0.58-5.48) 0.040 0.350 0.309 Education Level High Intermediate low 1 1.40 (0.80-2.45) 1.26 (0.76-2.09) 0.236 0.370 Daily WPTS in the past No Yes 1 2.13 (1.30-3.49)*0.003 Last WPTS variables Duration WPTS with others WPTS alone 1.15 (1.00-1.32)* 1 1.31 (0.80-2.15) 0.044 0.285 Model of factors associated with WPTS Dependency

12. 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)

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

14. 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

15. References 1- MAZIAK, W. 2011. The global epidemic of waterpipe smoking. Addict Behav, 36, 1-5 2- MAZIAK, W., WARD, K. D. & EISSENBERG, T. 2004e. Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users. Drug Alcohol Depend, 76, 101-6. 3-SALAMEH, P., WAKED, M. & AOUN, Z. 2008. Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11). Nicotine Tob Res, 10, 149-58. 4- Akl EA, Aleem S, Gunukula SK, Honeine R, Abou Jaoude P, Irani J. Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review. BMC Public Health. 2010;10:415 5-SALAMEH, P., KHAYAT, G. & WAKED, M. 2012. Lower prevalence of cigarette and waterpipe smoking, but a higher risk of waterpipe dependence in Lebanese adult women than in men. Women Health, 52, 135-50. 6- GREKIN, E. R. & AYNA, D. 2008. Argileh use among college students in the United States: an emerging trend. J Stud Alcohol Drugs, 69, 472-5. 7- JAMIL, H., TEMPLIN, T., FAKHOURI, M., RICE, V. H., KHOURI, R., FAKHOURI, H., AL-OMRAN, H., AL-FAUORI, I. & BAKER, O. 2009. Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults. J Immigr Minor Health, 11, 310-7. 8-JORDAN, H. M. & DELNEVO, C. D. 2010. Emerging tobacco products: hookah use among New Jersey youth. Prev Med, 51, 394-6. 9-Maziak, W., Rastam, S., Shihadeh, A. L., Bazzi, A., Ibrahim, I., Zaatari, G. S.,... Eissenberg, T. (2011). Nicotine exposure in daily waterpipe smokers and its relation to puff topography. Addictive Behavior, 36(4), 397-399. doi: S0306- 4603(10)00334-5 10.1016/j.addbeh.2010.11.013. 10- Neergaard, J., Singh, P., Job, J., & Montgomery, S. (2007). Waterpipe smoking and nicotine exposure: a review of the current evidence. Nicotine and Tobacco Research, 9(10), 987-994. doi: 783052859 10.1080/14622200701591591.

16. 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

17. Thank you for listening