Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 14

Respiratory health and quality of life in young exclusive, habitual smokers - a comparison of waterpipe smokers, cigarette smokers and non-smokers

Authors Hawari FI, Obeidat NA, Abu Alhalawa M, Al-Busaidi Z, Amara B, Baddar S, Elhabiby M, Elkholy H

Received 12 February 2019

Accepted for publication 10 July 2019

Published 13 August 2019 Volume 2019:14 Pages 1813—1824


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

F I Hawari,1 N A Obeidat,2 M Abu Alhalawa,2 Z Al-Busaidi,3 B Amara,4 S Baddar,3 M Elhabiby,5 H Elkholy5

1Cancer Control Office, King Hussein Cancer Center, School of Medicine, University of Jordan, Amman, Jordan; 2Cancer Control Office, King Hussein Cancer Center, Amman, Jordan; 3Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; 4Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 5Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Purpose: Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults’ respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups.
Method: We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured.
Result: The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS.
Conclusion: Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Keywords: tobacco, hookah, cough, phlegm, lung diseases, early onset

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]