Electronic Theses and Dissertations

Tony Lugemwa

Date

2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Social & Behavioral Sciences

Committee Chair

Shafi Bhuiyan

Committee Member

Kenneth Ward

Committee Member

Satish Kedia

Committee Member

Xichen Mou

Committee Member

Yong Yang

Abstract

Adolescent waterpipe smoking in Lebanon is still very high. Although very few are interested in quitting, we must encourage adolescents to stop smoking waterpipe. There is little known about e-cigarette use and the characteristics of quitting behaviors among adolescent waterpipe (hookah) smokers in Lebanon. This study examines factors associated with quitting behaviors among adolescent waterpipe (hookah) smokers in Lebanon and assesses the prevalence of ever e-cigarette use among this population. We conducted three cross-sectional studies among 8th and 9th grade school children from 4 regions in Lebanon (Beirut, Mount Lebanon, Nabatiye, South Lebanon) (n=256, n=256, and n=461) using data from Wave Four and Wave Nine of the Waterpipe Dependence among Lebanese Youth (WDLY) study. The first two studies used data at Wave Four, we focused on participants who were current waterpipe smokers; the third study used data at Wave Nine, we expanded the criteria to include active adolescent smokers who used cigarettes or waterpipes in the last 30 days (but not both) or non-smokers who were susceptible to using either cigarettes or waterpipes in the next year. The outcome variables were regressed with explanatory variables using chi-square. At the bivariable level, associations among categorical variables were tested using logistic regression. T-test (when normality was met) or Mann-Whitney U/Kruskal-Wallis tests (when normality was violated) were used to test group differences in continuous variables. All explanatory variables (sociodemographic, tobacco use characteristics, exposure to others smoking, beliefs/knowledge/attitude, psychological characteristics) significant at p<0.10 in the bivariable models were entered into a multivariable logistic regression model to identify the factors independently associated with the outcome variable (i.e., interest in quitting, past quit attempt, and ever-e-cigarette use) (0=No, 1=Yes). Odds ratios (OR) with 95% confidence intervals (CI) were reported from these models. All tests were two-tailed, and the statistical significance was p<0.05. Adolescents in Lebanon who were interested in quitting waterpipe smoking were more likely to be distracted. Additionally, those who had friends who smoked waterpipe and spent more than 30 minutes per session were less likely to show interest in quitting waterpipe. Regarding adolescents who made a past quit attempt in the last 6 months, those who reported interest in quitting had less than 20,000 LBP in weekly allowance and believed that waterpipe smokers had more friends than non-smokers were more likely to make a past quit attempt. In the study assessing the prevalence of ever e-cigarette use and its association with waterpipe use, adolescents who were in school or university, with high weekly allowance, and were depressed were more likely to use e-cigarettes. Also, waterpipe smokers who had made a quit attempt were more likely to use e-cigarettes compared to non-smokers. These results suggest that there are specific individual (knowledge/attitudes/beliefs, tobacco use characteristics) and interpersonal (exposure of others smoking) factors that are significantly associated with a desire to quit waterpipe smoking and use of e-cigarettes. Waterpipe smoking cessation among adolescents in Lebanon remains low; waterpipe smoking continues to be a complex behavior that requires continued monitoring and intervention efforts.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Open Access

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