Interventions for waterpipe smoking cessation

 

Abstract

Background

Waterpipe smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region, but its use is now spreading worldwide. It is smoked socially, often being shared between friends or family at home, or in dedicated bars and cafes that provide waterpipes to patrons. Because the smoke passes through a reservoir of water, waterpipe tobacco smoking is perceived as being less lethal than other methods of tobacco use. At least in some cultures, women and girls are more likely to use a waterpipe than to use other forms of tobacco, and it is popular among younger smokers. Accumulating evidence suggests that waterpipe smoking may be as addictive as other forms of tobacco use, and may carry similar risks to health.

Objectives

To evaluate the effectiveness of tobacco cessation interventions for waterpipe users.

Search methods

We searched the Cochrane Tobacco Addiction Review Group specialized register, in February 2011. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language, and especially in regions where waterpipe use is widespread. We have also used our own existing bibliography, compiled from conducting an earlier exhaustive review of the literature on waterpipe smoking.

Selection criteria

We sought randomized, quasi-randomized or cluster-randomized controlled trials of smoking cessation interventions for waterpipe smokers of any age or gender. The primary outcome of interest was abstinence from tobacco use, preferably sustained and biochemically verified, for at least six months from the start of the intervention.

Data collection and analysis

Each author intended to extract data and assess trial quality independently by standard Cochrane Collaboration methodologies, but no eligible trials were identified.

Main results

We found no completed intervention trials targeting waterpipe smokers. A pilot randomized controlled trial by the authors of this review is underway, and will be reported in future updates.

Authors' conclusions

Epidemiological and observational evidence suggests that waterpipe use is rapidly growing in popularity worldwide. It is widely and erroneously perceived to be less lethal than other forms of tobacco use. Women, girls, and young people are more likely to take up waterpipe smoking, especially in the Eastern Mediterranean Region. More research is needed on its addictive properties, and on the associated health risks, both for users and exposed non-smokers. Evidence-based information about waterpipes' addictive and harmful properties should be developed and disseminated in order to deglamourise and denormalise its use. A clear understanding of dependence development in young waterpipe smokers should guide the development of effective cessation treatments for waterpipe smokers. Such treatments need to be tested with the help of high quality randomized trials.

 

Plain language summary

Can users of waterpipe be helped to quit by smoking cessation interventions

Waterpipe smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region. Its use is now spreading worldwide. It is smoked socially, and is often shared between friends or family at home, or in bars and cafes that provide waterpipes to patrons. In the absence of relevant data, many waterpipe tobacco smokers believe that this form of tobacco use is less lethal and addictive than other methods of tobacco smoking, because the smoke passes through water on its way to the user. At least in some cultures, women and girls are more likely to use a waterpipe than to use other forms of tobacco, and it is popular among younger smokers. Current evidence suggests that waterpipe smoking may be as addictive as other forms of tobacco use, and may also carry similar or greater risks to health. We searched for controlled trials in the Cochrane Tobacco Addiction Review Group specialized register, in February 2011. We also searched a number of electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL, using a variety of names and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for published and unpublished trials in any language, and especially in areas where waterpipe use is widespread. We have not found any completed trials of smoking cessation interventions among waterpipe users. The authors of this review are conducting a pilot study of waterpipe smoking cessation, which will be reported in future updates. More research is needed on this tobacco use method's addictive properties, and on its associated health risks, both for users and exposed non-smokers. Evidence-based information about waterpipe should be collected and circulated to discourage the uptake and spread of its use so that it is no longer seen as normal or 'cool'. Effective treatments should be developed to help waterpipe smokers quit.

 

摘要

背景

水管菸的戒菸治療

水管菸是一種傳統的菸草使用方式，特別是在地中海東部地區，但它的使用現在在歐洲與北美傳播開來遍及各處。它在社交場合被使用，通常是在家裡與朋友或家人之間彼此分享，或在專門的酒吧及咖啡廳，提供水管菸給顧客。因為煙會經由貯水裝置通過，水管菸被認為不像其他菸草使用方式那樣有致命性。至少在某些文化中，女人及女孩較可能使用水管菸而非其他形式的菸草，水管菸在年輕的吸菸者中也比較流行。越來越多的證據顯示水管菸的使用可能與其他形式的菸草一樣具有成癮性，對健康也可能有相似或更高的危害。

目標

評估對水管菸使用者的戒菸介入的效果。

搜尋策略

我們搜尋Cochrane Tobacco Addiction Review Group specialized register至2007年6月。我們也使用不同的名詞與拼法(‘waterpipe’ 或 ‘narghile’ 或 ‘arghile’ 或 ‘shisha’ 或 ‘goza’ 或 ‘narkeela’ 或 ‘hookah’ 或 ‘hubble bubble’)來搜尋MEDLINE, EMBASE, CINAHL 和 PsycINFO。我們搜尋已發表或未發表的試驗，使用任何語言，尤其是在普遍使用水管菸的地區。我們也使用我們自己的文獻目錄，由早先詳盡地回顧水管菸的文獻編輯而成。

選擇標準

我們尋找對任何年齡或性別的水管菸使用者進行戒菸介入的隨機、類隨機或群聚隨機之對照試驗。主要關心的結果變項是戒菸率，最好在介入開始的至少六個月後仍維持並以生化方式驗證。

資料收集與分析

每位作者以標準Cochrane Collaboration方法，獨立地擷取資料，並評估試驗的品質，但沒有找到合格的試驗。

主要結論

我們沒有找到針對水管菸使用者已完成介入的試驗。這篇回顧的作者正在進行一個前導的隨機對照試驗，將在未來的更新中報告。

作者結論

流行病學與觀察的證據顯示水管菸的使用在世界各地都越來越廣泛。一般大眾廣泛而錯誤地認為水管菸比其他種類的香菸較不具致命性。女人、女孩和年輕人更容易使用水管菸，特別是在地中海東部地區。需要更多研究來瞭解其成癮性，與對使用者及暴露的非使用者相關連的健康風險。對於水管菸的成癮性與傷害性，應發展並傳播以證據為基礎的資料，來去除使用水管菸的魅力與正當性。需要高品質的隨機試驗來引導水管菸的戒菸治療。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

水管菸是一種傳統的菸草使用方式，特別是在地中海東部地區。它的使用現在在歐洲與北美傳播開來遍及各處。它在社交場合被使用，通常是在家裡與朋友或家人之間彼此分享，或在酒吧及咖啡廳，提供水管菸給顧客。在缺乏相關資料的情況下，許多水管菸的使用者相信這種形式的菸草使用，比起其他方式的菸草使用，比較不致命也較不具成癮性，因為產生的煙先通過水才被使用者吸入。至少在某些文化下，女人和女孩更容易去使用水管菸而非其他形式的菸草，水管菸在年輕的吸菸者中也很普遍。目前的證據顯示水管菸可能像其他形式的菸草一樣具有成癮性，對於健康可能也有相似或更大的危險。我們在2007年6月搜尋Cochrane Tobacco Addiction Review Group specialized register資料庫中的對照試驗。我們也使用不同的名詞與拼法(‘waterpipe’ 或 ‘narghile’ 或 ‘arghile’ 或 ‘shisha’ 或 ‘goza’ 或 ‘narkeela’ 或 ‘hookah’ 或 ‘hubble bubble’)來搜尋一些電子資料庫，包括MEDLINE, EMBASE, PsycINFO 和CINAHL 。我們搜尋已發表或未發表、使用任何語言撰寫的試驗，尤其是在普遍使用水管菸的地區。我們沒有找到任何對水管菸使用者進行戒菸介入的已完成試驗。這篇回顧的作者正在進行一個水管菸戒菸的前導研究，將在未來的更新中報告。需要更多研究來瞭解這種菸草使用方法的成癮性，與對使用者及暴露的非使用者相關連的健康風險。應該收集並累積關於水管菸的證據為基礎的資料，來勸阻水管菸的使用與傳播，不再被視為正常或"很酷"的。需要高品質的隨機試驗來提供所需要的證據來協助水管菸使用者戒菸。