Doctor of Philosophy (PhD)
First Advisor's Name
First Advisor's Committee Title
Second Advisor's Name
Second Advisor's Committee Title
Third Advisor's Name
Miguel Angel Cano
Third Advisor's Committee Title
Fourth Advisor's Name
Fourth Advisor's Committee Title
Fifth Advisor's Name
Fifth Advisor's Committee Title
Waterpipe smoking, Cigarette smoking, Nicotine dependence, Adolescents, Lebanon
Date of Defense
Nicotine dependence (ND) is the fundamental reason that people persist in using tobacco products, which kill more than eight million people every year globally. So far, ND research has primarily focused on cigarettes, yet for many youths worldwide, tobacco use, and addiction is maintained by means other than the cigarette including waterpipe (WP) smoking (a.k.a. hookah). It is important to better understand the WP-associated ND trajectories given its unique use features that can influence ND development such as its time-consuming preparation and consumption, intermittent use, and strong sensory and social cues. Hence, using data from 8 waves (2015-2020) of the Waterpipe Dependence in Lebanese Youth (WDLY) study, this pioneer research compared the development of ND symptoms and their predictors among adolescent current (past 30 days) WP (n=283) and cigarette (n=146) smokers. Also, we identified ND trajectories from early to late adolescence in current WP smokers and examine baseline correlates by each identified trajectory. We evaluated the initial ND symptoms using the Hooked on Nicotine Checklist (HONC) and the full syndrome of ND using the International Classification of Diseases-10th revision (ICD-10 ND).
Our findings indicated that compared with adolescent cigarette smokers, initial ND symptoms and full syndrome of ND can develop sooner after starting to smoke and progress more rapidly among adolescent WP smokers. Among WP smokers, predictors of developing full ND syndrome include being younger, believing that WP smokers have more friends, depression, high levels of impulsivity, and initiating smoking at a younger age. For cigarette smokers, predictors of full ND syndrome were being younger and initiating smoking at a younger age. Finally, A mixture modeling approach yielded a four-class solution that best fitted the data varying in the timing of ND onset during adolescence: no-onset of ND (43.9%), early-adolescence onset (16.2%), mid-adolescence (26.6%), and late-adolescence (13.3%) onset of ND symptoms among WP smokers.
In conclusion, our findings suggest that the developing, implementing, and evaluating intervention programs with adolescent WP smokers should be guided by the WP-specific trajectory of ND.
Previously Published In
Ebrahimi Kalan, M., R. Behaleh, J. R. DiFranza, Z. Bursac, Z. Ben Taleb, M. Tleis, T. Asfar, R. Nakkash, K. D. Ward, T. Eissenberg and W. Maziak (2020). "Natural Course of Nicotine Dependence Among Adolescent Waterpipe and Cigarette Smokers." Journal of Adolescent Health 67(6): 859-867.
Ebrahimi Kalan, M., Bahelah, R., Bursac, Z., Ben Taleb, Z., DiFranza, J.R., Tleis, M., Nakkash, R., Jebai, R., Alam, M.M., Cano, M.Á., Sutherland, M.T., Fenni, K., Asfar, T., Eissenberg, T., Ward, K.D., Maziak, W., 2020. Predictors of nicotine dependence among adolescent waterpipe and cigarette smokers: A 6-year longitudinal analysis. Drug and Alcohol Depend, 217, 108346.
Ebrahimi Kalan, Mohammad, "Characterizing the Development and Trajectories of Nicotine Dependence Among a Cohort of Adolescent Waterpipe and Cigarette Smokers" (2021). FIU Electronic Theses and Dissertations. 4677.
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