Secondhand smoke (SHS) exposure is a serious public health threat worldwide; in the developing world there are less serious efforts towards controlling women’s and children’s exposure to SHS. Knowledge, attitudes and avoidance practices among Jordanian women have never been thoroughly studied. The purpose of this study was to assess the knowledge, attitudes, and avoidance behavior towards SHS exposure among employed Jordanian women with higher education. Methods: A survey was conducted among employed Jordanian women at two universities. A total of 209 women were included in the analysis. Two questionnaires regarding SHS exposure were used to measure knowledge, attitudes and avoidance practices. Results: Most respondents were regularly exposed to SHS in various locations during daily life, even though they were very knowledgeable about the dangers of SHS exposure for women and children. However, the subject’s attitudes and avoidance behavior did not reflect the level of knowledge about SHS risks. The results suggests there is a large discrepancy between SHS exposure, knowledge, attitudes and avoidance behavior among highly educated Jordanian women that is likely influenced by culture and traditional gender roles. Public health initiatives are needed in Jordan to address public policy, institutional practices and to empowerment of women to reduce SHS exposure.

Despite the increase in attention to waterpipe tobacco smoking, the patterns and predictors of this method of tobacco use among Jordanian youth are not well known. The current study was conducted to assess the patterns and the predictors of waterpipe tobacco smoking among school aged students in one of Jordan’s Central Governorates. A cross-sectional survey was conducted to investigate the patterns and predictors of waterpipe tobacco smoking among youth (grades 6, 8, 10 and 12). Using a multistage random sampling more than 1,000 students was selected. Data were collected using the Arabic Youth Tobacco Use Composite Measure (YTUCM). Waterpipe smoking was assessed for “past 12 months”, “past month” and “past week”. Students’ ages ranged from 11 to 18 years, (mean age ± 14.7; SD ± 1.9 years). The percentage of girls who smoked waterpipe was greater for all frequencies of use than it was for boys. Age, gender, and belief that smoking makes more friends were predictors of smoking among study participants. This is the first known study to examine waterpipe smoking among youth aged 11 and 12. Our findings illustrate the need for public health campaigns to reach and educate youth, their families, teachers and school systems regarding the growing recognized health risks of waterpipe smoking.

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.

Background. Waterpipe nicotine dependence and its association with depressive symptoms and dual usage among adolescents are currently not examined in the literature. Adolescents are a vulnerable population that is susceptible to depression and initiation of tobacco use. We aim, in this novel study, to assess the association between depressive symptoms and waterpipe nicotine dependence among adolescents in Jordan, evaluate the association between waterpipe smoking status (waterpipe smoker vs. dual user) and waterpipe nicotine dependence, and assess the internal validity of the Waterpipe Nicotine Dependence Scale (WNDS). Method. A cross-sectional study among adolescents of grade 9^th to 12^th in Jordan was conducted through multistage cluster random sampling. The self-reported Arabic Youth Tobacco Use Composite Measure Questionnaire (YTUCM) was used to collect the surveys that include demographic information, smoking status, and the WNDS to assess waterpipe nicotine dependence and depressive symptoms. Multiple linear regression and the t-test were used to analyze the data. Findings. One thousand three hundred and three surveys were collected, of which 1082 were included in the study (443 males and 639 females). 64.9 of the sample were nontobacco users, while 20.1 were waterpipe- (WTP-) only smokers, 11.4 were dual users, and 3.7 were cigarettes-only users. After adjusting for weights, 66.6 were nonsmokers, 19.2 were WTP-only smokers, 10.2 were dual users, and 3.9 were cigarettes-only smokers. Using multiple linear regression, depressive symptoms were significantly associated with WTP nicotine dependence (β 0.618), upon adjusting for confounders. Furthermore, dual users were associated with higher WTP nicotine dependence (β 12.034) compared to WTP-only smokers after adjusting for confounders. Cronbachs alpha for the WNDS was 0.955. Conclusions. Our study shows that there is a statistically significant association between depressive symptoms and WTP nicotine dependence and higher dependence among dual users compared to WTP-only smokers. The WNDS can be a useful tool to assess WTP nicotine dependence with high internal consistency. However, a longitudinal study is needed to further understand the association and temporality between the depressive symptoms and WTP nicotine dependence. Additionally, research is needed to shorten the WNDS while maintaining high internal consistency and assess the external validity of the WNDS and the short- and long-term consequences of dual usage.

Background: Waterpipe tobacco smoking (WTS) emerges as a new component of the global tobacco epidemic. Adolescents smoking waterpipe are susceptible to cigarette smoking, but limited research has characterized dual (cigarette plus waterpipe) users. The study objective is to determine the prevalence estimates of dual users to understand how “collision” of the two epidemics is evolving in the Arab countries.Methods: Data (n = 31,359; N = 6,109,572) were obtained from nationally representative Global Youth Tobacco Surveys (GYTSs) from 17 Arab countries. Current tobacco use was categorized into four groups—cigarette smoking only, WTS only, dual use, and never use. Weighted age-, sex-, and country-specific prevalence estimates along with 95% confidence intervals were reported.Results: Overall 3.0%, 6.1%, and 3.8% of youth were cigarette smokers only, WTS only, and dual users. Boys reported high prevalence estimates of cigarette smoking only (5.1% vs 1.1%), WTS only (7.4% vs 4.6%), and dual use (3.7% vs 2.1%) than girls. Dual-use estimates ranged from 0.7% in Oman to 15.0% in West Bank and WTS only ranged from 0.9% in Oman to 6.6% in United Arab Emirates.Conclusion: Dual use and WTS is well established among Arab youth and represents a new dimension to the global tobacco epidemic that may not respond to traditional tobacco control interventions.