Waterpipe tobacco smoking: trends, toxicants, and capacity building in Jordan

说明（由申请人提供）：在全球范围内，烟草使用每年造成490万人死亡。吸烟对死亡人数的贡献已被充分证明。然而，数百万人使用其他方法吸烟，包括水烟（“水烟”或“水烟”）。正如世界卫生组织指出的那样，水烟吸烟正在全球蔓延，并与烟草引起的疾病有关。全球流行程度和疾病风险突出表明，需要更多地了解水烟吸烟，包括其区域流行程度和使用者接触有毒物质情况。它们还强调了全球对烟草相关研究能力的需求。西南亚国家尤其需要这种能力，那里的烟草使用率可能超过50%，水烟吸烟很常见。一些国家，如叙利亚和黎巴嫩，一直在建设烟草研究能力[例如，由美国国立卫生研究院资助的叙利亚烟草研究中心和贝鲁特美国大学的研究]。其他国家可能需要更多的研究能力才能加入区域烟草研究工作。例如，约旦的烟草使用率很高，水烟吸烟似乎很常见。研究约旦的水管使用率和使用者接触有毒物质情况将提供必要的当地数据，同时发展区域烟草相关研究能力。对PAR-08-223的回应描述了将主要在约旦伊尔比德完成的工作。约旦科技大学（JUST）的Mohammed Azab和Omar Khabour，是R01CA120142（02-21-2008至01-31-2013）的延伸。这项涉及美国水烟吸烟者的父母补助金的三个具体目标是：1)了解个人使用水烟吸烟时水烟烟雾有毒物质的产生和使用者有毒物质的暴露及其影响；2)了解如何分组使用影响水烟有毒物质的产生和效果，以及3)了解吸烟水烟的有毒物质暴露和急性影响与吸烟有何不同。这项拨款申请的具体目的是：1)在三年内研究约旦大学生中水烟吸烟率、知识和信仰的变化；2)研究水烟使用者依赖、吸烟行为和一氧化碳暴露之间的关系；3)加强地方和区域烟草相关研究能力。正式的培训机会（例如，SCTS的烟草控制研究国际暑期项目；一年级和二年级的项目重点讲习班）将通过在线合作和指导得到支持，以发展能力和促进长期的专业关系。这些关系分别加强了JUST、SCTS和AUB，同时提高了区域能力并鼓励未来的联合研究活动。因此，该项目提供了一个机会，可以更多地了解约旦的烟草使用情况，同时加强该国与烟草有关的研究能力。这样，该项目为区域烟草相关研究奠定了基础，同时实现了家长赠款关于使用者接触有毒物质的目标，并将其扩大到包括水管流行率。公共卫生相关性：本项目与公共卫生相关，因为水烟吸烟是一种鲜为人知但在全球烟草流行中迅速出现的疾病。该项目将通过揭示约旦大学生的使用流行程度和使用者接触有毒物质的情况，为防止水烟吸烟大大增加烟草发病率和死亡率的新努力提供信息。也许更重要的是，该项目在加强区域能力和促进国际合作的同时，建立了约旦与烟草有关的调查和实验室研究能力。这类研究能力和合作对烟草吸烟的积极健康影响有据可查；该项目寻求在另一种可能致命的烟草使用形式上取得类似的积极成果。

DESCRIPTION (provided by applicant): Globally, tobacco use accounts for 4.9 million deaths each year. The contribution of cigarette smoking to this toll has been well-documented. However, millions smoke tobacco using other methods, including waterpipes ("hookah" or "shisha"). As the WHO notes, waterpipe tobacco smoking is spreading globally and has been associated with tobacco-caused disease. Global popularity and disease risk highlight the need to learn more about waterpipe smoking, including its regional prevalence and user toxicant exposure profile. They also highlight a worldwide need for tobacco-related research capacity. This capacity is particularly needed in the countries of Southwest Asia, where tobacco use rates can exceed 50% and waterpipe tobacco smoking is common. Some countries, like Syria and Lebanon, have been building tobacco research capacity [e.g., NIH- funded research at the Syrian Center for Tobacco Studies (SCTS) and the American University of Beirut (AUB)]. Others may require more research capacity before they can join regional tobacco research efforts. For example, Jordan has high tobacco use rates and waterpipe tobacco smoking seems common. Studying Jordanian waterpipe use prevalence and user toxicant exposure would provide needed local data while developing regional tobacco-related research capacity. This response to PAR-08-223 describes work to be completed primarily in Irbid, Jordan with Drs. Mohammed Azab and Omar Khabour of the Jordan University of Science and Technology (JUST), and is an extension of R01CA120142 (02-21-2008 to 01-31-2013). The three specific aims of that parent grant, which involves U.S. waterpipe tobacco smokers, are to: 1) learn about waterpipe smoke toxicant yield and user toxicant exposure and effects when an individual uses a waterpipe to smoke tobacco; 2) learn how to group use influences waterpipe toxicant yields and effects, and 3) learn how the toxicant exposure and acute effects of waterpipe tobacco smoking differ from those of cigarette smoking. The specific aims of this grant application are to: 1) study, over three years, changes in waterpipe tobacco smoking prevalence, knowledge and beliefs among Jordanian university students; 2) examine relationships among waterpipe users' dependence, smoking behavior, and CO exposure; and 3) enhance local and regional tobacco-related research capacity. Formal training opportunities (e.g., SCTS' International Summer Program for Tobacco Control Research; project-focused workshops in Years 1 and 2) will be supported by on-line collaboration and mentorship to develop capacity and foster long-term professional relationships. These relationships strengthen JUST, SCTS, and AUB separately while increasing regional capacity and encouraging future joint research activity. Thus, this project provides an opportunity to learn more about tobacco use in Jordan while strengthening that country's tobacco-related research capacity. In so doing, the project establishes a foundation for regional tobacco-related research while simultaneously addressing the aims of the parent grant regarding user toxicant exposure and extending them to include waterpipe prevalence rates. PUBLIC HEALTH RELEVANCE: This project is relevant to public health because waterpipe tobacco smoking is a little-understood but rapidly emerging strain in the global tobacco epidemic. The project will inform nascent efforts to prevent waterpipe tobacco smoking from contributing substantially to tobacco's morbidity and mortality by revealing the use prevalence and user toxicant exposure among Jordanian university students. Perhaps more important, the project builds Jordanian tobacco-related survey and laboratory research capacity while strengthening regional capacity and fostering international collaboration. The positive health impact of this type of research capacity and collaboration on tobacco cigarette smoking is well-documented; this project seeks similar positive outcomes on another potentially lethal form of tobacco use.