title: Correlates of nicotine dependence among adolescent waterpipe smokers.
abstract: Waterpipe smoking is addictive and its use is increasing globally among youth, yet little is known about the factors associated with nicotine dependence (ND) among waterpipe smokers. We investigated the factors associated with ND symptoms among a sample of Lebanese adolescents who smoke a waterpipe.
  
  
  
  We collected data on factors potentially associated with ND (individual, socio-demographic, environmental, smoking patterns) among 160 current (past 30days) waterpipe smokers recruited from 8th and 9th school grades in Lebanon. We assessed the loss of autonomy over tobacco using the Hooked on Nicotine Checklist (HONC), ND using the International Classification of Diseases, 10th revision (ICD-10), and the number of ND symptoms endorsed.
  
  
  
  Depressive symptoms, lower self-esteem, and having at least one sibling who smokes a waterpipe were associated with the presence of ND symptoms, while enrollment in public schools, smoking a waterpipe ≥30min per session, and believing that cigarette smoking is harmful to health were associated with endorsement of a higher number of ND symptoms. Smoking a whole waterpipe head without sharing and being in 9th grade in this study were associated with the presence and endorsement of a higher number of ND symptoms.
  
  
  
  We identified specific social and psychological characteristics, waterpipe smoking patterns, and beliefs about harmful effects of smoking associated with the presence of ND among adolescent waterpipe smokers. Considering these factors when planning policies to prevent ND among waterpipe smokers is warranted.
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA; Faculty of Medicine and Health Sciences, Aden University, Yemen. Electronic address: rbahe002@fiu.edu.
authors.forename: Raed
authors.initials: R
authors.lastname: Bahelah
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: DiFranza
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria; University of Memphis School of Public Health, Memphis, TN, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria; American University of Beirut, Lebanon.
authors.forename: Fouad M
authors.initials: FM
authors.lastname: Fouad
authors.affiliation: Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Eissenberg
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Ben Taleb
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Jaber
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
authors.forename: Olatokunbo
authors.initials: O
authors.lastname: Osibogun
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D016739:Behavior, Addictive / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007861:Lebanon; D008297:Male; D012574:Schools; D012649:Self Concept; D012907:Smoking / Q000523:psychology*; D013334:Students / Q000523:psychology; D014029:Tobacco Use Disorder / Q000523:psychology*
keywords: Adolescents; Lebanon; Loss of autonomy; Nicotine dependence; Waterpipe