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Long-term study of cigarette and waterpipe tobacco smoking shows knowledge gap in perceived health risks

People who smoke both cigarettes and waterpipes — dual users — lack sufficient knowledge about the risks of tobacco smoking and are at considerable risk for dependence and tobacco-related diseases, such as cancer, heart disease and stroke later in life, according to findings of a new study by Virginia Commonwealth University.

The study, the first of its kind to assess trends in cigarette and waterpipe tobacco smoke based on long-term data, reveals few users perceive dangers of waterpipe tobacco. A common misconception about waterpipe smoking is that it is not as harmful as cigarette smoking.

In the past several years, a marked increase in waterpipe tobacco smoking, also known as hookah, has occurred among college students, especially those who did not smoke cigarettes before. While waterpipe smoking also can attract non-cigarette smokers, recent evidence has shown that a significant proportion of current cigarette smokers are using waterpipes, making them dual users of these tobacco products.

In a study, published online this week in the Journal of American College Health, researchers found that dual users — people who smoke both cigarettes and waterpipes — may have an increased exposure to nicotine, increased risk for tobacco dependence and are less likely to quit tobacco use.

“We often assume that everyone, including college students, is knowledgeable about the health risks associated with tobacco smoking,” said principal investigator Aashir Nasim, Ph.D., National Institute on Minority Health and Health Disparities scholar and associate professor of psychology and African American studies in the VCU College of Humanities and Sciences.

“This simply isn’t true, especially in relation to waterpipe tobacco smoking. Surprisingly, many hold the belief that waterpipe tobacco smoking is less harmful than cigarette smoking because the water filters out the ‘bad stuff,'” he said.

According to Nasim, the team observed that although cigarette smoking among college students has declined since 2006, waterpipe tobacco smoking has increased substantially — by about 20 percent — among non-cigarette smokers, and waterpipe tobacco smoking prevalence has remained relatively unchanged among current cigarette smokers. About 10 percent of cigarette smokers also use waterpipe, he said.

Secondly, the team found that compared to exclusive cigarette smokers or exclusive waterpipe users, dual cigarette and waterpipe users report being more susceptible to peer influences and perceive the probability of addiction associated with waterpipe tobacco smoking to be relatively low.

The team is now examining other types of dual use — for example, dual cigarette and cigar use — on college campuses. This work is being done in collaboration with Danielle Dick, Ph.D., associate professor of psychiatry, psychology and human and molecular genetics at VCU, and her Spit for Science research team.

Nasim collaborated with Caroline O. Cobb and Thomas Eissenberg, Ph.D., professor in the VCU Department of Psychology and the VCU Institute for Drug and Alcohol Studies; and Yousef Khader, Sc.D., with the Jordan University of Science and Technology in Irbid, Jordan.

The study was supported in part by United States Public Health Service grants R01CA120142, R01DA025659, R01DA024876, and F31DA028102.

People who smoke both cigarettes and waterpipes — dual users — lack sufficient knowledge about the risks of tobacco smoking and are at considerable risk for dependence and tobacco-related diseases, such as cancer, heart disease and stroke later in life, according to findings of a new study by Virginia Commonwealth University.

Moke: What It Is and Why It’s Unhealthy for Teens

Understanding Moke and Its Effects on the Body and Brain

Have you noticed the word “moke” being used lately, in the media and among young people? If so, you might have wondered, what is a moke?

Moke is a term for a mix of marijuana and tobacco, typically smoked with a bong, or water pipe. Mixing weed with tobacco is more common in Europe, Australia, and other parts of the world. According to some estimates, 90 percent of cannabis smokers in Europe mix marijuana with tobacco.

Furthermore, this mix is gaining popularity among American teenagers. In the United States, a marijuana and tobacco cigarette is known as a spliff.

It’s important to understand the health risks of smoking tobacco and weed together. Moreover, this tobacco and weed mix can have a detrimental impact on teen mental health .

What Happens When You Mix Marijuana and Tobacco

While both tobacco and weed have specific effects, mixing the two also has other effects on the body and mind.

A 2009 study showed that mixing cannabis and tobacco actually increases the THC content of the combined drugs. Thus, a moke produces a stronger high. In addition, both nicotine and THC produce a sensation of euphoria.

Moreover, smoking marijuana and tobacco, mixed, have resulted in what health officials call “respiratory cripples.” In 2016, doctors in St. Lucia reported an epidemic of young patients suffering from Chronic Obstructive Pulmonary Disease (COPD) as a result of this combination of drugs.

COPD is a debilitating, progressive disease that directly affects the lungs and cannot be reversed. Patients with the disease are confined to a bed with oxygen tanks to aid in breathing.

Moke Leads to an Increased Risk of Addiction

Smoking mokes may create a greater risk of teen substance use disorder . A 2008 study conducted with users between ages 17 and 35 showed that using tobacco with marijuana contributes to cannabis dependence symptoms.

Furthermore, a 2016 study confirmed these results. Researchers analyzed responses from 33,687 cannabis users from 18 countries who participated in the 2014 Global Drug Survey, an anonymous online survey of drug use.

Subsequently, they found that people who did not mix cannabis with tobacco were much more motivated to quit and thus more likely to seek professional help for cannabis and nicotine addiction. Therefore, researches concluded that people who regularly mix tobacco with cannabis are at greater risk of psychological dependence than people who use the drugs separately.

“Mixing tobacco with cannabis lowers the motivation to quit using these drugs,” said lead author Chandni Hindocha, a doctoral student at the Clinical Psychopharmacology Unit of University College London.

Tobacco, Marijuana, and the Brain

Both nicotine and marijuana interact with the body’s endocannabinoid system (ECS). Furthermore, the ECS has receptors in the brain and body that help regulate basic metabolic functions, including pain, pleasure, mood, digestion, and motor control.

A large number of these receptors are found in the hippocampus and amygdala, the parts of the brain that play important roles in remembering, decision making, emotional responses, and addiction. Therefore, drugs that alter the functioning of these receptors can negatively affect functioning in these areas.

In a study done at the Center for Brain Health at the University of Texas at Dallas, scientists uncovered significant differences in the brains of people who use both tobacco and marijuana, as compared to the brains of those who only use marijuana. Researchers studied the size of the hippocampus as it related to memory function.

They found that the combination of nicotine and marijuana had a unique effect on the brain, as compared to the brains of people who did not smoke or who smoked only one of the two substances.

According to the principal investigator in the study, Dr. Francesca Filby, “Our findings confirm that the interaction between marijuana and nicotine is indeed much more complicated due to the different mechanisms at play. Future studies need to address these compounding effects of substances.”

Effects of Marijuana vs. Tobacco

According to the World Health Organization, tobacco and cannabis are used respectively by 1 billion and 182 million people worldwide.

It is difficult to directly compare marijuana and tobacco in terms of the long-term changes they make in the body and brain. However, both substances are dangerous and unhealthy.

Consequently, the marijuana-tobacco mix known as a moke carries two sets of unhealthy effects.

The Mental Health Risks of Tobacco

Most Americans are very familiar with the physical health risks of smoking nicotine, including lung cancer, stroke, and heart disease. Cigarette smoking is the leading preventable cause of death in the United States, resulting in more than 480,000 deaths each year, according to the Centers for Disease Control and Prevention.

However, smoking tobacco is also associated with substance abuse and depression . This is particularly true for teens.

What Parents Need to Know About Moke

Specifically, statistics compiled by the National Survey on Drug Use and Health show that teens who smoke cigarettes are five times more likely to drink. They are also 13 times more likely to abuse marijuana, and seven times more likely to abuse drugs like cocaine and heroin. Thus, alcohol abuse and addiction is nine times higher among teens who smoke tobacco than among their peers who do not smoke.

These findings are supported by a report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University. The report, titled “Tobacco: The Smoking Gun,” showed that the changes created by nicotine make a teen’s brain more susceptible to the effects of drugs and alcohol.

The brain’s receptors for nicotine increase when smoking, making it more likely for nicotine addiction to develop and making it harder for teens to stop smoking once they start. Moreover, the brain receptors are also altered, which increases the chances of cravings for other drugs. Additionally, the serotonin receptors change, which increases the chance of depression when not smoking.

Furthermore, the report revealed that smokers ages 12 to 17 are twice as likely as non-smokers to experience symptoms of clinical depression.

Marijuana’s Effects on Teen Mental Health

Like tobacco, marijuana use leads to both physical and mental symptoms. Not only is marijuana addictive, it is extremely harmful to users, especially when they are in the critical developmental stages of adolescence. Teenagers’ use of drugs such as marijuana creates chemical changes in the brain, resulting in disruption of mental and physical growth and health.

Regular marijuana use can lead to the following short- and long-term effects:

  • Changes in mood
  • Impaired memory
  • Cognitive difficulties (thinking and problem-solving)
  • Respiratory problems (coughing, lung infections, etc.)
  • Faster heart rate
  • Hallucinations and paranoia
  • Depression and anxiety
  • Suicidal thoughts in teens
  • Decreased IQ: One study showed that people who started smoking marijuana heavily in their teens and continued to use it lost an average of eight IQ points between the ages of 13 and 38.

In conclusion, not only do marijuana and nicotine each have individual consequences for teen mental health, the combination of both has additional effects. It’s important not to underestimate the negative impact of these addictive and life-threatening drugs. Therefore, parents need to help their teens find safe, healthy ways to navigate challenges and feel empowered.

Sources

Inhal Toxicol. 2009 Feb;21(2):87-90.

Drug Alcohol Depend. 2008 Jun 1; 95(3): 199–208.

Behavioural Brain Research. 2015 October 15; Vol. 293: 46–53.

Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64.

National Center on Addiction and Substance Abuse

Have you noticed the word “moke” being used lately, in the media and among young people? Moke is a term for a mix of marijuana and tobacco, that can be dangerous for teens.