Association between cumulative cigarette and Waterpipe smoking and symptoms of dependence in Lebanese adults

Background Waterpipe and cigarette smoking dependence are becoming increasingly prevalent forms of addiction globally. This study examined whether cumulative cigarette smoking and cumulative waterpipe smoking are associated with higher dependence on both cigarettes and waterpipe. Methods This cross-sectional study conducted between February and April 2020, enrolled 363 participants drawn from all Lebanese districts. The mean age was 29.51 years, 64.8% were females, and 124 (34.2%) exclusive cigarette smokers, 189 (52.1%) exclusive waterpipe smokers, and 50 (13.8%) dual smokers (waterpipe and cigarette). We used the Hooked on Nicotine Checklist (HONC) as an indicator of decreased autonomy towards nicotine, in addition to the Lebanon Waterpipe Dependence Scale-11 (LWDS11) and the Lebanese Cigarette Dependence scale (LCD). A stepwise linear regression was performed taking the HONC scores due to cigarette and waterpipe smoking, LCD and LWDS-11 scores as dependent variables. Results The results showed that in the total sample, higher cumulative cigarette smoking (B = 0.005 with a confidence interval of 0.004, 0.006) was significantly associated with higher HONC cigarette scores, whereas higher cumulative waterpipe smoking (B = -0.006 with a confidence interval of - 0.009, - 0.002) was significantly associated with lower HONC cigarette scores. Moreover, higher cumulative waterpipe smoking (B = 0.012 with a confidence interval of 0.009,0.015) was significantly associated with higher HONC waterpipe scores. The results showed that, in both sexes, higher cumulative cigarette smoking was associated with higher HONC cigarette scores and lower HONC waterpipe scores. Furthermore, higher cumulative waterpipe smoking was significantly associated with higher HONC waterpipe scores in both sexes. Conclusion Our study supports the fact that heavy nicotine consumption, related to both the increased frequency and smoking duration, can increase the risk of dependence. It raises the need for strategic plans to minimize and discourage the use of nicotine products in Lebanese community settings.