¹Najwa Baassiry, ²Marwa El-Hallak, ³Ali Alkhatib, ⁴Sami Tlais, ⁵Hassan S. Hajj Hussein

¹,²,³Department of Nutrition and Food Sciences, School of Arts and Sciences, Lebanese International University, Beirut, Lebanon

⁴,⁵Department of Biological and Chemical Sciences, School of Arts and Sciences, Lebanese International University, Rayak, Lebanon

Background:
to assess smoking habits and investigate any impact of smoking on COVID-19 susceptibility and symptom development.
Study design:
a cross-sectional study.
Methods:
A total of 1642 participants volunteered and took part in answering the questionnaire. Information about the level of knowledge on COVID-19, smoking habits, and COVID-19-related symptoms of participants were collected using an online questionnaire.
Results:
The study revealed that a very high percentage of the Lebanese population, especially males, are smokers. Smoking was independent of age and level of education; however, we detected a shift in preference among the younger smokers from cigarette to shisha smoking. We did not detect any influence of smoking, level of education, or geographical location on the probability of contracting COVID-19. COVID-19 patients who are also shisha smokers were significantly more likely to experience severe body pain and speaking and moving difficulty compared to cigarette smokers. In addition, infected shisha smokers who used artificial coal as a burning agent were more likely to experience loss of smell and taste compared to those that used natural coal.
Conclusions:
Shisha smokers, and especially those that use artificial coal, may be at a higher risk of developing more severe symptoms of COVID-19 and possibly other respiratory-related illnesses. The increased tendency of the younger generations to smoke shisha is alarming

COVID-19, symptoms, smoking, shisha, cigarette, Lebanon

1) Corona Virus. Lebanese Ministry of Information website; 2021 [updated 5 Apr 2021; cited 5 Apr 2021]; Available from: https://corona.ministryinfo.gov.lb

2) Lowe KE, Zein J, Hatipoglu U, Attaway A. Association of Smoking and Cumulative Pack-Year Exposure With COVID-19 Outcomes in the Cleveland Clinic COVID-19 Registry. JAMA Intern Med. 2021 Jan 25:e208360.

3) Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Lian N et al. The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis. J Med Virol. 2020; 92(10):1915-1921

4) Russo P, Bonassi S, Giacconi R, Malavolta M, Tomino C, Maggi F. COVID-19 and smoking: is nicotine the hidden link? Eur Respir J. 2020; 55(6): 2001116.

5) Gaiha SM, Cheng J, Halpern-Felsher B. Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19. J Adolesc Health. 2020; 67(4): 519-523.

6) Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020; 18(20): 1-4

7) Miyara, M., Tubach, F., Pourcher, V., Morelot-Panzini, C., Pernet, J., Haroche, J., et al. Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19. Qeios. 2020; doi:10.32388/WPP19W.3

8) Li, M., Zhang, Z., Cao, W., Liu, Y., Du, B., Chen, C. et al. Identifying novel factors associated with COVID-19 transmission and fatality using the machine learning approach. Sci Total Environ. 2021; 764: 142810.

9) Smoking and COVID-19. WHO website; June, 2020 [cited 20 Mar 2021]; Available from: https://www.who.int/news-room/commentaries/detail/smoking-and-covid-19

10) Chaaya M, El-Roueiheb Z, Chemaitelly H, Azar G, Nasr J, Al-Sahab B. Argileh smoking among university students: a new tobacco epidemic. Nicotine Tob Res. 2004; 6(3): 457-463.

11) Tamim, H., Al-Sahab, B., Akkary, G., Ghanem, M., Tamim, N., El Roueiheb, Z.et al. Cigarette and nargileh smoking practices among school students in Beirut, Lebanon. Am J Health Behav. 2007; 31(1): 56-63.

12) Nakkash RT, Khalil J, Afifi RA. The rise in narghile (shisha, hookah) waterpipe tobacco smoking: a qualitative study of perceptions of smokers and non-smokers. BMC Public Health. 2011; 11: 315.

13) Report on the global tobacco epidemic. WHO website; 2020 [cited 20 Mar 2021]; Available from: https://www.who.int/teams/health-promotion/tobacco-control/who-report-on-the-global-tobacco-epidemic-2019

14) Kaleta D, Makowiec-Dąbrowska T, Dziankowska-Zaborszczyk E, Fronczak A. Determinants of heavy smoking: results from the global adult tobacco survey in Poland (2009-2010). Int J Occup Med Environ Health. 2012; 25(1): 66-79

15) Burden of Cigarette Use in the U.S. Centers for Disease Control and Prevention. CDC website; 2019 [cited 12 Mar 2021]; Available from: https://www.cdc.gov/tobacco

16) European tobacco use. WHO website; 2019 [cited 12 Mar 2021]; Available from: https://www.euro.who.int

17) Smoking and tobacco use. CDC website; 2019 [cited 12 Mar 2021]; Available from: https://www.cdc.gov/tobacco

18) Monod, M., Blenkinsop, A., Xi, X., Hebert, D., Bershan, S., Tietze, S., et al. (2021). Age groups that sustain resurging COVID-19 epidemics in the United States. Science. 2021; 371(6536): eabe8372.

19) Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review. Ann Intern Med. 2020; 173(5): 362-367.

20) Grace M.S., Birrell M.A., Dubuis E., Belvisi M.G. Tobacco smoke induced cough: mechanisms driving acute and chronic cough pathology. In: Moldoveanu A.M., editor. Advanced topics in environmental health and air pollution case studies. 2nd ed. In Tech; 2011. pp. 97–120.

21) Friedman GD, Siegelaub AB, Dales LG. Cigarette smoking and chest pain. Ann Intern Med. 1975; 83(1): 1-7.

22) Symptoms, spread and other essential information about coronavirus and COVID-19. Harvard Medical School website; 2021 [cited 17 Feb 2021]; Available from: https://www.health.harvard.edu/diseases-and-conditions/covid-19-basics

VOLUME 04 ISSUE 05 MAY 2021