{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:08:20Z","timestamp":1788955700368,"version":"build-2803163510"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"DOI":"10.1186\/s12913-026-15530-x","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:44:28Z","timestamp":1788500668000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to tobacco smoke, concurrent short-term symptoms of respiratory, allergic, cardiovascular morbidities and health-services use among young adults in Kuwait"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1261-788X","authenticated-orcid":false,"given":"Saeed","family":"Akhtar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Almutairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wadhah","family":"Alhajri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Alrashidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouf","family":"Almutairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghadeer","family":"Almutairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manar","family":"Aladwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulowa","family":"Al-Sanafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"issue":"9","key":"15530_CR1","first-page":"621","volume":"17","author":"G Heydari","year":"2014","unstructured":"Heydari G, Ebn Ahmady A, Lando HA, Shadmehr MB, Fadaizadeh L. The second study on WHO MPOWER tobacco control scores in Eastern Mediterranean Countries based on the 2013 report: improvements over two years. Arch Iran Med. 2014;17(9):621\u20135.","journal-title":"Arch Iran Med"},{"key":"15530_CR2","unstructured":"WHO. WHO global report on trends in prevalence of tobacco smoking 2015. Geneva; 2015."},{"issue":"1","key":"15530_CR3","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jadohealth.2009.03.013","volume":"45","author":"TP Mulye","year":"2009","unstructured":"Mulye TP, Park MJ, Nelson CD, Adams SH, Irwin CE Jr., Brindis CD. Trends in adolescent and young adult health in the United States. J Adolesc Health. 2009;45(1):8\u201324.","journal-title":"J Adolesc Health"},{"issue":"2","key":"15530_CR4","doi-asserted-by":"publisher","first-page":"134","DOI":"10.5811\/westjem.2021.8.52231","volume":"23","author":"A Navas","year":"2022","unstructured":"Navas A, Guzman B, Hassan A, Borawski JB, Harrison D, Manandhar P, Erkanli A, Limkakeng AT Jr. Untapped Potential for Emergency Department Observation Unit Use: A National Hospital Ambulatory Medical Care Survey (NHAMCS) Study. West J Emerg Med. 2022;23(2):134\u201340.","journal-title":"West J Emerg Med"},{"issue":"3 Pt 2","key":"15530_CR5","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.2466\/pr0.96.3c.1009-1010","volume":"96","author":"B Alansari","year":"2005","unstructured":"Alansari B. Prevalence of cigarette smoking among male Kuwait University undergraduate students. Psychol Rep. 2005;96(3 Pt 2):1009\u201310.","journal-title":"Psychol Rep"},{"issue":"1","key":"15530_CR6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/146642408710700113","volume":"107","author":"A Bener","year":"1987","unstructured":"Bener A. Smoking habits among male students at King Saud University. J R Soc Health. 1987;107(1):28\u201330.","journal-title":"J R Soc Health"},{"issue":"3","key":"15530_CR7","doi-asserted-by":"publisher","first-page":"325","DOI":"10.3109\/10826089409047384","volume":"29","author":"RR Hamadeh","year":"1994","unstructured":"Hamadeh RR, McPherson K, Doll R. Tobacco consumption and chemical analysis of cigarettes in Bahrain. Int J Addict. 1994;29(3):325\u201337.","journal-title":"Int J Addict"},{"issue":"11","key":"15530_CR8","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1016\/S0277-9536(98)00204-4","volume":"47","author":"TN Sugathan","year":"1998","unstructured":"Sugathan TN, Moody PM, Bustan MA, Elgerges NS. Age patterns of smoking initiation among Kuwait university male students. Soc Sci Med. 1998;47(11):1855\u20138.","journal-title":"Soc Sci Med"},{"issue":"3","key":"15530_CR9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1159\/000321273","volume":"20","author":"M Waheedi","year":"2011","unstructured":"Waheedi M, Al-Tmimy AM, Enlund H. Preparedness for the smoking cessation role among health sciences students in Kuwait. Med Princ Pract. 2011;20(3):237\u201343.","journal-title":"Med Princ Pract"},{"issue":"9","key":"15530_CR10","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1093\/ntr\/ntq123","volume":"12","author":"CJ Berg","year":"2010","unstructured":"Berg CJ, Parelkar PP, Lessard L, Escoffery C, Kegler MC, Sterling KL, Ahluwalia JS. Defining smoker: college student attitudes and related smoking characteristics. Nicotine Tob Res. 2010;12(9):963\u20139.","journal-title":"Nicotine Tob Res"},{"issue":"Suppl 3","key":"15530_CR11","doi-asserted-by":"publisher","first-page":"S371","DOI":"10.1080\/14622200412331320770","volume":"6","author":"R Murphy-Hoefer","year":"2004","unstructured":"Murphy-Hoefer R, Alder S, Higbee C. Perceptions about cigarette smoking and risks among college students. Nicotine Tob Res. 2004;6(Suppl 3):S371\u2013374.","journal-title":"Nicotine Tob Res"},{"issue":"4","key":"15530_CR12","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/j.amepre.2017.03.020","volume":"53","author":"AL Merianos","year":"2017","unstructured":"Merianos AL, Jandarov RA, Mahabee-Gittens EM. Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations. Am J Prev Med. 2017;53(4):441\u20138.","journal-title":"Am J Prev Med"},{"issue":"1","key":"15530_CR13","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1177\/0890117116686885","volume":"32","author":"AL Merianos","year":"2018","unstructured":"Merianos AL, Odar Stough C, Nabors LA, Mahabee-Gittens EM. Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States. Am J Health Promot. 2018;32(1):123\u201330.","journal-title":"Am J Health Promot"},{"issue":"4","key":"15530_CR14","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/ije\/7.4.373","volume":"7","author":"LG Dales","year":"1978","unstructured":"Dales LG, Ury HK. An improper use of statistical significance testing in studying covariables. Int J Epidemiol. 1978;7(4):373\u20135.","journal-title":"Int J Epidemiol"},{"issue":"11","key":"15530_CR15","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1093\/oxfordjournals.aje.a116813","volume":"138","author":"G Maldonado","year":"1993","unstructured":"Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923\u201336.","journal-title":"Am J Epidemiol"},{"issue":"1","key":"15530_CR16","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1093\/oxfordjournals.aje.a115101","volume":"129","author":"RM Mickey","year":"1989","unstructured":"Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129(1):125\u201337.","journal-title":"Am J Epidemiol"},{"issue":"6","key":"15530_CR17","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1093\/oxfordjournals.aje.a112339","volume":"104","author":"OS Miettinen","year":"1976","unstructured":"Miettinen OS. Stratification by a multivariate confounder score. Am J Epidemiol. 1976;104(6):609\u201320.","journal-title":"Am J Epidemiol"},{"key":"15530_CR18","doi-asserted-by":"crossref","unstructured":"Akhtar S, Al-Shanfari S, Booalayan H, Abdulrasool M, Boujarwa A, Al-Mukaimi A, Alkandery O. Exposure to household secondhand tobacco smoke and the odds of developing atopic dermatitis among adolescents: a causal mediation analysis. Tob Induc Dis 2024, 22.","DOI":"10.18332\/tid\/176967"},{"issue":"12","key":"15530_CR19","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1093\/ntr\/ntz020","volume":"21","author":"M Zhang","year":"2019","unstructured":"Zhang M, Liu S, Yang L, Jiang Y, Huang Z, Zhao Z, Deng Q, Li Y, Zhou M, Wang L, et al. Prevalence of Smoking and Knowledge About the Hazards of Smoking Among 170 000 Chinese Adults, 2013\u20132014. Nicotine Tob Res. 2019;21(12):1644\u201351.","journal-title":"Nicotine Tob Res"},{"issue":"11","key":"15530_CR20","first-page":"597","volume":"58","author":"R Ahmed","year":"2008","unstructured":"Ahmed R, Rizwan ur R, McDonald PW, Ahmed SW. Prevalence of cigarette smoking among young adults in Pakistan. J Pak Med Assoc. 2008;58(11):597\u2013601.","journal-title":"J Pak Med Assoc"},{"issue":"6","key":"15530_CR21","doi-asserted-by":"publisher","first-page":"369","DOI":"10.34172\/aim.2020.29","volume":"23","author":"M Varmaghani","year":"2020","unstructured":"Varmaghani M, Sharifi F, Mehdipour P, Sheidaei A, Djalalinia S, Gohari K, Modirian M, Pazhuheian F, Peykari N, Haghshenas R, et al. Prevalence of Smoking among Iranian Adults: Findings of the National STEPs Survey 2016. Arch Iran Med. 2020;23(6):369\u201377.","journal-title":"Arch Iran Med"},{"key":"15530_CR22","doi-asserted-by":"publisher","first-page":"32","DOI":"10.18332\/tpc\/152254","volume":"8","author":"S Al Dharman","year":"2022","unstructured":"Al Dharman S, Safar K, Al Enezi F, Al Bahar H, Ali A, Al Qallaf Z, Al Shaya A, Alenezi M, Al Otaibi S, Al Nassar M, et al. An experimental vignette study to assess stigmatized attitudes towards tobacco smokers in Kuwait. Tob Prev Cessat. 2022;8:32.","journal-title":"Tob Prev Cessat"},{"issue":"2","key":"15530_CR23","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1093\/ntr\/ntp015","volume":"11","author":"LC An","year":"2009","unstructured":"An LC, Berg CJ, Klatt CM, Perry CL, Thomas JL, Luo X, Ehlinger E, Ahluwalia JS. Symptoms of cough and shortness of breath among occasional young adult smokers. Nicotine Tob Res. 2009;11(2):126\u201333.","journal-title":"Nicotine Tob Res"},{"issue":"2","key":"15530_CR24","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1378\/chest.114.2.388","volume":"114","author":"A Senthilselvan","year":"1998","unstructured":"Senthilselvan A. Prevalence of physician-diagnosed asthma in Saskatchewan, 1981 to 1990. Chest. 1998;114(2):388\u201392.","journal-title":"Chest"},{"issue":"5\u20136","key":"15530_CR25","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1159\/000492054","volume":"234","author":"M Abdualrasool","year":"2018","unstructured":"Abdualrasool M, Al-Shanfari S, Booalayan H, Boujarwa A, Al-Mukaimi A, Alkandery O, Akhtar S. Exposure to Environmental Tobacco Smoke and Prevalence of Atopic Dermatitis among Adolescents in Kuwait. Dermatology. 2018;234(5\u20136):186\u201391.","journal-title":"Dermatology"},{"issue":"1","key":"15530_CR26","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1186\/s12889-020-09245-9","volume":"20","author":"H Booalayan","year":"2020","unstructured":"Booalayan H, Abdualrasool M, Al-Shanfari S, Boujarwa A, Al-Mukaimi A, Alkandery O, Akhtar S. Exposure to environmental tobacco smoke and prevalence of asthma among adolescents in a middle eastern country. BMC Public Health. 2020;20(1):1210.","journal-title":"BMC Public Health"},{"issue":"1","key":"15530_CR27","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s12931-022-02144-0","volume":"23","author":"YS Jo","year":"2022","unstructured":"Jo YS, Kim KJ, Rhee CK, Yoo KH, Jung KS, Park YB. Prevalence, characteristics, and risk of exacerbation in young patients with chronic obstructive pulmonary disease. Respir Res. 2022;23(1):212.","journal-title":"Respir Res"},{"key":"15530_CR28","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.2147\/COPD.S161555","volume":"13","author":"B Zhu","year":"2018","unstructured":"Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:1353\u201364.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"8","key":"15530_CR29","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1164\/rccm.200612-1749OC","volume":"176","author":"N Zhong","year":"2007","unstructured":"Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, Chen B, Wang C, Ni D, Zhou Y, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med. 2007;176(8):753\u201360.","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"15530_CR30","doi-asserted-by":"publisher","first-page":"2698","DOI":"10.1186\/s12889-025-23927-2","volume":"25","author":"F Issa","year":"2025","unstructured":"Issa F, Abdulla M, Abouzoor R, Abdallah AM, Al-Hamdani M. Second-hand smoke exposure level in the household increases risk of chest pain and wheezing: evidence from Qatar biobank. BMC Public Health. 2025;25(1):2698.","journal-title":"BMC Public Health"},{"issue":"7","key":"15530_CR31","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1080\/03007995.2022.2065142","volume":"38","author":"PSP Cho","year":"2022","unstructured":"Cho PSP, Shearer J, Simpson A, Campbell S, Pennington M, Birring SS. Healthcare utilization and costs in chronic cough. Curr Med Res Opin. 2022;38(7):1251\u20137.","journal-title":"Curr Med Res Opin"},{"issue":"1","key":"15530_CR32","first-page":"5","volume":"12","author":"S Hossain","year":"2010","unstructured":"Hossain S, Larson CP, Quaiyum MA, Khan AI, Zaman K, Begum V, Saha NC. Adults with chronic cough in urban Bangladesh: healthcare utilization and management of cases by private practitioners. World Health Popul. 2010;12(1):5\u201317.","journal-title":"World Health Popul"},{"issue":"2","key":"15530_CR33","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s40122-016-0057-y","volume":"5","author":"E Marrett","year":"2016","unstructured":"Marrett E, Kwong WJ, Frech F, Qian C. Health Care Utilization and Costs Associated with Nausea and Vomiting in Patients Receiving Oral Immediate-Release Opioids for Outpatient Acute Pain Management. Pain Ther. 2016;5(2):215\u201326.","journal-title":"Pain Ther"},{"issue":"3","key":"15530_CR34","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.amjmed.2004.12.015","volume":"118","author":"MC Sha","year":"2005","unstructured":"Sha MC, Callahan CM, Counsell SR, Westmoreland GR, Stump TE, Kroenke K. Physical symptoms as a predictor of health care use and mortality among older adults. Am J Med. 2005;118(3):301\u20136.","journal-title":"Am J Med"},{"issue":"5","key":"15530_CR35","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1080\/02770903.2022.2114086","volume":"60","author":"GN Lim","year":"2023","unstructured":"Lim GN, Allen JC, Tiew PY, Chen W, Koh MS. Healthcare utilization and health-related quality of life of severe asthma patients in Singapore. J Asthma. 2023;60(5):969\u201380.","journal-title":"J Asthma"},{"key":"15530_CR36","first-page":"1","volume":"32","author":"LJ Akinbami","year":"2011","unstructured":"Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality: United States, 2005\u20132009. Natl Health Stat Rep. 2011;32:1\u201314.","journal-title":"Natl Health Stat Rep"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-026-15530-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-15530-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-15530-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:40:59Z","timestamp":1788954059000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-026-15530-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["15530"],"URL":"https:\/\/doi.org\/10.1186\/s12913-026-15530-x","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"assertion":[{"value":"15 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The research protocol, consent form, and data collection instrument were approved by the Ethics Committee of the Health Sciences Center of Kuwait University (# 272\/ dated 1\/25\/2021). An informed consent was obtained from each participant. This study was undertaken in accordance with the principles and guidelines of the Declaration of Helsinki for medical research involving human subjects. Furthermore, the methods including design, conduct, data collection, analysis and reporting of the results conformed with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1253"}}