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However, a release of dopamine can create a sense of reduced stress, mainly by relieving nicotine withdrawal symptoms, such as: Irritability Anxiety Restlessness Trouble concentrating These symptoms can appear within hours of the last cigarette or vape and oftentimes drive continued use

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The following variables were, therefore, included in the final multivariable logistic regression model: age, sex, rural/urban residence, education level, religion, household wealth, employment status, having family members who smoke shisha, the number of close friends who smoke shisha, current cigarette smoking status, current alcohol consumption status, stress, depression and anxiety