Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina

Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States.
Drug and alcohol dependence (Impact Factor: 3.42). 02/2011; 115(1-2):131-6. DOI: 10.1016/j.drugalcdep.2011.01.018
Source: PubMed


Known most commonly in the U.S. as "hookah," waterpipe tobacco smoking appears to be growing among college students. Despite beliefs that waterpipe use is safer than cigarette smoking, research to date (albeit limited) has found health risks of waterpipe smoking are similar to those associated with cigarette smoking, including lung cancer, respiratory illness, and periodontal disease. The goals of this study were to estimate the prevalence of use among a large, multi-institution sample of college students and identify correlates of waterpipe use, including other health-risk behaviors (i.e., cigarette smoking, alcohol, marijuana, and other illicit drug use) and availability of commercial waterpipe tobacco smoking venues.
A cross-sectional sample of 3770 college students from eight universities in North Carolina completed a web-based survey in fall 2008.
Forty percent of the sample reported ever having smoked tobacco from a waterpipe, and 17% reported current (past 30-day) waterpipe tobacco smoking. Correlates associated with current waterpipe use included demographic factors (male gender, freshman class); other health-risk behaviors (daily and nondaily cigarette smoking, alcohol use, marijuana use, other illicit drug use); perceiving waterpipe tobacco smoking as less harmful than regular cigarettes; and having a commercial waterpipe venue near campus.
The results highlight the popularity of waterpipe tobacco smoking among college students and underscore the need for more research to assess the public health implications of this growing trend.

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Available from: Kimberly Wagoner, May 14, 2014
    • "For hookah, this finding may be the result of the popularity of hookah smoking among college students and the concentration of hookah bars around college campuses (Sutfin et al., 2011). Also of note, almost a third of lifetime tobacco users reported their age of initiation was 18 years or older. "
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    ABSTRACT: As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students. A cross-sectional web survey of 3146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010. Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco. While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Addictive behaviors 07/2015; 51:152-157. DOI:10.1016/j.addbeh.2015.07.022 · 2.76 Impact Factor
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    • "A study using the 2008–2009 National College Health Assessment (NCHA) showed that 8.4% are current waterpipe smokers and that current waterpipe smoking was strongly associated with younger age, male gender, white race, and fraternity/sorority membership (Primack et al., 2013). Other studies using local/regional samples have also reported that gender, ethnicity , and cigarette use are associated with current waterpipe smoking (Smith-Simone et al., 2008; Sutfin et al., 2011). Overall, these studies have concluded that college students have some of the highest prevalence rates for waterpipe smoking (Akl et al., 2011; Maziak et al., 2015). "
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    ABSTRACT: Some waterpipe smokers exhibit nicotine dependent behaviors such as increased use over time and inability to quit, placing them at high risk of adverse health outcomes. This study examines the determinants of dependence by measuring frequency of use among current waterpipe smokers using a large national U.S. Data were drawn from four waves (Spring/Fall 2009 and Spring/Fall 2010) of the American College Health Association-National College Health Assessment datasets. The sample was restricted to students who smoked a waterpipe at least once in the past 30 days (N=19,323). Ordered logistic regression modeled the factors associated with higher frequency of waterpipe smoking. Among current waterpipe smokers, 6% used a waterpipe daily or almost daily (20-29 days). Daily cigarette smokers were at higher odds of smoking a waterpipe at higher frequencies compared with non-smokers of cigarettes (OR=1.81; 95% CI=1.61-2.04). There was a strong association between daily cigar smoking and higher frequency of waterpipe smoking (OR=7.77; 95% CI=5.49-11.02). Similarly, students who used marijuana had higher odds of smoking a waterpipe at higher frequencies (OR=1.57; 95% CI=1.37-1.81). Daily consumers of other addictive substances are at a higher risk of intensive waterpipe smoking and thus higher risk of waterpipe dependence. Intervention programs must incorporate methods to reduce waterpipe dependence and subsequently prevent its deleterious health effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 05/2015; 153. DOI:10.1016/j.drugalcdep.2015.05.015 · 3.42 Impact Factor
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    • "daily and weekly WP use , respectively ( Smith - Simone et al . , 2008b ) . These results were confirmed by another US cross - sectional internet - based survey of university students ( Eissenberg et al . , 2008 ) . More recent studies performed in California , North Carolina , and Florida found current WP smoking percentages between 10% and 17% ( Sutfin et al . , 2011 ; Barnett et al . , 2013 ; Nuzzo et al . , 2013 ) . Among military recruits , Ward et al . ( 2006 ) reported WP use of only 0 . 3% . In a first report of the prev - alence in an Arabic - speaking Australian population , 11 . 4% of the participants used a WP ( Carroll et al . , 2008 ) . The situation in Europe has not been well documente"
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    ABSTRACT: Waterpipe (WP) smoking is growing as an alternative to cigarette smoking, especially in younger age groups. E-cigarette use has also increased in recent years. A majority of smokers mistakenly believe that WP smoking is a social entertainment practice that leads to more social behavior and relaxation and that this type of smoking is safe or less harmful and less addictive than cigarette smoking. In reality, WP smokers are exposed to hundreds of toxic substances that include known carcinogens. High exposures to carbon monoxide and nicotine are major health threats. Persons exposed to secondhand WP smoke are also at risk. There is growing evidence that WP smoke causes adverse effects on the pulmonary and cardiovascular systems and is responsible for cancer.
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