Article

Hookah Use Among U.S. College Students: Results From the National College Health Assessment II

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Abstract

Tobacco use is the leading cause of morbidity and mortality in the United States. Hookah use is a growing tobacco trend among young adults; yet little is known about how young adult college student hookah smokers differ from nonsmokers or cigarette smokers. Results from 18- to 24-year-old participants in the Fall 2008-Spring 2009 National College Health Assessment II (N = 82,155) were used in multinomial logistic regression models to compare nonsmokers, cigarette-only smokers, hookah-only smokers, and dual (cigarette and hookah) users. Ten percent of the sample reported hookah use in the last 30 days. Compared with nonsmokers, cigarette, hookah, and dual users were more likely to be younger, male, White, and use other substances (including alcohol). Compared with nonsmokers, hookah and dual users were more likely to be members of fraternities/sororities (odds ratio [OR] = 1.17 and 1.14, respectively), live in the West (OR = 1.49 and 1.31, respectively), and attend larger institutions. Compared with cigarette-only smokers, hookah and dual users were more likely to be younger, male, live on campus, live in the West, attend large institutions, and were less likely to attend public institutions. Compared with cigarette-only smokers, hookah-only users were more likely to be non-White and less likely to use marijuana or other drugs. Conclusions: Hookah-only and dual users are demographically different than cigarette-only or nonsmoking college students. Interventions for tobacco use on college campuses should address the demographic differences among tobacco users (including polysubstance use) and attempt to recruit students as entering freshman to provide education and prevent hookah use uptake.

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... Analyzing Spring 2008-Fall 2009 National College Health Assessment data, Jarrett and colleagues found 23% lifetime hookah use in this predominately Caucasian and female sample (n=82,155). 13 With respect to African American students specifically, the researchers reported a protective effect on cigarette and hookah smoking. Nonetheless, African Americans were at higher odds of being a hookah-only and a dual hookah and cigarette user when they did smoke. ...
... students. 12,13,21,22 African American college students are less likely than their White peers to smoke cigarettes or hookah. Existing evidence, however, demonstrates higher risks for negative health effects, such as increased susceptibility to nicotine dependence, among African American smokers. ...
... Results from other studies of college student tobacco smoking corroborate our findings concerning the co-occurrence of tobacco and alcohol, marijuana, and other substance use. 12,13,[25][26][27] In our study, specifically, the adjusted odds ratios were the highest for respondents who reported dual, or both cigarette and hookah, use within the last 30 days. Current alcohol, marijuana, and other illicit drug use were, respectively, statistically significant correlates of cigarette-only and dual use. ...
Article
Objective: To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. Participants: AA college students (N = 1,402; mean age = 20, range = 18-24 years; 75% female) who completed the Fall 2012 American College Health Association-National College Health Assessment II. Methods: Respondents were stratified into 4 mutually exclusive groups by last-30-day smoking status: cigarette-only use (5.1%), hookah-only use (5.9%), dual use (2.4%), and nonuse (86.6%). Multinomial logistic regression models identified the relative odds of exclusive and dual hookah and cigarette smoking. Results: Current hookah and cigarette smoking rates were comparably low. Age, gender identity, current substance use, interest in tobacco use information, and student population prevailed as risks and protections for hookah and cigarette smoking. Conclusions: Campus health promotion campaigns may need to tailor messages to AA students, particularly those who use substances, to underscore the health risks of hookah and cigarette smoking.
... 8 9 The proliferation of hookah cafés and bars, particularly around college campuses, is likely a contributing factor in the increased prevalence of use among young adults. [10][11][12] While hookah use is popular among youth and young adults, it is not limited to this population. Published data from the Tobacco Products and Risk Perceptions Surveys found that in 2014-2015, prevalence of ever and P30D hookah smoking among US adults was 15.8% and 1.5%, respectively, 13 and 0.6% of adults used hookah every day or some days as reported by the National Health Interview Survey, 2013-2014. ...
... 8 One of the most salient aspects among hookah users is the concomitant use of other tobacco products, or polytobacco use. 1 Based on 2014-2015 data from the Population Assessment of Tobacco and Health (PATH) Study, 9.7 % of US young adults and 1.0% of US adults 25+ used hookah plus at least one other tobacco product. 14 One study among college students showed almost 30% of hookah users also used cigarettes in the past 30 days, 12 while another study showed almost half (48.6%) of current hookah users also smoked cigarettes. 15 Additionally, among US high school seniors, occasional and regular cigarette smokers were four and five times more likely to use hookah than non-smokers, respectively. ...
... 13 17 The current hookah literature is limited to either cross-sectional national studies or studies based on convenience samples of college students. 12 13 Despite the pervasive belief that hookah use is less harmful than smoking cigarettes, on April 22, 2020 by guest. Protected by copyright. ...
Article
Objective The goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older). Design Data were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses. Results Young adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes. Conclusions Hookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.
... While gains have been made in reducing cigarette use among college students, the prevalence of hookah use is increasing (Smith et al., 2011;Sutfin et al., 2011). In a nationally representative sample of college students, 9.3% of students reported past 30-day hookah use while 22.9% reported ever use (Jarrett et al., 2012). Smaller studies of college students have found wide ranges in the prevalence of hookah, with one study finding that current use was as high as 22% (Heinz et al., 2013;Latimer et al., 2013;Sutfin et al., 2011). ...
... Research on hookah has focused on the socio-demographic characteristics and other tobacco and substance use behaviors of hookah users. Correlates of hookah use include male gender, being younger, alcohol use, and past 30-day cigarette use (Jarrett et al., 2012;Sutfin et al., 2011). Further, college students perceive hookah as a safe alternative to conventional cigarettes (Berg et al., 2015b;Heinz et al., 2013;Primack et al., 2008). ...
... The results indicate that a majority of college students have tried hookah and current users smoke hookah approximately once per week. Similar to other studies, correlates of hookah use included younger age and current tobacco use (Jarrett et al., 2012;Sutfin et al., 2011). More than one quarter of all students were not aware that hookah contained tobacco and more than one third of the students were not aware of nicotine in hookah. ...
... Thus evidence on the negative health effects of hookah contradicts the widely held perception that hookah is less harmful than cigarettes (Barnett, Curbow, Soule Jr, Tomar, & Thombs, 2011). In addition, nicotine dependence can also be a long-term consequence (Jackson & Aveyard, 2008) of hookah smoking, as numerous studies indicate significant numbers of students who previously never smoked a cigarette are experimenting with hookah (Jarrett, Blosnich, Tworek, & Horn, 2012;Primack, Shensa, Kim, Carroll, Hoban, et al., 2012;Fielder, Carey & Carey, 2013;Heinz, Giedgowd, Crane, Veilleux, Conrad, Braun, Olejarska & Kassel, 2013). ...
... Lifetime use ranges from 15% (Grekin & Ayna, 2008) to 61% (Noonan, Kulbok, & Yan, 2011) and current use from 5% (Fielder, Carey & Carey, 2012) to 30% (Sutfin et al., 2011). Higher use is seen at schools in the West, in cities of all sizes, (Johnston, O'Malley, Bachman, Schulenberg, & Miech, 2014) at schools with fraternities and sororities, (Jarrett et al., 2012, Sidani, Shensa & Primack, 2013 and at schools with nearby off-campus hookah bars/cafés (Sutfin et al., 2011). Furthermore longitudinal results from the Monitoring the Future study that is conducted in four-year colleges have shown that annual prevalence rates are increasing among young college-aged adults (Johnston et al., 2014). ...
... Common correlates of hookah use at four-year schools included the concurrent use of other substances like alcohol, marijuana, cigars/cigarillos, and/or other illegal drugs (Braun, Glassman, Wohlwend, Whewell & Reindl, 2012;Jarrett et al., 2012, Rath et al., 2012. Although cigarette smokers may already be using hookah (Braun et al., 2012;Jarrett et al., 2012), users perceived hookah smoke to contain less nicotine, and therefor saw it as less addictive and harmful than cigarette smoke (Heinz, et al, 2013;Griffith & Ford, 2014;Noonan & Patrick, 2012). ...
Article
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Background and purpose: Hookah smoking is a growing young adult phenomenon, particularly among college students. Many users feel that it is safer than other tobacco products, although its health threats are well documented. Little is known about hookah use rates in community colleges that are attended by nearly half of all US college students. This study examined hookah use in a diverse convenience sample of students attending two southern California community colleges. Methods: In fall 2011, a cross-sectional, in-classroom survey was administered to 1,207 students. A series of fully adjusted multivariate logistic regressions were conducted to explore demographic, other substance use, and attitudinal correlates of lifetime and current hookah use. Results: Lifetime hookah use (56%) was higher than lifetime cigarette use (49%). Gender and personal socioeconomic status were not related to hookah use. Current use (10.8%) was associated with current use of alcohol, cigars, and cigarettes. Compared to African-Americans, Whites were 2.9 times more likely to be current users, and students who perceive hookah to be more socially acceptable were 21 times more likely to currently use. Conclusion: Since hookah use rates are high, colleges should offer health education programs to inform incoming students about the health risks of hookah and cessation programs.
... The majority of hookah tobacco users in college are European-Americans of non-Hispanic ethnicity (9,19,38,49,50). Less is known about other ethnicities among these users, but a few studies show that individuals of Arab ethnicity have the highest prevalence of hookah tobacco consumption among all hookah tobacco consumers (51,52). ...
... The majority of young adults who smoke hookah tobacco also consume other tobacco products and abusable substances (49,63). However, about 40% of current hookah tobacco users in college smoke only this product (64) suggesting that hookah tobacco smoking substantially contributes to the initiation of tobacco use among tobacco-naïve individuals. ...
... The peer environment is integral to the initiation of hookah tobacco smoking (11,19,63), particularly among students living on campus or in a fraternity/sorority house (49,74). Female students are more susceptible to initiating hookah tobacco smoking in response to peer-pressure than their male peers (75). ...
Article
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BACKGROUND: About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. OBJECTIVE: Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. METHODS: PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy". RESULTS: Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking. CONCLUSION: Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.
... Even though hookah use dates back centuries, it is growing in popularity among youth and young adults Grekin & Ayna, 2012;Jarrett et al., 2012) despite mounting evidence concerning hookah's carcinogenic and other chronic disease consequences for both active and passive smokers (Blachman-Braun, Del Mazo-Rodr ıguez, L opez-S amano, & Buend ıa-Rold an, 2014; Akl, Gaddam, Gunukula, Honeine, Jaoude, & Irani, 2010;Shaikh, Vijayarahavan, Sulaiman, Kazi, & Shafi, 2008). In addition, hookah use has been found to be associated with college students' greater likelihood of using other substances, such as alcohol, cigarettes, cannabis, cocaine, and stimulants (Goodwin et al., 2014). ...
... In fact, hookah use may often precede other substance use (Jensen, Cortes, Engholm, Kremers, & Gislum, 2010;Soneji, Sargent, & Tanski, 2016). Among college students, rates of hookah use, which range from 15% to 30% across various studies, have risen to a near comparable level to cigarette use rates at 30% (Grekin & Ayna, 2012;Primack et al., 2008;Jarrett et al., 2012). In a study of college freshmen, hookah use prevalence increased from 9% to 13% among first-year students during the first month of college (Shepardson & Hustad, 2016). ...
... Even characteristics of the college/university setting may pose certain risks and protections for hookah smoking. For example, Greek fraternity/sorority membership, Greek housing residence, U.S. region and size of the city where the college/ university is located were found to be associated with risk for hookah use, with attendance at public college/universities being associated with lower risk among a national sample of college students using the National College Health Assessment (NCHA; Jarrett et al., 2012). By contrast, in a later data collection of the NCHA, focusing only on African American college students, no other institutional context variables were found to be risk factors in multivariable models. ...
Article
Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.
... The majority of hookah tobacco users in college are European-Americans of non-Hispanic ethnicity (9,19,38,49,50). Less is known about other ethnicities among these users, but a few studies show that individuals of Arab ethnicity have the highest prevalence of hookah tobacco consumption among all hookah tobacco consumers (51,52). ...
... The majority of young adults who smoke hookah tobacco also consume other tobacco products and abusable substances (49,63). However, about 40% of current hookah tobacco users in college smoke only this product (64) suggesting that hookah tobacco smoking substantially contributes to the initiation of tobacco use among tobacco-naïve individuals. ...
... The peer environment is integral to the initiation of hookah tobacco smoking (11,19,63), particularly among students living on campus or in a fraternity/sorority house (49,74). Female students are more susceptible to initiating hookah tobacco smoking in response to peer-pressure than their male peers (75). ...
Article
Abstract BACKGROUND: About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. OBJECTIVE: Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. METHODS: PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy". RESULTS: Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking. CONCLUSION: Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.
... Between 2009Between -2010Between and 2013Between -2014, the prevalence of past 30-day hookah use among young adults (aged 18-24) increased from 7.8% to 18.2% and ever hookah use increased from 28.6% to 44.4% [15][16][17]. A different study found that among [18][19][20][21][22][23][24] year old never hookah users in 2013-2014, 14.1% initiated ever use, 6.1% initiated past 30-day use, and 0.2% initiated frequent hookah use (i.e. use on at least 20 days in the past 30-days) one year later [18]. ...
... Three behavioral outcomes are reported: age of initiation of (i) ever hookah use, (ii) past 30-day hookah use, and (iii) fairly regular hookah use. The current study goes beyond prior research that has provided prevalence (yes/no) of hookah use [15,16,19,20] by analyzing age with each yes/no initiation outcome. Prior studies provide evidence that hookah use among adults (aged 18+) varies by demographic factors such as sex and race/ethnicity. ...
... Prior studies provide evidence that hookah use among adults (aged 18+) varies by demographic factors such as sex and race/ethnicity. We therefore explore differences in the age of initiation of each hookah use behavior by sex and by race/ethnicity [15,19,[21][22][23]. A PATH study from 2013-2016 examined the role of other tobacco product use correlates on the initiation of hookah, which found that past 30-day hookah use was associated with ever e-cigarette use and ever cigar products use [24]. ...
Article
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Objective: To prospectively estimate the age of initiation of ever, past 30-day, and fairly regular hookah use among young adults (ages 18-24) overall, by sex, by race/ethnicity, and to explore the association of prior use of other tobacco products with these hookah use behaviors. Methods: Secondary data analyses of the first four waves (2013-2017) of the PATH study, a nationally representative longitudinal cohort study of US young adults. Young adult never hookah users at the first wave of adult participation in PATH waves 1-3 (2013-2016) were followed-up into waves 2-4 (2014-2017) to estimate the age of initiation of three outcomes: (i) ever use, (ii) past 30-day use, and (iii) fairly regular hookah use. Weighted interval-censoring Cox proportional hazards regression models were used to examine the differences in the estimated age of initiation by sex and by race/ethnicity while controlling for the total number of other tobacco products ever used at participants' first wave of PATH participation. In addition, to examine if prior use of other tobacco products was associated with the age of hookah initiation behaviors, six additional Cox models are reported for each hookah initiation behaviors. Results: The largest increase in hookah use occurred between ages 18 and 19: 5.8% for ever use and 2.7% for past 30-day hookah use. By age 21, 10.5%, 4.7% and 1.2% reported initiation of ever, past 30-day and fairly regular hookah use, respectively. There were statistically significance differences in the age of initiation of hookah use behaviors by race/ethnicity. Conclusion: Educational interventions should target young adults before the age of 21, focusing efforts specifically on males, non-Hispanic Blacks and Hispanics, to stall initiation and progression of hookah use behaviors.
... 14 Evidence indicates that WPT initiation among the young people is associated with individual factors such as low addictive and harm perception compared to cigarettes, [8][9][10]15,16 socialization, 17,18 appealing flavors, 19 and sensation seeking, 20,21 as well as social factors (e.g., peer or family influence) 22 and other substance use (e.g., alcohol, marijuana, and other tobacco products). 18,[23][24][25][26][27][28][29][30] Whereas, progression in WPT among this population is associated with additional factors 31,32 such as nicotine dependence, 33 and owning a WPT smoking device. 34 Most available evidence, however, is based on small samples, cross-sectional data, limited span longitudinal data, or lacks an appropriate theoretical framework. ...
... The selection of study variables in our study was guided by the Host, Agent, Vector, Environment (HAVE) A c c e p t e d M a n u s c r i p t conceptual model of the PATH study 49 and a review of the literature. [8][9][10][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] According to the HAVE model, behavioral and health outcomes are influenced by the interactions between these four critical domains. Host factors are related to individuals who are tobacco users or at risk of becoming tobacco users and include perceptions and demographic characteristics. ...
Article
Full-text available
Background: Waterpipe tobacco (WPT) smoking has increased among the young population in the United States (US). This study assessed the extent and predictors of WPT smoking initiation and progression among US adolescents (12-17 years) and young adults (18-24 years) longitudinally. Methods: We analyzed data from 4 waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) study comprising 10,692 respondents (adolescents=5,428 and young adults=5,264). Kaplan-Meier survival method estimated probabilities of WPT initiation and progression. Cox proportional hazards regression models delineated predictors of the outcomes. Results: Between 2013 to 2018, 4.8% of adolescents initiated and 10.6% progressed WPT smoking. Among young adults, 18.5% initiated and 14.1% progressed WPT smoking during the same time interval. Predictors among adolescents included, WPT initiation: Hispanic ethnicity (adjusted odds ratio (aHR)=1.75, 95% confidence interval (CI)=1.23-2.49), lower harm perception (aHR=2.89, 95% CI=2.10-3.98), and other tobacco products use (aHR=3.97, 95% CI=2.73-5.78); WPT progression: illicit drug use (aHR=4.60, 95% CI=1.99-10.67). Predictors among young adults included, WPT initiation: non-Hispanic Black (aHR=2.31, 95% CI=1.78-3.00), Hispanic (aHR=1.77, 95% CI=1.34-2.33), lower harm perception (aHR=2.77, 95% CI=2.19-3.50), and other tobacco products use (aHR=3.14, 95% CI=2.25-4.38); WPT progression: non-Hispanic Black (aHR=1.51 95% CI=1.09-2.10), lower harm perception (aHR=1.80, 95% CI=1.41-2.30), and alcohol use (aHR=1.61, 95% CI=1.13-2.30). Conclusions: Results indicate a high prevalence of WPT initiation and progression among adolescents and young adults over time, with minority racial/ethnic groups being at greater risk for both. WPT-specific risk communication interventions (e.g., educational campaigns and health warning labels) are warranted to limit WPT smoking among young people.
... According to the random effect model, the pooled prevalence of water-pipe smoking at least once in a lifetime was 25% (95% CI: 22-29) in university student, and the pooled prevalence of water-pipe smoking at least once in a lifetime in male and female was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively ( Table 2). The pooled prevalence of water-pipe smoking at least once in the last year in mixed gender in college student was 21% (95%CI: [16][17][18][19][20][21][22][23][24][25] and in male and female student was 31% (95%CI: 20-42) and 14% (95%CI: 8-20), respectively ( Table 2). In addition, the pooled prevalence of water-pipe smoking at least once in the last month in both male and female student was 8% (95%CI: 5-11), and in male and female subgroup was 11% (95%CI: 5-16) and 4% (95%CI: 2-6) respectively (Table 2). ...
... Another study in the United States showed that the prevalence of hookah smoking among university students was 7.8% in the past month (24). The results of the National Collage Health Assessment (NCHA) indicate that among United States university students, the lifetime prevalence of hookah smoking increased from 24.8% to 30.8%, from 2008 to 2010 and last year prevalence ranged from 7% to 10.2% in this time interval (25). The comparison of our findings as a meta-analysis and the prevalence of hookah smoking in western countries indicated that the prevalence of hookah smoking among Iranian university students is slightly lower than in western countries. ...
Article
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Background: The rise in popularity of waterpipe smoking among younger people cause increase its deleterious effects on health in recent years. The aim of this study was to estimate the pooled prevalence of water-pipe smoking in university students in Iran. Methods: We performed the literature search from 1946 to January 21, 2019, in several international and na-tional databases such as Medline/PubMed, Web of Science, Scopus, Google Scholar, Magiran, Iranmedex, and IranPsych. To investigate the between-study heterogeneity we used the chi-squared test and I2 index. We used a random-effects model to estimate the pooled prevalence of water-pipe smoking. The potential source of heter-ogeneity was assessed by subgroup analysis and meta-regression. Results: According to the eligibility criteria, we included 37 relevant studies in our meta-analysis. The pooled prevalence of lifetime water-pipe smoking was 25% (95% CI: 22-29) and in male and female subgroups was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively. The pooled prevalence of water-pipe smoking in last year was 21% (95%CI: 16-25) and in last month was 8% (95%CI: 5-11). Results of meta-regression analysis showed that there was not any significant association between suspected variables and the prevalence of water-pipe smoking. Conclusion: The higher prevalence rate of water pipe smoking among university students indicates the emer-gency need for planning preventive program.
... Despite the rise in hookah use and its known risks, there is scant research on the correlates of hookah use in the general adult population. What is known about the correlates of hookah use come mainly from convenience samples (Daniels & Roman, 2013;Jarrett, Blosnich, Tworek, & Horn, 2012;Linde et al., 2015;Smith et al., 2011) or representative samples of adolescents (Amrock, Gordon, Zelikoff, & Weitzman, 2014), high school students (Palamar et al., 2014), and college students (Chen & Loukas, 2015;Montgomery et al., 2015). However, findings from these studies cannot be generalized to the overall adult populationadditionally because a large minority of US high school students fail to complete high school, and of those who receive a high school degree, a smaller percentage enroll in university and earn a college degree (Chapman, Laird, Ifill, & KewalRamani, 2011). ...
... Another striking correlate of hookah use is geographic region. Consistent with the literature (Jarrett et al., 2012;Primack et al., 2013), hookah use is most prevalent in the western part of the US. This is particularly interesting given that several states in the western part of the US are known to have one of the most stringent anti-cigarette (but not hookah) smoking laws and the lowest cigarette smoking rate in the country (e.g., Utah and California) (Centers for Disease Control and Prevention, 2014). ...
Article
Background: Hookah use may be increasing among adults in the US. Information on the prevalence and correlates of hookah use in the adult population is relatively limited. Objectives: To determine the prevalence of current (past 30-day) and lifetime use of hookah among adults ages 18-40 in the US and to investigate the socio-demographic characteristics associated with lifetime use. Methods: Data were drawn from the Tobacco Use Supplement of the Current Population Survey data from May 2010, August 2010, and January 2011 (n = 85,545). Logistic regression was used to examine various demographic correlates of lifetime hookah use. Results: Among 18-40 year olds, the past month prevalence rate of hookah use was 0.6% and the lifetime prevalence rate of hookah use was 3.9%. Being male, non-Hispanic white, having higher levels of educational attainment, having never been married, not having any children, earning less than $20,000 annually, residing in the Midwest or western US, being a student, and being a cigarette smoker were associated with increased likelihood of lifetime hookah use. The prevalence of hookah use among current, cigarette smokers was 7.9%, more than double that of the general adult population. Conclusions: Hookah use is significantly more common among cigarette smokers and among various demographic subgroups among general adult population. Given the risks associated with hookah and poly-tobacco use, targeted public health efforts are recommended. Additionally, health-care providers may consider expanding screening tests to include hookah use.
... 14 Evidence indicates that WPT initiation among the young people is associated with individual factors such as low addictive and harm perception compared to cigarettes, [8][9][10]15,16 socialization, 17,18 appealing flavors, 19 and sensation seeking, 20,21 as well as social factors (e.g., peer or family influence) 22 and other substance use (e.g., alcohol, marijuana, and other tobacco products). 18,[23][24][25][26][27][28][29][30] Whereas, progression in WPT among this population is associated with additional factors 31,32 such as nicotine dependence, 33 and owning a WPT smoking device. 34 Most available evidence, however, is based on small samples, cross-sectional data, limited span longitudinal data, or lacks an appropriate theoretical framework. ...
... The selection of study variables in our study was guided by the Host, Agent, Vector, Environment (HAVE) A c c e p t e d M a n u s c r i p t conceptual model of the PATH study 49 and a review of the literature. [8][9][10][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] According to the HAVE model, behavioral and health outcomes are influenced by the interactions between these four critical domains. Host factors are related to individuals who are tobacco users or at risk of becoming tobacco users and include perceptions and demographic characteristics. ...
Article
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Background: Waterpipe tobacco (WPT) smoking has increased among the young population in the United States (US). This study assessed the extent and predictors of WPT smoking initiation and progression among US adolescents (12-17 years) and young adults (18-24 years) longitudinally. Methods: We analyzed data from 4 waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) study comprising 10,692 respondents (adolescents=5,428 and young adults=5,264). Kaplan-Meier survival method estimated probabilities of WPT initiation and progression. Cox proportional hazards regression models delineated predictors of the outcomes. Results: Between 2013 to 2018, 4.8% of adolescents initiated and 10.6% progressed WPT smoking. Among young adults, 18.5% initiated and 14.1% progressed WPT smoking during the same time interval. Predictors among adolescents included, WPT initiation: Hispanic ethnicity (adjusted odds ratio (aHR)=1.75, 95% confidence interval (CI)=1.23-2.49), lower harm perception (aHR=2.89, 95% CI=2.10-3.98), and other tobacco products use (aHR=3.97, 95% CI=2.73-5.78); WPT progression: illicit drug use (aHR=4.60, 95% CI=1.99-10.67). Predictors among young adults included, WPT initiation: non-Hispanic Black (aHR=2.31, 95% CI=1.78-3.00), Hispanic (aHR=1.77, 95% CI=1.34-2.33), lower harm perception (aHR=2.77, 95% CI=2.19-3.50), and other tobacco products use (aHR=3.14, 95% CI=2.25-4.38); WPT progression: non-Hispanic Black (aHR=1.51 95% CI=1.09-2.10), lower harm perception (aHR=1.80, 95% CI=1.41-2.30), and alcohol use (aHR=1.61, 95% CI=1.13-2.30). Conclusions: Results indicate a high prevalence of WPT initiation and progression among adolescents and young adults over time, with minority racial/ethnic groups being at greater risk for both. WPT-specific risk communication interventions (e.g., educational campaigns and health warning labels) are warranted to limit WPT smoking among young people.
... 7 The most common product combination for YAs was cigarettes with little cigars/cigarillos 8 and hookah. [9][10][11][12] Among youth who used tobacco in the past 30 days, 43% reported use of multiple tobacco and nicotine products in 2013, with use of cigarettes and e-cigarettes reported as the most common product combination. 3 Cross-sectional studies of adolescents have demonstrated an association between past 30-day tobacco use and risk behaviors such as illicit substance use. ...
... National data highlight that YAs (aged 18-24) reported a higher prevalence of any past 30-day tobacco use than adults aged ≥25, and YAs have been shown to be more likely to use multiple products than older adults. 3,6,7,19 To address these gaps in the literature, this study used data from the 2011-2015 National Youth Tobacco Survey (NYTS) and corresponding years of data from the Truth Initiative Young Adult Cohort (YA Cohort) Study to assess patterns of past 30-day tobacco and nicotine product use in youth (aged [12][13][14][15][16][17] and YAs (aged [18][19][20][21][22][23][24] and changes in use pattern prevalence over time. Tobacco and nicotine products of interest include cigarettes, e-cigarettes, cigars, little cigars/cigarillos, hookah tobacco, and smokeless tobacco. ...
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Introduction: As cigarette smoking has decreased among youth and young adults (YAs) in the United States, the prevalence of other tobacco and nicotine product use has increased. Methods: This study identified common past 30-day patterns of tobacco and nicotine product use in youth (grades 6-12) and YAs (aged 18-24). Using data from the 2011-2015 National Youth Tobacco Survey (NYTS) and corresponding years of the Truth Initiative Young Adult Cohort Study (TIYAC), past 30-day use of the following products was assessed: cigarettes, e-cigarettes, any type of cigar, smokeless tobacco, hookah, and other tobacco products (pipe, bidis, kreteks, dissolvable tobacco, and snus). A user-generated program in R was used to assess all possible combinations of product-specific and polytobacco use. Results: The top five patterns of past 30-day use in youth were exclusive cigarette use (12.0%), exclusive cigar use (10.3%), exclusive e-cigarette use (10.0%), dual use of cigarettes and cigars (6.1%), and exclusive hookah use (5.2%). In YAs, the top five patterns were exclusive cigarette use (46.5%), exclusive cigar use (10.0%), dual use of cigarettes and cigars (6.4%), exclusive hookah use (5.9%), and dual use of cigarettes and e-cigarettes (3.9%). Conclusions: As noncigarette tobacco and nicotine products become increasingly popular among tobacco users, further research is needed to identify predictors and correlates of specific tobacco use patterns in youth and YAs. This analysis can inform tobacco prevention efforts focusing on emerging tobacco products such as e-cigarettes and hookah. Educational and other intervention efforts should focus on the diversity of products and use patterns in these age groups. Implications: This study uses population-based data to provide new information on the most prevalent patterns of past 30-day nicotine and tobacco use over a 5-year period among youth and young adults. Study findings demonstrate that youth and young adults report using tobacco and nicotine products in different combinations, with varying popularity over time. Additionally, by examining young adults as a separate group, this study highlights the unique patterns of use not previously discussed in the adult literature.
... Fielder et al. [13] state that 34% of female college students used hookah during their first year 1 3 of being on campus. Additionally, Jarrett et al. [20], found that 8% of female college women surveyed in the National College Health Assessment II indicated using hookah during the last 30 days. Previous studies found higher prevalence of hookah use among freshmen and sophomores than juniors and seniors [5,13] suggesting the former may be at greater risk of negative consequences from engaging in smoking than the latter. ...
... College students' perception of hookah as a harmless substitute to conventional cigarettes may account for the increased use, and therefore remains an area of concern [7, 16,33]. Alternative tobacco and substance use behaviors have been the focus of some research while correlates of hookah use have included recent tobacco use, marijuana and alcohol use [20,41]. Several researchers have recommended assessment of students' knowledge and attitudes toward hookah use for informing the design of prevention messages [8,38]. ...
Article
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Notwithstanding the efforts of health educators and other health professionals regarding tobacco and smoking cessation, research indicates that hookah smoking among college students remains a health concern. Research shows an upward trend in college students’ hookah use. The purpose of this study was to identify and describe potential patterns/differences in college students’ hookah use, and the relations among attitudes toward and knowledge about hookah use and use of this drug. A four-page, 20-item survey was used to collect data from participants (N = 403) and to measure participants ‘recent use, knowledge of health risks, attitudes and reasons for hookah use among college students. Results indicated increased prevalence rates (53.8%) among participants of this study. Participants’ recent hookah use was consistent with that of current research. Study findings supports current research, which found that college students have low negative perceptions of the health risks (addictive and detrimental properties) of hookah use. Analyses also determined that college students’ attitudes toward hookah was associated with use of this drug. Regarding reasons why students may use hookah, data analysis indicated statistical significance in lifetime hookah use based on reasons for use. Study provide information for health educators creating hookah risk awareness educational programs aimed at reducing rates of hookah smoking among college students.
... Hookah use was reported among 18.2% of U.S. young adults; cigar smoking 8.9%; electronic cigarette (e-cigs) and smokeless tobacco 8.3 and 4.4% respectively [20]. Tobacco and substance use behaviors have been the focus of some research while correlates of use have included recent cigarette use, marijuana and alcohol use [16,35]. ...
... Furthermore, students reported becoming familiar with hookah as a result of their association with friends (50.3%) while a further (20.9%) of respondents reported engaging in hookah use at a hookah lounge [9,32]. Young adults who reported hookah use also used other tobacco and abusable substances [14,16]. Twenty-seven percent of included studies reported an association between hookah and sex, race and co-occurring substance use (i.e. ...
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The rate of Hookah use among college students during the last decade is about 30%. Although college students perceive hookah use as a safer alternative to conventional cigarettes, hookah use increases the risk of disease and nicotine dependence, and therefore remains an area of concern. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. This review attempts to assess empirical literature relating to hookah use while focusing on the consequences for regulatory policy. PubMed (including MEDLINE 2010–2017), PsycINFO, EBSCO, Scopus (Elsevier) databases were examined to pinpoint articles published in English. The following terms were used in the searches: Hookah or Waterpipe or nargile or “arghile” or “shisha” or “hubble bubble” or “alternative tobacco product” or “flavored tobacco”. Hookah use may initiate smoking among tobacconaïve college students. College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior. In addition, few public health messages target college-age adults with anti-hookah messages. A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of “safety” which inadvertently may imply a suggestion of no need for safety measures. Hence, a research agenda that would inform about health policy actions has been proposed.
... Hookah (also called waterpipe, shisha or narghile) is one of the most commonly used combustible tobacco products by young adults in the United States [1,2]. Hookah smokers often perceive it as safer than cigarettes [3][4][5], but a growing literature points to deleterious health effects, including toxicant exposure, [6] nicotine addiction and cardiorespiratory consequences [7,8]. ...
Article
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Background: Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. Methods: A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. Results: Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. Conclusions: The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.
... 10 Interestingly, in our sample, we documented a high prevalence of hookah use among all racial and ethnic minorities, with Whites reporting the lowest prevalence, which somewhat contradicts other literature showing higher prevalence of hookah use among Whites, Asians, and Hispanics. 4,69,70 In our sample, we also found the highest rates of e-cigarette use among Whites, other races, and Hispanics, somewhat contradictory to prior research showing the highest e-cigarette use rates among Hispanics and other races/ ethnicities. 71 However, there is also a documented increase in e-cigarette use among Whites in recent years. ...
Article
Objectives: We examined psychographic characteristics associated with tobacco use among Project DECOY participants. Methods: Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. Results: Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p < .001) and intellectual curiosity (p = .010) and less interest in tangible creation (p = .002) and social conservatism (p < .001). Correlates of LCC use included greater novelty seeking (p < .001) and greater fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p < .001). Correlates of e-cigarette use included greater novelty seeking (p < .001) and less social conservatism (p = .002). Correlates of hookah use included greater novelty seeking (p < .001), fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). Conclusions: Psychographic characteristics distinguish users of different tobacco products.
... Emerging adults have a higher risk for hookah use, relative to younger and older age groups (Cavazos-Rehg, Krauss, Kim, & Emery, 2015;Grekin & Ayna, 2012;Smith et al., 2011). In the U.S., recent research demonstrated that 25% of emerging adults reported lifetime hookah use (Villanti, Cobb, Cohn, Williams, & Rath, 2015), and demonstrated that 10% of college students reported past 30-day use (Jarrett, Blosnich, Tworek, & Horn, 2012). A systematic review of the literature suggested that the majority of hookah smokers were unaware of its potential risks (Haddad et al., 2015), and research has suggested that emerging adults perceive fewer negative consequences of hookah use compared with combustible cigarette use (Holtzman, Babinski, & Merlo, 2013;Heinz et al., 2013). ...
Article
Introduction: Hookah (or waterpipe) use is increasing worldwide with implications for public health. Emerging adults (ages 18 to 25) have a higher risk for hookah use relative to younger and older groups. While research on the correlates of hookah use among emerging adults begins to accumulate, it may be useful to examine how transition-to-adulthood themes, or specific thoughts and feelings regarding emerging adulthood, are associated with hookah use. This study determined which transition-to-adulthood themes were associated with hookah use to understand the risk and protective factors for this tobacco-related behavior. Methods: Participants (n=555; 79% female; mean age 22) completed surveys on demographic characteristics, transition-to-adulthood themes, hookah, and cigarette use. Results: Past-month hookah use was more common than past-month cigarette use (16% versus 12%). In logistic regression analyses, participants who felt emerging adulthood was a time of experimentation/possibility were more likely to report hookah use. However, transition-to-adulthood themes were not statistically significantly related to cigarette use. Conclusions: The profile for hookah use may differ from that of cigarettes among emerging adults. Themes of experimentation/possibility should be addressed in prevention programs on college campuses and popular recreational spots where emerging adults congregate. These findings can inform future studies of risk and protective factors for hookah use among emerging adults.
... 20 College students who are hookah or dual users (cigarette and hookah) differ demographically from both nonsmokers and cigarette only smokers. 21 This further emphasizes that nicotine use among young adults shows variation with regard to sex, ethnicity/race, and type of tobacco products. ...
Article
Objective: The purpose of this study was to assess patterns of tobacco use across the first year of college, transitions in use, and associated predictors. Methods: The frequency of tobacco use (cigarettes, cigars, smokeless tobacco, and hookah) during the fall and spring of 4073 college students' first year at college were used as indicators in latent class (LCA) and latent transition analyses (LTA). Results: The LCA yielded 3 classes that represent levels of use frequency and not specific tobacco product classes: non-using, experimenting, and frequent using. The LTA results demonstrate stability in class membership from fall to spring. The most common transition was for the fall experimenters to transition out of experimentation. A series of demographic, environmental, and intrapersonal predictors were found to influence both fall class membership, and transitions from fall to spring. Conclusions: Students are likely to use multiple alternative tobacco products along with cigarettes. Their frequency of use of these products is fairly stable across the first year of college. Predictors reflecting experiences during the first year of college had the greatest impact on college tobacco use, demonstrating the importance of the college experience on young adult tobacco use.
... Hookah lounges are increasingly prevalent and may increase tobacco usage due to misperceptions of reduced harm (51). This usage of tobacco and nicotine may result in dependence (52). However, hookahs provide an inconvenient form of nicotine delivery and thus adolescents may be tempted to begin to use other more convenient, portable nicotine delivery forms, such as cigarettes, cigars, pipes, and e-cigarettes. ...
Article
Background: Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. Objectives: The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. Methods: The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. Results: Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]). Conclusion: Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.
... Four of the focus groups were comprised of current college students and two included non-college students. While previous research indicates that hookah use is common among college students (Barnett et al., 2013;Eissenberg et al., 2008;Goodwin et al., 2014;Rahman et al., 2012;Primack et al., 2008;Sutfin et al., 2011;Grekin, & Ayna, 2008;Jarret et al., 2012), separate non-college student focus groups were included to obtain responses that may have been unique to non-college students. However, differing themes did not emerge in the focus groups, and therefore groups were combined for analysis. ...
Article
Background: Despite the dangers associated with hookah tobacco smoking, use and popularity in the United States among young adults continue to increase. While quantitative studies have assessed users' attitudes toward hookah, qualitative research can provide a more in-depth description of positive and negative attitudes and beliefs associated with hookah use. Objectives: To determine outcome expectancies associated with hookah use among young adults. Methods: We conducted six focus groups in 2013 to identify outcome expectancies associated with hookah use. Participants (N = 40) were young adults aged 18-23 who reported hookah use in the past three months. Using Outcome Expectancy Theory perspective, we posed the question "Hookah smoking is _______?" to elicit words or phrases that users associate with hookah use. Results: Over 75% of the users' hookah use outcome expectancies were positive, including associating hookah smoking with relaxation and a social experience. Content analysis of the words engendered six themes. These themes included Social Appeal, Physical Attractiveness, Pleasant Smoke, Comparison to Cigarettes, Relaxation, and Deterrents. Fewer negative hookah use expectancy words and phrases were identified, but included "tar" and "cough." Conclusions: The findings suggest that participants lacked basic knowledge about hookah tobacco smoking, had misconceptions about its danger, and had many positive associations with hookah use. Incorporating components addressing positive hookah expectancies may improve the efficacy of established and new hookah use prevention and cessation interventions and policies.
... WP smoke contains many of the same toxicants present in cigarette smoke (Al Rashidi et al., 2008;Daher et al., 2010;Sepetdjian et al., 2008) and is associated with many of the same negative health outcomes as cigarette smoking (Akl et al., 2010). Alcohol is often consumed in conjunction with WP smoking (Goodwin et al., 2014;Haider et al., 2015;Jarrett et al., 2012;Sutfin et al., 2011;Villanti et al., 2015). Notably, WP smokers are about twice as likely to use alcohol compared to their nonsmok-ing counterparts (Sutfin et al., 2011). ...
Article
Background and aims: Concurrent alcohol use and waterpipe (WP) smoking is common among young adults. WP smokers are more than twice as likely to use alcohol as non-users and frequently consume alcohol immediately before and during a WP smoking session. It is unclear what impact alcohol has on WP smoking patterns and resultant exposure to tobacco-related toxicants. The current research aimed to understand the association between alcohol consumption and WP smoke exposure among WP lounge patrons. Methods: Seventy-one lounge patrons (66.2% male; Mage=27.03, SD=5.32) completed pre- and post-WP session self-report measures and biomarkers of smoking (expired carbon monoxide; eCO) and alcohol consumption (breath alcohol concentration; BrAC) upon entering and exiting the WP lounge. Results: After controlling for number of bowls and charcoals smoked, greater consumption of alcohol was associated with greater smoke exposure among WP lounge patrons (p<0.05), such that a 0.1 unit increase in BrAC was associated with an eCO increase of 19.44ppm. This relationship was mediated by time spent in the WP lounge. Conclusions: Concurrent alcohol use resulted in greater eCO, likley due to participants spending a greater amount of time in the WP lounge and experiencing longer sustained exposure to secondhand smoke. These findings illustrate a need for further research on the impact of alcohol consumption on WP smoking to assess the potential need for regulation of these products in WP lounges.
... Though WTS in the United States is a relatively recent trend, it has increased in popularity rapidly, particularly among adolescents and young adults. Young adults in the U.S. report current (past 30 day) WTS rates ranging from 7.2% to 20.3% [19][20][21][22][23][24][25], past-year WTS rates of 12.1% to 43.4% [19,20,23,26,27] and lifetime use rates ranging from 10% to 48.4% [19,20,23,25,26]. In one study [19], more participants reported past year WTS than past year cigarette smoking (46.4% vs. 42.1%) ...
Article
Waterpipe (hookah, narghile) tobacco smoking (WTS) is becoming prevalent worldwide and is one of the most popular forms of tobacco use among youth. WTS prevalence has increased dramatically among youth in the USA within the past decade. Misperceived as less harmful than cigarette smoking, WTS is associated with many of the same chronic health effects such as lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, bronchitis, and asthma. Much of this risk is due to the fact that a single WTS session exposes users to large volumes of smoke that contain toxic chemicals such as carbon monoxide, cancer-causing polycyclic aromatic hydrocarbons, and volatile aldehydes. Unlike cigarette smoking, WTS poses unique risks of acute negative health outcomes including carbon monoxide poisoning and the spread of communicable diseases such as herpes and tuberculosis. Because waterpipe tobacco smoke contains the addictive chemical nicotine, youth who smoke tobacco from a waterpipe may be at risk for dependence. As a result, many youth may initiate WTS and continue to use despite negative health effects. Considering many of the potential negative health effects associated with WTS affect the pulmonary system, pulmonologists and primary care providers may treat patients who are waterpipe tobacco smokers and should be aware of the risk associated with WTS. The purpose of this review is to describe a waterpipe, the prevalence and correlates of WTS, the toxicants found in waterpipe tobacco smoke, the health effects of WTS, and implications for pulmonologists and other clinicians.
... 31 In addition, hookah use is more likely among youth who use alcohol, marijuana, and other illegal drugs. 18,22,29,32 Most research on comorbid substance use has been cross-sectional, preventing understanding of temporal patterns of use. The few extant longitudinal studies have primarily examined whether hookah use predicts cigarette smoking initiation. ...
Article
The prevalence of hookah tobacco smoking is increasing, and the transition to college is a vulnerable time for initiation. Hookah use is associated with other forms of substance use, but most research has been cross-sectional, thus limiting our understanding of temporal patterns of use. The goals of this longitudinal study were to assess the prevalence of hookah use and initiation, as well as other forms of substance use among hookah users, and identify which forms of substance use predicted hookah initiation during the first 30 days of college. Incoming students (N = 936, 50% female) reported on past 30 day substance use prior to the start of the Fall 2011 semester and again 30 days later (n = 817). Substances included hookah, cigarettes, other forms of tobacco, alcohol, marijuana, and other illegal drugs. Current prevalence of hookah use increased from 9.0% before college to 13.1% during the first month of college. At baseline and follow-up, current hookah users were more likely than non-users to report current use of cigarettes, cigars/little cigars/clove cigarettes, smokeless tobacco, marijuana, and alcohol. Among pre-college hookah never users, 13.8% initiated hookah use in the first month of college. Alcohol (adjusted odds ratio [AOR] 1.11, 95% confidence interval [CI], 1.05, 1.17) and marijuana (AOR 1.30, 95% CI 1.03, 1.65) were the only substances predictive of hookah initiation. Findings indicate that hookah prevention and intervention is needed during the transition to college, and interventions may need to address comorbid alcohol, marijuana, and hookah use. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
... College students represent a particularly at-risk group. 30-50% of college students report lifetime WTS (Heinz et al., 2013;Primack et al., 2013;Sutfin et al., 2011) with 6-22% reporting past 30-day WTS (Braun, Glassman, Wohlwend, Whewell, & Reindl, 2012;Heinz et al., 2013;Jarrett, Blosnich, Tworek, & Horn, 2012;Primack et al., 2013). Importantly, WTS is associated with many of the same negative health outcomes as cigarette use (Cobb, Sahmarani, Eissenberg, & Shihadeh, 2012;El-Zaatari, Chami, & Zaatari, 2015). ...
Article
Introduction: Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample. Methods: Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS. Results: Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university. Discussion: The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students.
... 31 Furthermore, most hookah research has assessed specialized groups of individuals who use hookah culturally, 5,32 or convenience samples of college students. 5,6,8,[33][34][35][36][37] Limited research can be found on the receptivity to warning labels among young adults who are not currently enrolled in a university. 6 ftere are notable differences between young adults who currently attend college/university versus those who are not; being within a college environment may result in greater exposure to a variety of different experiences and worldviews, including possible experimentation with substances. ...
Article
Objectives: We examined the receptivity of non-college young adult hookah users to health warning labels. Methods: We conducted in-person qualitative interviews with 23 hookah users, aged 18-29 in Austin, Texas, who were not currently enrolled in college/university. Data were transcribed, coded, and thematically analyzed using NVivo Pro, version 11. Results: Gaps in knowledge were evident regarding the level of chemical exposure, cancer risks, and negative health consequences of hookah use. Respondents preferred warning labels that factually listed health consequences rather than labels that used "sensationalistic" wording (eg, "kills") or technical terms. Participants thought placement of hookah warning labels would be most effective on product packaging or on the door of establishments selling hookah. Respondents thought most of the warning labels would be effective in deterring hookah use; however, the majority stated they would likely continue to use hookah over the next year. Conclusions: Non-college-attending young adult hookah users preferred hookah health warning labels that are simple, factual, informative, and non-sensationalistic. These results may inform regulations regarding the packaging of tobacco products, specifically in the design and placement of warning labels, which may result in better user message receptivity.
... Despite reports on the harmful effects of smoking on the cardiovascular system, reduced lung function, and nicotine addiction [18], the impact of WPs on public health remains commonly unknown, mainly due to the frequency of WP use and the substanc-es smoked. At present, WP smokers are primarily youths, i.e. university and college students [19][20][21][22] and high school students [5,6,[23][24][25]. ...
Article
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Introduction Waterpipe smoking is gaining popularity among the youth in Poland and is evaluated for the first time in this work. The authors address the social and demographic factors that motivate young people to smoke and attempt to determine which of them contribute to habit formation. Material and methods The data were collected among school and university students in Poland during a global survey on various forms of tobacco use. Multivariable regression models were applied for odds-ratio evaluation. The data concern waterpipe and cigarette smoking habits. Results The survey was completed by 19,097 respondents. The survey included 144 schools and 32 universities from 16 voivodeships in Poland. Respondent gender exhibited the highest ORs (95% Cl), both in the case of current and ever WP users: 2.11 (2.10–2.12) and 2.16 (2.15–2.17), respectively. The other important factor was a place of living: 1.83 (1.82–1.84) and 2.17 (2.16–2.18), respectively. All ORs were statistically significant for p = 0.05. Conclusions The prevalence of tobacco smoking among Polish youths is high. Waterpipe tobacco smoking was found to be the second most popular habit after cigarette smoking. Moreover, young smokers use other non-tobacco products in waterpipes, and drink alcohol during smoking sessions. Many young people try waterpipe smoking without previous experience with cigarettes.
... 20 The limited research on hookah and alcohol use indicates that many young adult hookah users also engage in alcohol use. 14,15,21 Those who drink alcohol are more likely to be hookah smokers compared to non-drinkers 12,22,23 and many hookah smokers drink alcohol and attend traditional bars in the same evenings and nights they also attend hookah bars. 24 However, these studies do not attempt to describe the experience of drinking alcohol before, during, or after smoking hookah. ...
Article
Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults. Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah. Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors. For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.
... [26] Previous research Studies from the US suggest between 33-48% of university students have ever tried waterpipe smoking, and 10-22% are past-30 day users. [33][34][35][36] Looking closer at frequency of use, studies of university students in the UK identified that the proportion of at least weekly use among past-30 day waterpipe users varied between 26-52%. [18,19] and among university students in the US showed that of those who had tried waterpipe smoking, 42% were at least monthly users. ...
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Introduction: Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking. Methods: We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly. Results: f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking. Conclusions: While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
... A study among high school students revealed an overall report of stress (~29%), anxiety (~12%), and depression (~5%) (Moeller et al., 2020). In fact, American College Health Association and World Health Organization (WHO) have reported that, even in regular academic periods, heightened psychological distress and mental disorders associated with attrition are common among college students, particularly when they are temporarily away from their schools (Auerbach et al., 2016;Jarrett et al., 2012). It is, therefore, expected that the time of lockdown and uncertainty as a result of a global pandemic brings alarming consequences at individual and collective levels. ...
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The COVID-19 pandemic and the enforced restrictions have harshly affected educational sectors in 161 countries around the world. With more than 1.6 billion students away from normal school life, the crisis threatens the teaching and learning processes and the students’ emotional health. Herein, we present the result of a careful assessment of the feelings of over 13,000 students at high school, undergraduate, and postgraduate levels across 36 campuses over 8 subsequent weeks from the onset of the COVID-19 pandemic. The results indicate a general low energy level and dominance of negative feelings among the students regardless of their academic levels. We have recorded 5 responses (being anxious, stressed, overwhelmed, tired, and depressed) as the most frequently reported feelings in the time of lockdown. Overall, 14% of those who have reported to suffer from these feelings have also identified a need for professional help in managing their feelings throughout the quarantine period. The current study also presents several strategies to combat the undesirable consequences of COVID-19 pandemic.
... The survey collects data from random samples of students at voluntarily participating universities on physical health, mental health, use and dependence on alcohol, tobacco or drugs, sex behavior and contraception practices, weight, nutrition and exercise along with student demographic information (American College Health Association, 2008). Further details on survey methodology are reported elsewhere (Jarrett et al., 2012). Our study sample was pooled from four waves (semesters) of ACHA-NCHA II datasets (Spring/Fall, 2009 andSpring/Fall, 2010) and included 247,118 respondents. ...
... 2,5,6 The co-occurrence of alcohol use and WP smoking is quite common among adults 7,8 and young adults. [9][10][11] Compared to non-WP smokers, WP smokers are more than twice as likely to use alcohol. 11 Participants in qualitative research note that alcohol use makes it easier to start smoking WP due to decreased inhibition. ...
Article
Introduction: Relative to non-waterpipe (WP) smokers, WP smokers are more than twice as likely to use alcohol and frequently consume alcohol before or during smoking sessions. Co-use of alcohol and WP may result in greater toxicant exposure compared to WP smoking alone. To date, no study systematically has investigated the impact of acute alcohol intoxication on WP smoking topography, exposure to tobacco-related toxicants, or abuse liability. Methods: Dyads of current WP smokers and drinkers (N=42; age=21-32 years) completed two in-laboratory ad libitum smoking sessions (≤2-hours) following 12-hour nicotine abstinence in a double-blind, randomized crossover design in which they consumed a placebo versus active drink (sustained BrAC=.08). Exhaled carbon monoxide (eCO) and plasma nicotine concentration were assessed. Questionnaires assessed smoking experience and smoking urge. Smoking topography was measured continuously throughout each smoking session. Results: The alcohol session was associated with increased inhaled volume, flow rate, and WP session duration compared to placebo. Compared to placebo, participants reported a more positive overall smoking experience following the alcohol session and greater smoking urges pre- and post-smoking session. While both sessions resulted in significant increases in eCO and plasma nicotine, no significant differences emerged in eCO or nicotine exposure between the active and placebo sessions. Conclusions: Co-use of alcohol and WP may contribute to the maintenance of WP smoking through enhanced smoking experiences, increased urge to smoke, and significant exposure to addictive nicotine. Regulations may be necessary to limit the sale of alcohol in WP smoking lounges and reduce exposure to secondhand smoke. Implications: The findings suggest co-use of alcohol and WP tobacco likely maintain WP use and dependence by enhancing the smoking experience and increasing urges to smoke. These findings have implications for regulations aimed at limiting co-use of alcohol and WP tobacco in WP lounges and limiting exposure to secondhand smoke.
... Hu and colleagues also found that K2 users were more likely to report hookah use and report using hookah to smoke K2 (17). In addition, the majority of these students first used K2/Spice in the spring semester of their freshman year, which is a time that they would be more likely to use hookah (47,48). These may be students who are more likely to experiment with substances that are legal (K2/Spice was legal the 6 months preceding the Spring 2011 wave of the survey) and easily accessible. ...
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K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults. This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college. In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights. Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort's fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use. Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.
... Waterpipe tobacco smoking, however, is often described as a pleasurable experience that centres on socializing with others (11). Nearly all research on the differences between dual and waterpipe-only tobacco use has been done in the USA or the United Kingdom, and such studies are generally limited to assessing sociodemographic differences (12)(13)(14)(15)(16)(17). Only a few studies have assessed patterns of use in more detail. ...
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Background: Little is known about dual use of waterpipe tobacco and cigarettes, especially in countries where both are prevalent. Aims: This study aimed to assess demographic correlates, patterns of use and quit behaviours of waterpipe users in Pakistan who also smoke cigarettes. Methods: Data were taken from a randomized controlled trial in Pakistan that assessed smoking cessation in 510 adult waterpipe users, stratified on concurrent cigarette use. Logistic regression analysis was done to assess the association between waterpipe tobacco users who also smoke cigarettes (dual use) and their demographic characteristics, smoking history and quit behaviour. Unadjusted odds ratios (OR) and adjusted OR (ORa) and 95% confidence intervals (CI) were determined. Results: Dual use was significantly associated with younger age (ORa = 0.36, 95% CI: 0.19-0.70) and middle-school educational level (11-15 years), versus no formal education, (ORa = 2.01, 95% CI: 1.15-3.50). Dual use was also associated with smoking less than all day versus all day (defined as continuously for several hours) (ORa = 2.71, 95%: CI 1.73-4.25) and younger age at starting smoking (ORa = 0.95, 95% CI: 0.93-0.98). No association was found between dual use and sex, marital status, duration of smoking, nicotine dependence or quit history. Conclusion: Waterpipe tobacco users who also smoke cigarettes differ from waterpipe-only users, particularly in demographic characteristics. More research is needed to explore the interaction between these two smoking behaviours. Health promotion and cessation interventions in Pakistan should consider tailoring their approach to account for the unique characteristics of dual waterpipe and cigarette users.
... Current WTS studies found EAs are more receptive to trying WTS and perceive the health risks to be lower than cigarette smoking (Mays et al., 2016;Roditis, Delucchi, Cash, & Halpern-Felsher, 2016). National College Health Assessment studies have found higher prevalence among younger EAs (Haider et al., 2015;Jarrett, Blosnich, Tworek, & Horn, 2012), which is consistent with the finding that 18-to 21-year-old EAs (*60%) are more likely to be current WTS than 22-to 24-year-old EAs in the NATS waves. In both waves of the NATS, over 60% of the respondents reported that their highest level of education is a high school diploma or less, referred to as noncollege EAs. ...
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Water pipe (i.e., hookah) tobacco smoking (WTS) had the highest prevalence among 18- to 24-year-olds in recent Centers for Disease Control and Prevention National Adult Tobacco Surveys (NATS). This study examines the national prevalence and determinants of current WTSs among emerging adults (EAs). Of the 3,577 EAs from the 2012 to 2013 NATS, 18.3% were current water pipe smokers; among the 4,439 EAs from the 2013 to 2014 NATS, the percentage increased to 20.1%. Multivariable analyses demonstrate that current users of cigarettes, cigar/cigarillos, pipes, and/or e-cigarettes were more likely to be current WTSs, while 22- to 24-year-old EAs and African Americans were less likely to smoke water pipe across both surveys. Different interventions and anti-marketing campaigns are needed for different tobacco products within subpopulations in the 18- to 24-year-old EA population. Strategies aimed at college students may not be as effective for noncollege EAs for stemming WTS. More representative research is needed on EAs during this pivotal period of self-exploration and self-development.
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Young adults have the highest rates of alcohol, tobacco, and other drug use relative to any other age group. Few studies have examined the co-occurrence of substance use with new and emerging tobacco products in this vulnerable group, or the underlying personality factors that may explain these associations. To address this gap, this study examined the association of current alcohol and marijuana use with the use of cigarettes and emerging tobacco products in a nationally representative sample of young adults. Data were drawn from 18 to 24year olds in Wave 4 (January 2013; n=1609) of the Legacy Young Adult Cohort, a nationally-representative sample of men and women. Never, ever (lifetime), and past 30-day use of little cigars/cigarillos (LCCs), hookah, e-cigarettes, and cigarettes were assessed separately in current (everyday or some days) alcohol and marijuana users. Using weighted estimates, multivariable multinomial logistic regression models showed that current alcohol and marijuana use were associated with lifetime and past 30-day use of cigarettes, LCCs, e-cigarettes, and hookah, with different magnitudes of association found across each product. Post-hoc exploratory analyses showed that sensation-seeking traits moderated the relationship of alcohol (but not marijuana) use to current use of select tobacco products. Marijuana and alcohol use may enhance risk for emerging tobacco products use in young adulthood. Prevention and intervention programs may need to target poly-use of alcohol, marijuana, and tobacco rather than focusing on a single risk behavior during these critical years. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
The present study examined change in use of various smoked and smokeless non-cigarette alternative products in a sample of college students, stratified by current, or past 30-day, cigarette smoking status. Participants were 698 students from seven four-year colleges in Texas. Participants completed two waves of online surveys regarding tobacco use, knowledge, and attitudes, with 14months between each wave. The most prevalent products used by the entire sample at Wave 1 were cigarettes, followed by hookah, cigars/cigarillos/little cigars, and electronic cigarettes (e-cigarettes). At Wave 2, prevalence of e-cigarette use surpassed use of cigars/cigarillos/little cigars. Snus and chew/snuff/dip were relatively uncommon at both waves. Examination of change in use indicated that e-cigarette use increased across time among both current cigarette smokers and non-cigarette smokers. Prevalence of current e-cigarette use doubled across the 14-month period to 25% among current smokers and tripled to 3% among non-cigarette smokers. Hookah use also increased across time, but only among non-cigarette smokers, whereas it decreased among current cigarette smokers. Use of all other non-cigarette alternatives remained unchanged across time. Logistic regression analysis was used to examine the socio-demographic predictors of Wave 2 e-cigarette use, the only product that increased in use among both current cigarette smokers and non-cigarette smokers. Results indicated that Wave 1 current cigarette use and Wave 1 current e-cigarette use, but not gender, age, or race/ethnicity, were significantly associated with Wave 2 e-cigarette use. Findings underscore the need to track changes in the use of non-cigarette alternatives and call for additional research examining the factors contributing to change in use. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Objective: To analyze the literature in which researchers have utilized the NCHA I or the NCHA II. Participants and methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses. Results: The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers. Conclusions: Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.
Article
Objectives: We aimed to assess pharmacy students' self-efficacy to provide cessation counseling for commercial cigarette and hookah tobacco use. Methods: A cross-sectional study including PharmD students at a College of Pharmacy was conducted in Spring 2014. Confidence in counseling and perception of knowledge were self-rated and based on the Ask-Advise-Assess-Assist-Arrange follow-up (5A's) model and general tobacco cessation counseling skills. Comparisons were made between cigarettes and hookahs and by program level using t-tests, Wilcoxon signed-rank test, analyses of variance, and Tukey-Kramer tests. Results: Overall, 82% and 16% of the students, respectively, reported receiving training on cigarette smoking and hookah tobacco use cessation. Students were moderately confident in their ability to counsel. Compared to hookah tobacco use cessation counseling, students were more confident in their general counseling skills and ability to counsel on cigarette smoking cessation using the 5A's (p < 0.001 in each case). Students perceived themselves to be more knowledgeable about cigarette smoking cessation than about hookah tobacco use cessation. Almost half of the students (42.0%) thought hookah tobacco was less harmful than traditional cigarettes. Conclusions: Pharmacy students need further training to address hookah and other alternative tobacco products to support patients' cessation needs, decrease risks for tobacco-related morbidity and mortality, and increase medication effectiveness.
Article
Hookah tobacco smoking (HTS) has been increasing, particularly among young adults and has similar health effects compared to cigarette smoking. The link between HTS and poly-tobacco use is well documented, but fewer show an association between HTS and alcohol use. It is essential to identify factors that increase the risk for or addictiveness and consequences of HTS, given its growing prevalence. This study examined whether the association between HTS and poly-tobacco use differed as a function of age and alcohol consumption within in a sample of 1223 adult cigarette smokers. Approximately 20% of participants reported HTS. Compared to non-users, hookah users were more likely to be male, highly educated, and to report drug and alcohol use, binge drinking, and poly-tobacco use but were less likely to be heavy smokers (≥10 cigarettes per day). Regression analyses predicting number of tobacco products used (excluding cigarettes and HTS) indicated a three-way interaction of HTS, frequency of alcohol use, and age such that the association between HTS and number of tobacco products used was strongest for younger respondents who consumed alcohol more frequently. As observed in previous studies, alcohol is an important risk factor in the relationship between HTS and poly-tobacco use, particularly among younger cigarette smokers. The links between alcohol, HTS, and poly-tobacco use should be considered when developing HTS education and prevention materials directed toward younger cigarette smokers. Findings provide information relevant to FDA's interest in the addiction potential of HTS and its link to poly-tobacco use.
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Introduction Waterpipe tobacco smoking is harmful to health however its prevalence estimates remain uncertain. We aimed to systematically review the medical literature on waterpipe tobacco prevalence and trends. Methods We searched Medline, Embase and ISI Web of Science for ‘waterpipe’ and its synonyms, without using language or date restrictions. We included any measure of waterpipe tobacco smoking prevalence in jurisdictionally representative populations. We stratified findings by prevalence measure (past 30 day, ever, regular or occasional, daily, other or unspecified) and age (adults or youth). Results We included 129 studies reporting 355 estimates for 68 countries. In general, prevalence estimates among adults were highest in the Eastern Mediterranean, and among youth were about equal between Eastern Mediterranean and European regions. Past 30 day use was highest among Lebanese youth (37.2% in 2008), ever use was highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%), regular or occasional use was highest in among Iranian university students (16.3% in 2005), and daily use was highest among Egyptian youth (10.4% in 2005). Trend data were limited but most studies reported increased use over time, ranging from 0.3–1.0% per year among youth in the US to 2.9% per year among youth in Jordan (both for past 30 day use). Results were similar for ever use trends. Turkey (2.3% in 2008 to 0.8% in 2010) and Iraq (6.3% in 2008 and 4.8% in 2012) both witnessed decreased waterpipe use. Conclusion Waterpipe tobacco smoking is most prevalent in Eastern Mediterranean and European countries, and appears higher among youth than adults. Continued surveillance will be important to assess and inform policy measures to control waterpipe tobacco use.
Article
Background: Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. Objectives: This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Methods: Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. Results: Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. Conclusions: The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.
Article
Introduction: Hookah use is particularly prevalent among U.S. college students; however, few studies have investigated whether hookah use is a risk factor for the initiation of other tobacco products. This study examined whether hookah use predicted subsequent initiation of other combustible tobacco products (conventional cigarettes and cigar products) and Electronic Nicotine Delivery Systems (ENDS) among Texas college students during a 2.5-year study period. Methods: This study involved a longitudinal analysis of data from Waves 1-6, with 6 months between each wave, of the Marketing and Promotions Across Colleges in Texas Project (Project M-PACT). Two separate multilevel discrete-time survival analyses were used to model the associations between past 30-day hookah use and subsequent initiation of 1) other combustible tobacco products, and 2) ENDS during the 2.5 year study period, after controlling for demographic, other tobacco use, and risk-taking personality characteristics (i.e. sensation seeking and impulsivity). Results: After controlling for covariates, past 30-day hookah use was associated with significantly higher odds of subsequent initiation of other combustible tobacco products. Past 30-day hookah use also predicted subsequent initiation of ENDS after controlling for covariates. Conclusions: This study is one of the first to demonstrate that hookah use is a predictor of subsequent initiation of other combustible tobacco products and ENDS among college students. These findings suggest that hookah may prime individuals to use other tobacco products, which has important implications for prevention programs and future research.
Article
Background: Hookah tobacco use is an emerging public health problem. Purpose: The purpose of the present study is to examine recent hookah tobacco use among college students and potential correlates including other drugs and drug education. Methods: The paper version of the National College Health Assessment II was completed by 765 students enrolled at one urban university. Results: Findings indicated that 14.2% of students used hookah in the past 30 days. Significant differences were found based on recent alcohol, recent cigarette use, recent cigar use, recent smokeless tobacco use, and recent marijuana use. Students who received tobacco education were at increased odds for hookah use (χ² = 5.592, df = 1, P = .018). The final regression model predicted recent hookah use (omnibus χ² = 129.779, df = 6, P < .001) and accounted for 15.6% to 28.0% of the variance in recent hookah use. Discussion: Students using hookah were found to use other type of substances, which may warrant attention on college campuses. Translation to Health Education Practice: Study findings indicate that tobacco education programs may not adequately address hookah use. Health Education professionals may need to implement specific lessons on hookah as part of tobacco education programs. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars
Article
Purpose: The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers. Methods: A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke. Results: The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p < .05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked. Conclusions: Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.
Article
Background: Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing. Objectives: This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors. Methods: Data from a 2-year longitudinal study of 2,397 US college students (aged 18-25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist. Results: Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.
Article
Objective: There has been a growth in popularity of hookah (or waterpipes) among American college students, despite the health risks. This study investigated factors that predict hookah susceptibility and whether hookah susceptibility predicts hookah initiation and continued use. Method: The study established a cohort of 529 incoming college freshmen (51.6% female) who completed an online survey approximately 1 week before their arrival to a large U.S. university. Students were sent four follow-up surveys throughout the 2016-2017 academic year; 90.5% completed at least one follow-up survey. Results: A total of 13.2% of the sample had used hookah at baseline and 9.9% initiated hookah use over the course of their freshman year. Among the nonusers who had no hookah susceptibility at baseline, 30.0% came to indicate some susceptibility. Multivariable logistic regression indicated that the personality construct conscientiousness was protective against becoming susceptible, whereas coming from a rural part of the state was a risk factor. Susceptibility predicted both continued use among the baseline ever-users and initiation among the baseline never-users. Conclusions: These findings highlight the role of susceptibility in the trajectory of hookah use among U.S. college students.
Chapter
Predictive analysis of psychological disorders on health discuss psychological disorder and their consequences. It is a significant disturbance in feelings, behaviors, and thoughts; these disturbances cause different kinds of dysfunction (psychological, developmental, or biological). Psychological disorders are referred to as abnormalities of the mind which result in changes in behavior patterns that can seriously affect day-to-day function and life. The reader is appropriate by discussing psychological disorders, behavior, other factors, complications, treatment, and prevention. It leads to long-term consequences by disturbing biological, psychological, and developmental pathways that lead to normal, healthy psychological functioning as well it greatly impairs ability of a person to function as a normal individual.
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Hookah, or waterpipe, tobacco smoking has increased among young adults (YAs) in the U.S., but few prospective studies have examined predictors of hookah use. The current study examined correlates of hookah use and predictors of hookah initiation at a 6-month follow-up in a nationally representative, prospective sample of U.S. YAs. Data were drawn from a subset of participants aged 18-24 years at study entry from two waves of the Legacy Young Adult Cohort Study. Wave 5 was completed in July 2013 by 1,555 participants and 74% (n=1,150) completed follow-up 6 months later in January 2014. Weighted bivariate and multivariable analyses were conducted in June 2014 to estimate the prevalence and correlates of ever and past 30-day hookah use and to examine associations between baseline covariates and hookah initiation 6 months later. At baseline (Wave 5), almost 25% of the sample had ever used hookah and 4% reported past 30-day use. Alcohol, marijuana, and cigarette use were more prevalent among ever and past 30-day hookah users than among never users. Eight percent of never users at baseline reported trying hookah at the 6-month follow-up. Significant predictors of hookah trial in a multivariable model included college enrollment; alcohol, marijuana, and cigarette use; and perceptions that hookah is less harmful than cigarettes. Results highlight rapid transitions in hookah use and several risk factors for initiation. Future studies should examine how these factors could be used as intervention targets to reduce tobacco use in this vulnerable age group. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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The present study examined cultural orientation as a protective factor against tobacco and marijuana smoking for African American young women (ages 18 to 25). African American college students (N=145) from a predominantly White university were administered subscales from the African American Acculturation Scale-Revised (AAAS-R); the shortened Individualism/Collectivism (INDCOL) Scale; a Tobacco and Drug Use Survey; and a background survey. Multiple logistic regression was conducted using cultural orientation variables as predictors and smoking status (i.e., tobacco and marijuana) as the criterion. It was expected that young women who endorsed traditional African American cultural characteristics (i.e., religious beliefs, health, family values, and socialization) and were collectivistic in their community (i.e., cultural interdependency) and familial (i.e., familial interdependency) interactions would be less likely to smoke. Results show that traditional religious beliefs and practice was protective against tobacco smoking for this sample of young women. Familial interdependency (e.g., supportive exchanges between friends, and consultation and sharing with parents), and traditional religious beliefs and practices surfaced as protective factors against marijuana smoking. Traditional health beliefs and practices was a risk factor for both tobacco and marijuana smoking. The implications signal the need for smoking prevention and cessation programs to focus on interpersonal factors which may strengthen African American young women’s religious and familial bonding.
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OBJECTIVES: We examined prevalence rates of water pipe tobacco smoking among young people as a first step in assessing the health implications of this form of tobacco use. METHODS: We examined water pipe use with data from the 2007 Florida Youth Tobacco Survey, which assessed tobacco-related beliefs, attitudes, and behaviors among the state's middle and high school students. RESULTS: Four percent of middle school students and 11% of high school students reported ever having used a water pipe. Adolescent boys were significantly more likely than adolescent girls to use water pipes, and African American adolescents were significantly less likely than adolescents from other racial/ethnic backgrounds to do so. Those who indicated ever having tried cigarettes and those who reported positive attitudes toward the social nature of cigarette use were more likely to have tried water pipes. CONCLUSIONS: Water pipe use appears to be widespread among middle and high school students. Further research is needed to assess the health risks associated with water pipe tobacco smoking as well as young people's attitudes toward this form of tobacco use.
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National data indicate nearly a quarter of college students smoked from a hookah at some point in their lifetime regardless of gender. To address this issue, researchers assessed the perceptions, knowledge, beliefs of hookah users at a large Midwestern University and also determined what other drug related high-risk behaviors were associated with this behavior. An anonymous, online survey was sent to 2,000 randomly selected undergraduate students from a large Midwestern University. Researchers used a cross sectional research design to determine the prevalence and motivating factors associated with hookah use. Respondents included 438 individuals (60% female) with an average age of 23.1 (SD = 12.32), yielding a response rate of 22%. Approximately 15.4% of the sample had previously smoked hookah, while 6% used hookah within the past 30 days. Common motivating factors associated with smoking hookah included socializing/partying (29%), peer influence (27%), and for relaxation (25%). Correlations were calculated comparing hookah use to other high risk behaviors with the two highest correlations consisted of 30-day tobacco use (r = 0.67) and marijuana (r = 0.39). The results from this study suggest hookah use is limited to a small percentage of students. Students appear to smoke hookah for social reasons and underestimate the addictive properties associated with the product. Researchers and practitioners need to develop and evaluate specific interventions to educate college students about the health hazards associated with hookah use.
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Despite the sustained public health efforts to decrease cigarette smoking, there is an increasing trend in the use of alternative tobacco products that are perceived by some as less harmful. One example is hookah smoking. This study aimed to assess hookah trends among White Americans. Two hundred and forty-five White American adults residing in southeast Michigan answered a self-administered standardized questionnaire that included basic demographics, socioeconomic status, and questions related to hookah smoking behavior. Logistic regression was used to determine risk indicators for hookah smoking. The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco. In addition to reporting the prevalence of use in this important group of potential users, we outline important sociodemographic risk factors for hookah use in a non-Arab American population. More research is needed with a larger population to better understand this new tobacco trend in order to curb a new potential health threat.
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Tobacco cigarette smoking a well-known cause of cancer and other diseases. Hookah smoking is another form of tobacco use that has rapidly spread in the United State and Europe. This study assessed beliefs about the harmfulness of smoking hookah. We surveyed hookah users in all cafes that provided hookah to its customers in downtown San Diego, California and nearby areas. A total of 235 hookah users participated in this study. Average age of study participants was 22 years, 57% were males, and 72% were not cigarette smokers. Whites were more likely to use hookah than the other ethnic groups (33%), older hookah users (26-35 years) were mostly males, and mint flavor of hookah tobacco was the most popular among a wide variety of flavors (23%). There was no significant difference in gender in relation to the wrong perception that hookah is less harmful than cigarettes, but those of Asian ethnicity were much less likely than other ethnic groups to believe that hookah is less harmful than cigarettes. More frequent users of hookah were more likely to believe that hookah is less harmful than cigarettes. The majority of hookah users (58.3%) believe hookah is less harmful than cigarette smoking. Compared to cigarettes, there appears to be a lack of knowledge about the harmfulness of smoking hookah among users regardless of their demographic background. Education about the harmfulness of smoking hookah and policies to limit its use should be implemented to prevent the spread of this new form of tobacco use.
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Narghile, or water-pipe smoking (WPS), has been practiced extensively for approximately 400 years. It is common in the Arabian Peninsula, Turkey, India, Pakistan, and other countries. In recent years, there has been a revival of WPS, notably among youth. Most US health professionals are unfamiliar with the practice and health consequences of WPS. Therefore, this trend presents a new challenge for adolescent health care providers. The composition of the tobacco used in WPS is variable and not well standardized. Studies that have examined narghile smokers and the aerosol of narghile smoke have reported high concentrations of carbon monoxide, nicotine, "tar," and heavy metals. These concentrations were as high or higher than those among cigarette smokers. The few scientific data regarding the adverse health consequences of WPS point to dangers that are similar to those associated with cigarette smoking: malignancy, impaired pulmonary function, low birth weight, and others. Additional dangers not encountered with cigarette smoking are infectious diseases resulting from pipe sharing and the frequent addition of alcohol or psychoactive drugs to the tobacco. Public health strategies for controlling the emerging epidemic of WPS include carrying out epidemiologic and toxicologic research; implementation of laws to limit acquisition and use; and health education, targeting adolescents in particular.
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This study examined personal, psychosocial, sociocultural, and environmental predictors in tobacco use for 1671 Arab American adolescents. Cigarette smoking in past 30 days was 6.9%. This increased from 1% at age 14 to 14% at age 18. Twenty-nine percent of the youths reported 'ever cigarette smoking.' Experimentation with narghile was 27%; it increased from 23% at 14 years to 40% at 18 years. All trends were significant (p < .001). Logistic regression analyses found ten predictors for 'smoked a cigarette in past 30 days' and nine and seven, respectively, for 'ever smoked a cigarette or narghile'. Friends and family members smoking were the strongest predictors of cigarette smoking and 'ever narghile use.' 'Ever narghile use' supported cigarette smoking.
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This study examined the association of sociodemographic characteristics and smoking behaviors (i.e., cigarette, cigar, and waterpipe) with nicotine product harm perception in college freshmen. Students were asked to compare the perceived harmfulness of 11 nicotine-delivering products with that of a regular cigarette. Data were from a cross-sectional Internet survey conducted during the spring 2004 semester at a private university (N = 411). Binomial logistic regression was used to determine the association between sociodemographic and behavioral factors with nicotine product harm perception. A statistically significant association was found between nicotine product harm perception and sex, race, income, citizenship, and smoking behavior (p< or =.05). Regarding the three medicinal nicotine replacement therapies, 19.6% of respondents incorrectly perceived the nicotine patch to be as harmful as or more harmful than a regular cigarette; corresponding values were 24.1% for nicotine gum and 52.9% for nicotine inhaler. Respondents incorrectly perceived the following smoked tobacco products to be less harmful than regular cigarettes: ultra-light cigarettes (40.4%), waterpipe (37%), light cigarettes (35.2%), cigarillos (17.4%), and cigars (16.9%). Regarding smokeless nicotine products, 89.3% of respondents incorrectly perceived dip and chew to be as harmful as or more harmful than regular cigarettes; corresponding values were 36.2% for nicotine lollipops and 35.2% for nicotine water. Our findings reveal misperceptions about nicotine product harmfulness and underscore the importance of developing a science base to inform policies and educate consumers about these products.
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Objective. —To assess the prevalence, content, and growth of state and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage.Design. —A mailed survey of city clerks in US cities with a population of 25000 or greater (N =980) and review of existing data sources confirmed the status of smoking restrictions in 902 (92%) of the cities in the sample. State laws were identified by contacting each state's Legislative Reference Bureau (100% response). Content of laws was coded using previously developed categories.Main Outcome Measures. —Prevalence, comprehensiveness, and cumulative incidence of no-smoking laws in states and in cities with a population of 25000 or greater.Results. —By July 1989, 44 states and 500 (51%) of the cities in our sample had adopted some smoking restriction, but content varied widely. While 42% of cities limited smoking in government buildings, 27% in public places, 24% in restaurants, and 18% in private workplaces, only 17% of cities and 20% of states had comprehensive laws restricting smoking in all four of these sites. The number of city no-smoking laws increased tenfold from 1980 to 1989. City no-smoking laws were independently associated with population size, geography, state tobacco production, and adult smoking prevalence. Laws were more common in larger cities, Western cities, and states with fewer adult smokers. Laws were less common in tobacco-producing states and in the South.Conclusions. —No-smoking laws are more widespread than previously appreciated, especially at the local level, reflecting a rapid pace of city government action in the 1980s. Nonetheless, comprehensive laws, which are most likely to provide meaningful protection from environmental tobacco smoke exposure, remain uncommon and represent a major gap in smoking control policy. Laws are most needed in smaller and non-Western cities and in states that produce tobacco and have a higher proportion of smokers.(JAMA. 1991;266:3162-3167)
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Purpose: To inform healthcare providers about waterpipe smoking, a new trend in tobacco use that is gaining popularity among adolescents and young adults. Data sources: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note on Waterpipe Smoking, and pertinent publications available in the literature. Conclusions: Waterpipe smoking is a new trend in tobacco use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction. Implications for practice: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long-lasting problem of nicotine addiction.
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This study's objective is to examine the relative effectiveness of cigarettes and waterpipe (WP) in reducing tobacco abstinence symptoms in dual cigarette/WP smokers. Sixty-one dual cigarette/WP smokers participated (mean age±SD 22.0±2.6 year; mean cigarettes/day 22.4±10.1; mean WPs/week 5.2±5.6). After 12-hour abstinence participants completed two smoking sessions (WP or cigarette), while they responded to subjective measures of withdrawal, craving, and nicotine effects administered before smoking and 5, 15, 30 and 45 min thereafter. For both tobacco use methods, scores on measures of withdrawal and craving were high at the beginning of session (i.e., before smoking) and were reduced significantly and comparably during smoking. Analysis of smoking and recovery (post-smoking) phases showed similarity in the way both tobacco use methods suppressed withdrawal and craving, but the recovery of some of these symptoms can be faster with cigarette use. This study is the first to show the ability of WP to suppress abstinence effects comparably to cigarettes, and its potential to thwart cigarette cessation.
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This paper examines the links between attitudes towards cigarette smoking and the social environments of communities involved in the U.S. National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). Our objective is to identify sources of social-geographic variation in smoking attitudes and norms which can hinder or enhance public health efforts to reduce tobacco use. The analysis had two stages: (1) place (measured as region and community) was identified as an important main effect accounting for individual variation in smoking attitudes independent of smoking status and personal characteristics; (2) case studies of COMMIT sites in North Carolina, Iowa, Washington, New Jersey and New Mexico were conducted to reveal features of the local milieux which could account for variations in smoking attitudes. Some of the place characteristics that we suggest are linked to local attitudes include economic reliance on the tobacco industry, libertarian political orientations, socio-economic conditions, legislative context and ethnic composition. Given the effects of regional and community attributes on individual attitudes towards smoking, we conclude that public health efforts to control smoking should continue to be targeted beyond individual smokers to the broader social environment.
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Because narghile waterpipe (shisha, hooka) smoking normally involves the use of burning charcoal, smoke inhaled by the user contains constituents originating from the charcoal in addition to those from the tobacco. We have previously found that charcoal accounts for most of the polyaromatic hydrocarbons (PAH) and carbon monoxide in the smoke of the waterpipe, both of which are present in alarming quantities. Because charcoal manufacturing conditions favor formation of PAH, it is reasonable to assume that charcoal sold off the shelf may be contaminated by PAH residues. These residues may constitute a significant fraction of the PAH inhaled by the waterpipe user and those in her/his vicinity. We measured PAH residues on three kinds of raw waterpipe charcoal sampled from Beirut stores and cafés. We found that PAH residues in raw charcoal can account for more than half of the total PAH emitted in the mainstream and sidestream smoke, and about one sixth of the carcinogenic 5- and 6-ring PAH compounds. Total PAH content of the three charcoal types varied systematically by a factor of six from the charcoal with the least to the greatest PAH residue. These findings indicate the possibility of regulating charcoal carcinogen content.
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The objectives of this analysis were to identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use. Data on sociodemographic characteristics, water-pipe smoking, and use of other psychoactive substances were collected in 2007 through mailed self-report questionnaires completed by 871 young adults, 18 to 24 years of age, who were participating in the Nicotine Dependence in Teens Study, a longitudinal investigation of the natural history of nicotine dependence among adolescents in Montreal, Canada. Independent sociodemographic correlates of water-pipe use were identified in multivariate logistic regression analyses. Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year. Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes. Evidence-based public health and policy interventions are required to equip the public to make informed decisions about water-pipe use.
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Waterpipe smoking among Danish, Swedish, and German youth is increasing dramatically, indicating the emergence of a new health threat. This study assessed the association between waterpipe smoking and progression to regular cigarette smoking among Danish continuation school students during 2004-2005. All participants (N = 762) had smoked cigarettes on a nonregular basis at baseline. Among boys, waterpipe smoking frequency was predictive of being a regular cigarette smoker at follow-up eight months later. Further research should examine waterpipe smoking as a potential predictor of cigarette smoking. The study's limitations are noted.
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Popularity of waterpipe smoking or hookah smoking in the United States has been growing for some time now among youth and young adults. Currently, many cities and states have exemptions that allow hookah bars to remain in operation despite the passage of clean indoor air legislation. From a public health perspective this is concerning for many reasons. One public health concern with the increase in popularity of this type of tobacco use is the associated health effects. Another concern is that hookah smoke produces a sweet smelling aroma making it less obvious that patrons and employees of hookah bars are inhaling noxious fumes from mainstream smoke, as well as the toxins from the charcoal that is used to heat the tobacco. The purpose of this paper is to discuss smoke-free air legislation in relation to hookah use, the public health implications of exempting hookah bars from current smoke-free legislation, and implications for the public health nurse in protecting the public from the dangers of second-hand smoke, and limiting this new form of tobacco use.
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Young adults have the highest smoking rate of any age group in the U.S., and new strategies to decrease young adult smoking are needed. The objective of the current study was to identify psychographic and demographic factors associated with current smoking and quitting behaviors among young adults. Attitudes, social groups, and self-descriptors, including supporting action against the tobacco industry, advertising receptivity, depression, alcohol use, and other factors associated with smoking were tested for associations with smoking behaviors in a 2005 cross-sectional survey of 1528 young adults (aged 18-25 years) from a web-enabled panel. Analyses were conducted in 2007. Being older was associated with current smoking, whereas having some higher education and being African American or Hispanic were negatively associated with smoking. Supporting action against the tobacco industry was negatively associated with smoking (AOR=0.34 [95% CI=0.22, 0.52]). Perceived usefulness of smoking, exposure to smokers, increased perceived smoking prevalence, receptivity to tobacco advertising, binge drinking, and exposure to tobacco advertising in bars and clubs were associated with smoking. Supporting action against the tobacco industry was associated with intentions to quit smoking (AOR=4.43 [95% CI=2.18, 8.60]). Young adults are vulnerable to tobacco-industry advertising. Media campaigns that denormalize the tobacco industry and appeal to young adults appear to be a powerful intervention to decrease young adult smoking.
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Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community. A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008. Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.
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To assess the prevalence, content, and growth of state and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage. A mailed survey of city clerks in US cities with a population of 25,000 or greater (N = 980) and review of existing data sources confirmed the status of smoking restrictions in 902 (92%) of the cities in the sample. State laws were identified by contacting each state's Legislative Reference Bureau (100% response). Content of laws was coded using previously developed categories. Prevalence, comprehensiveness, and cumulative incidence of no-smoking laws in states and in cities with a population of 25,000 or greater. By July 1989, 44 states and 500 (51%) of the cities in our sample had adopted some smoking restriction, but content varied widely. While 42% of cities limited smoking in government buildings, 27% in public places, 24% in restaurants, and 18% in private workplaces, only 17% of cities and 20% of states had comprehensive laws restricting smoking in all four of these sites. The number of city no-smoking laws increased tenfold from 1980 to 1989. City no-smoking laws were independently associated with population size, geography, state tobacco production, and adult smoking prevalence. Laws were more common in larger cities, Western cities, and states with fewer adult smokers. Laws were less common in tobacco-producing states and in the South. No-smoking laws are more widespread than previously appreciated, especially at the local level, reflecting a rapid pace of city government action in the 1980s. Nonetheless, comprehensive laws, which are most likely to provide meaningful protection from environmental tobacco smoke exposure, remain uncommon and represent a major gap in smoking control policy. Laws are most needed in smaller and non-Western cities and in states that produce tobacco and have a higher proportion of smokers.
Article
We studied the carbon monoxide (CO) fractions in hookah and cigarette smoke, using a carbon monoxide micro smokerlyzer (model EC50, BEDFONT, U.K.). Mean carbon monoxide fractions (% by volume) of hookah smoke, using domestic charcoal were 0.38 +/- 0.07 (large hookah; unfiltered); 1.40 +/- 0.43 (small hookah; unfiltered); 0.34 +/- 0.06 (large hookah; filtered); 1.36 +/- 0.35 (small hookah; filtered) and 0.41 +/- 0.08 (cigarette smoke). The highest fractions were obtained with small size hookah and increase in size of hookah (i.e., volume of air in water base, fire bowl volume, pipe length, etc.) reduced the CO fraction significantly (P < 0.001). The fractions of cigarette lie between large and small hookah. The fractions vary slightly with different varieties of tobacco, e.g., CO fractions with Dera wala tobacco are significantly low (P < 0.05). Use of commercial charcoal gives significant rise in CO fractions (P < 0.001). Comparison of filtered and unfiltered smoke shows no significant difference in values. We conclude that the CO hazard is as high with hookah smoking as with cigarette smoking.
Article
Adolescent smoking prevalence is tracked annually and has increased since 1991. In contrast, little is known about trends in smoking among college students, a group that has previously been more resistant to tobacco use than other young adults. To examine changes in cigarette smoking among college students between 1993 and 1997 and among different types of students and colleges. Self-administered survey (Harvard School of Public Health College Alcohol Study). One hundred sixteen nationally representative 4-year colleges. A total of 15103 randomly selected students in 1993 (70% response rate) and 14251 students in 1997 (60% response rate). Self-reports of cigarette smoking in the past 30 days and in the past year, age at smoking first cigarette, and number of attempts to quit. Over 4 years, the prevalence of current (30-day) cigarette smoking rose by 27.8%, from 22.3% to 28.5% (P<.001). The increase was observed in 99 of 116 colleges and was statistically significant (P<.05) in 27 (23%) of them. Current smoking increased across all student subgroups (defined by sex, race/ethnicity, and year in school) and in all types of colleges. Smoking is rising faster in public schools (from 22.0% to 29.3%) than in private schools (from 22.9% to 26.8%). Eleven percent of college smokers had their first cigarette and 28% began to smoke regularly at or after age 19 years, by which time most were already in college. Half of current smokers tried to quit in the previous year; 18% had made 5 or more attempts to quit. Cigarette use is increasing on campuses nationwide in all subgroups and types of colleges. Substantial numbers of college students are both starting to smoke regularly and trying to stop. National efforts to reduce smoking should be extended to college students.