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Keller-Hamilton B, Stevens EM, Villanti AC, Leshner G, Wagener TL, Mays D. Messaging to prevent and reduce young adults' waterpipe tobacco smoking: A randomized trial. Addict Behav 2023; 138:107546. [PMID: 36455379 PMCID: PMC9780172 DOI: 10.1016/j.addbeh.2022.107546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION More than 10% of U.S. young adults have smoked waterpipe tobacco in the past month and >25% of those who have never smoked are susceptible. We tested messages designed to prevent and reduce waterpipe tobacco smoking (WTS). METHODS In 2020, we recruited 830 U.S. young adults (18-30 years) who had never smoked waterpipe tobacco and were susceptible or currently smoked waterpipe tobacco for an online study. We randomized participants to intervention messages about the risks of WTS or control messages unrelated to tobacco. Participants had up to four message exposures over 12 weeks and completed two-, four-, and six-month follow-ups. Outcomes were WTS initiation and curiosity (susceptible never smokers), WTS frequency, cessation, motivation to quit (those who currently smoked), and WTS risk perceptions. RESULTS Intervention messages increased perceived addictiveness of WTS at two months (β = 0.27; 95% CI: 0.11, 0.43) in susceptible never smokers. There were no significant intervention effects in those who currently smoked. Exploratory analyses among intervention participants showed that higher dose of message exposure decreased WTS initiation at six months in susceptible never smokers (RR = 0.68; 95% CI: 0.48, 0.96) and decreased WTS frequency (IRR = 0.84; 95% CI: 0.73, 0.97) and increased cessation (RR = 1.31; 95% CI: 1.07, 1.59) at six months in those who smoked. CONCLUSIONS Although the WTS intervention messages had few significant effects on outcomes overall, a higher dose of message exposure affected behavioral outcomes in the intervention arm. Findings highlight the need to identify effective message content and optimal message dose, especially for digital media campaigns.
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Affiliation(s)
- Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Department of Health, Behavior, Society, & Policy, Rutgers School of Public Health, New Brunswick, NJ, United States
| | - Glenn Leshner
- Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK, United States
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States.
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Mays D, Long L, Alalwan MA, Wagener TL, Shang C, Roberts ME, Patterson JG, Keller-Hamilton B. The Effects of Oral Nicotine Pouch Packaging Features on Adult Tobacco Users' and Non-Users' Product Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3383. [PMID: 36834078 PMCID: PMC9965054 DOI: 10.3390/ijerph20043383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Oral nicotine pouches (ONPs) are novel products that are marketed as "tobacco-free" alternatives to cigarettes and smokeless tobacco (ST). This study examined the effects of ONP packaging features on adult tobacco users' and non-users' product perceptions. MATERIALS AND METHODS Adult tobacco users (cigarettes, ST, and dual cigarette/ST) and non-users (total N = 301) viewed ONP pack images in a 4 × 3 × 2 between-subject experiment testing the effects of the displayed flavor (cool mint, coffee, dark frost, and smooth), nicotine concentration (none displayed on the package, 3 mg, and 6 mg), and addiction warning label (yes or no). The outcomes were perceived substitutability of ONPs for cigarettes and ST and perceived risks. We modeled the effects of tobacco user status and the experimental factors on these outcomes. RESULTS All tobacco user groups perceived ONPs to be significantly less harmful and less addictive than non-users. There were significant effects of nicotine concentration on perceived risks. Compared to packages that did not display nicotine concentration, packages displaying 6 mg nicotine concentration produced significantly lower perceived harm (β = -0.23, 95% CI -0.44, -0.02), perceived addictiveness (β = -0.28, 95% CI -0.51, -0.05), risk appraisals of harm (β = -0.50, 95% CI -0.88, -0.12) and risk appraisals of addictiveness (β = -0.53, 95% CI -0.95, -0.11). CONCLUSIONS The study findings demonstrate that the nicotine concentration displayed on ONP packaging can affect adults' perceptions of ONPs. Further research on the effects of ONP packaging features emphasizing nicotine (e.g., "tobacco free" nicotine claims) on tobacco users and non-users is needed to assess their potential public health impact.
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Affiliation(s)
- Darren Mays
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Lauren Long
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Mahmood A. Alalwan
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Theodore L. Wagener
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Megan E. Roberts
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Joanne G. Patterson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Brittney Keller-Hamilton
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
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Gautam P, Sharma E, Li T, Maziak W. Prevalence and predictors of waterpipe smoking cessation among young adults in the US: Findings from a population-based study. Addict Behav 2022; 135:107457. [PMID: 35986954 DOI: 10.1016/j.addbeh.2022.107457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prevalence of waterpipe tobacco (WPT) smoking is 9.2 % among young adults aged 18-24 years in the United State (US). Adequate understanding of the factors predicting WPT smoking cessation among the young population is essential to tobacco control efforts. This study assessed the prevalence and predictors of WPT smoking cessation among young adults. METHODS The population assessment of tobacco and health (PATH) study data (waves 1-5) was used for the study. A total sample of 561 young adults exclusively using WPT (past 30-days) was used for the analysis. The probability of WPT smoking cessation (no use in the past 12 months) was estimated using the Kaplan-Meier survival method, and the predictors were assessed using the Cox proportional hazards regression model. RESULTS During the five waves, 25.1 % of the young adult WPT smokers quit smoking. Among them, 58.2 % were females and the remaining 41.8 % were males. The Hispanics (40.2 %) had the highest rate of cessation among the ethnic groups. Regret smoking (adjusted hazard ratio (aHR) = 2.33, 95 % confidence interval (CI) = 1.24-4.36), smoking restriction at home (aHR = 2.86, 95 % CI = 1.41-5.88), and living in Midwest geographical region (aHR = 2.11, 95 % CI = 1.16-3.84) increased the likelihood whereas alcohol use (aHR = 0.62, 95 % CI = 0.41-0.93) decreased the likelihood of cessation among the young adult WPT smokers. CONCLUSIONS Communicating the health and economic consequences associated with WPT smoking (e.g., pictorial health warning labels), involving smoker's household members in WPT awareness campaigns, and closing regulatory loopholes related to WPT venues will increase the WPT smoking cessation rate among the young population in the US.
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Affiliation(s)
- Prem Gautam
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL 33199, USA.
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD 20850, USA.
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St AHC5, 4th Floor, Miami, FL 33199, USA.
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL 33199, USA; Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, Aleppo, P.O. Box: 16542, Syria.
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El-Shahawy O, Labib K, Stevens E, Kahn LG, Anwar W, Oncken C, Loney T, Sherman SE, Mead-Morse EL. Exclusive and Dual Cigarette and Hookah Smoking Is Associated with Adverse Perinatal Outcomes among Pregnant Women in Cairo, Egypt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412974. [PMID: 34948585 PMCID: PMC8701206 DOI: 10.3390/ijerph182412974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the prevalence of prenatal smoking, factors associated with prenatal smoking, and its association with birth outcomes in a sample of pregnant women in Egypt. Pregnant women were recruited during their last trimester from antenatal clinics in Cairo from June 2015 to May 2016. Participants completed an interviewer-administered survey that assessed tobacco use and attitudes, and exhaled carbon monoxide (CO) was measured. Gestational age at delivery and offspring birth weight were collected via a postnatal phone interview. Two hundred pregnant women ages 16–37 years participated. More than a quarter (29.0%) of women reported smoking (cigarettes, hookah, or both) during their current pregnancy, and hookah was more popular than cigarettes. Most women who smoked prior to their current pregnancy either maintained their current smoking habits (46.6%) or switched from dual to hookah-only smoking (46.6%). Current smokers during pregnancy had a higher mean (±SD) exhaled CO level (2.97 ± 1.45 vs. 0.25 ± 0.60 ppm, p < 0.001) and had babies with a lower mean birth weight (2583 ± 300 vs. 2991 ± 478 g, p < 0.001) than non-smokers. Smokers during pregnancy had greater odds of premature birth and/or low birth weight babies compared to non-smokers. Dual cigarette-hookah smokers had the highest risk. Additional focused programs are required to prevent women of childbearing age from initiating tobacco use and empower women to stop tobacco use during the preconception and gestational periods.
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Affiliation(s)
- Omar El-Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
- School of Global Public Health, New York University, New York, NY 10013, USA
- Correspondence: or ; Tel.: +1-646-501-3587
| | - Kareem Labib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt;
| | - Elizabeth Stevens
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
| | - Linda G. Kahn
- Departments of Pediatrics and Population Health, New York University School of Medicine, New York, NY 10016, USA;
| | - Wagida Anwar
- Department of Community and Environmental Medicine, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt;
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (C.O.); (E.L.M.-M.)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Heath Sciences, Dubai P.O. Box 505055, United Arab Emirates;
| | - Scott E. Sherman
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
| | - Erin L. Mead-Morse
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (C.O.); (E.L.M.-M.)
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Lipkus I, Sanders C. A Pilot Study Assessing Reactions to Educational Videos on Harm of Waterpipe among Young Adults Susceptible to Waterpipe Tobacco Smoking. JOURNAL OF HEALTH COMMUNICATION 2021; 26:743-752. [PMID: 34758698 DOI: 10.1080/10810730.2021.2000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Young adults who never engaged in waterpipe tobacco smoking (WTS) yet are open to trying it, that is, are susceptible, is a high-risk group for initiation WTS. Very few interventions dissuade this group from WTS. Thus, we explored how four short videos that varied themes of WTS harms influenced susceptible young adults' risk perceptions, risk beliefs, and susceptibility to future WTS. As part of online cross-sectional study, 208 participants aged 18-34 were randomized to watch or not a short video; each video focused on different themes of WTS risks: physical harms, myths about WTS, addiction, and harms to others. The main outcomes were perceived personal risks, risk beliefs, perceived harm of WTS compared to cigarettes, and susceptibility to future WTS. Watching any video increased beliefs of harm of WTS and lowered susceptibility to future WTS compared to not watching a video. The theme of physical harms was most effective at increasing risk beliefs and lowering susceptibility to future WTS. All four videos were rated as credible, engaging, personally relevant, producing negative affect toward WTS, and effective at dissuading WTS. These promising findings suggest further testing is needed to determine if effects persist and prevent WTS among adults susceptible to WTS.
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Affiliation(s)
- Isaac Lipkus
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Camilla Sanders
- Duke University School of Nursing, Durham, North Carolina, USA
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Phan L, Mays D, Tercyak KP, Johnson AC, Rehberg K, Lipkus IM. Initial development of the Hookah Smoker Scale: Assessing young adults' mental schemas about hookah "smokers". Transl Behav Med 2021; 11:206-215. [PMID: 31722424 DOI: 10.1093/tbm/ibz155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many young adult hookah tobacco users do not consider themselves hookah "smokers," but data on this topic are limited. There are no existing measures of young adults' mental schemas of hookah "smokers." We examined the factor structure and reliability of the Hookah Smoker Scale and examined associations with perceived harm and addictiveness and attitudes toward hookah. Two hundred and forty-six young adult (ages 18-30) hookah smokers participated in a cross-sectional online study. Participants completed items assessing schemas characterizing hookah smokers and valid measures of perceived harm and addictiveness of hookah smoking, risk appraisals, and attitudes toward hookah. Exploratory factor analysis using principal axis factoring with oblique rotation extracted a 12-item scale with three dimensions (Regular Use, Social-Enabled Use, and Self-Enabled Use). The scale explained 69.7% of the variance (eigenvalue = 9.2). Cronbach's α for the scale was .89, with Cronbach's α ≥ .80 for four-item subscales. Higher subscale scores indicate stronger beliefs that the dimension characterizes a hookah smoker. Higher Regular Use scores (score variance = 46.9%; eigenvalue = 5.6) were associated with greater perceived harm and addictiveness (β = 0.21, p = .01), greater risk appraisals (β = 0.20, p = .02), and more negative attitudes toward hookah (β = -0.18, p = .03). The Hookah Smoker Scale is a promising measure that can be used to identify targets for preventing and reducing young adults' hookah tobacco use. Findings also suggest young adults associate health risks of hookah with daily smoking, but not with intermittent social smoking patterns.
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Affiliation(s)
- Lilianna Phan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Kathryn Rehberg
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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E8-LWDS: Factorial Structure and Psychometric Properties of the Lebanese Waterpipe Dependence Scale-11 in 1490 Egyptian Waterpipe Tobacco Smokers-A Critical Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136741. [PMID: 34201512 PMCID: PMC8269008 DOI: 10.3390/ijerph18136741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is no universal scale for assessing waterpipe tobacco (WT) dependence. We examined the factorial structure and psychometric properties of the Waterpipe Dependence Scale-11 (LWDS-11) among Egyptian WT smokers. METHODS We administered the LWDS-11 during face-interview questionnaires in two cross-sectional surveys among 1490 current WT smokers recruited via purposive quota sampling. Exploratory factor analysis was performed on half of the sample. Confirmatory factor analysis of the resulting model was done using structural equation modelling on the other half. Scale reliability was examined. We assessed convergent construct validity using regression models to examine the association between the adapted dependence scale and factors conceptually expected to be associated with WT dependence. RESULTS Exploratory factor analysis of the scale yielded eight items (E8-LWDS) supporting a three-factor structure: physical dependence (three items); psychological dependence (three items); and psychological craving (two items). Cronbach's α were 0.635 for the total scale and 0.823, 0.654, and 0.785 for the three subscales. E8-LWDS was confirmed to have good model fit (comparative fit index = 0.995; root mean squared error of approximation = 0.027). E8-LWDS was independently associated with daily WT smoking, rural residence, being a skilled worker, non-exclusive WTS, smoking ≥ eight WT hagars/day, and measures of perceived behavioral control (self-reported addiction to WT, perceived ability to quit, and previous quit attempts). CONCLUSION E8-LWDS showed adequate psychometric properties among this sample of Egyptian current WT smokers, which makes it appropriate for use by researchers and practitioners. Adding items related to perceived behavioral control might enhance the scale robustness.
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Yang Y, Lindblom EN, Salloum RG, Ward KD. Perceived health risks associated with the use of tobacco and nicotine products during the COVID-19 pandemic. Tob Induc Dis 2021; 19:46. [PMID: 34163314 PMCID: PMC8191569 DOI: 10.18332/tid/136040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health. METHODS We conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables. RESULTS For all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes (OR=1.65; 95% CI: 1.20-2.27) and cigars (OR=1.63; 95% CI: 1.17-2.27) to COVID-19 severity were more likely to have decreased or quit their use. CONCLUSIONS Tobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use.
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Affiliation(s)
- Yong Yang
- School of Public Health, The University of Memphis, Memphis, United States
| | - Eric N. Lindblom
- O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Policy, University of Florida, Gainesville, United States
| | - Kenneth D. Ward
- School of Public Health, The University of Memphis, Memphis, United States
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Perceptions of Waterpipe Smoking among Young Adults: A Phenomenological Study. Dent J (Basel) 2020; 8:dj8040134. [PMID: 33321834 PMCID: PMC7763057 DOI: 10.3390/dj8040134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/11/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Waterpipe tobacco smoking is becoming increasingly popular in the West among young people. Given the associated health risks of this behaviour, we aimed to investigate why young adults take up waterpipe tobacco smoking and their attitudes to the associated risks. METHODS This was a qualitative study, with a phenomenological perspective. Focus groups and face-to-face semi-structured interviews were conducted among waterpipe smokers aged 20-30 years living in London, UK. Transcripts were analysed using constant comparison and cycling between the data and analysis. Data collection continued until thematic saturation was achieved. RESULTS Sixteen smokers attended focus groups and face-to-face interviews. Seven main themes emerged encompassing four main dimensions relating to: lack of knowledge, perceived risk, affordability, and social addiction. Waterpipe was perceived to be safer than cigarette smoking due to the pleasant odour, fruity flavours, and belief that water filtered the toxins. The waterpipe had become a "social addiction" enhancing group atmosphere, was cheap and did not have the dangers of violence or hallucinations associated with other addictions like alcohol and drugs. Because of their intermittent smoking patterns and the lack of statutory warnings, none felt they were not at risk of any adverse side effects. CONCLUSIONS Waterpipe smoking is a growing public health problem; the social environment associated with its use is perceived to be a positive outlet by smokers who do not consider it harmful to their health. These perceptions need to be addressed urgently by anti-smoking policies.
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Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238752. [PMID: 33255675 PMCID: PMC7728075 DOI: 10.3390/ijerph17238752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 12/23/2022]
Abstract
Young adults’ hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition (n = 12 total messages). Young adults aged 18–30 (N = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity (p < 0.001), positive attitudes (p < 0.001), and negative emotional response (p < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages (p = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.
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Johnson AC, Mays D. Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults. HEALTH EDUCATION & BEHAVIOR 2020; 48:627-636. [PMID: 33073594 DOI: 10.1177/1090198120963104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs. AIMS This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults. METHOD Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment (n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures. RESULTS There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone. DISCUSSION Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco. CONCLUSION This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.
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Affiliation(s)
| | - Darren Mays
- The Ohio State University, Columbus, OH, USA
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Yang Y, Lindblom EN, Salloum RG, Ward KD. The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addict Behav Rep 2020; 11:100273. [PMID: 32368612 PMCID: PMC7186365 DOI: 10.1016/j.abrep.2020.100273] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Flavors play an important role in the initiation and use of tobacco products. The FDA, states, and cities have been implementing or considering banning flavored e-cigarettes or any flavored tobacco products. This study empirically assessed the impact of one of the first comprehensive bans of all flavored tobacco products other than tobacco-flavored e-cigarettes among young adults in San Francisco, California. METHODS Using Amazon Mechanical Turk, a sample of San Francisco residents aged 18-34 who previously used tobacco products (N = 247) were surveyed about their tobacco use both before and after the ban. Descriptive statistics and regression models were applied. RESULTS The prevalence of overall flavored tobacco use decreased from 81% and 85% to 69% and 76% for 18-24 years and 25-34 years old, respectively. The prevalence of flavored e-cigarettes decreased from 57% and 56% to 45% and 48% for 18-24 years and 25-34 years old, respectively. The prevalence of cigars uses reduced as well. However, cigarette smoking increased, although not statistically significant among 25-34 years old. 66% of participants did not support the ban and 65% believed the ban had not been enforced completely. Most users reported being able to obtain flavored tobacco products in multiple ways despite the ban. CONCLUSIONS These findings suggest that comprehensive local flavor bans, by themselves, cannot sharply reduce the availability or use of flavored tobacco products among residents. Nevertheless, local bans can still significantly reduce overall e-cigarette use and cigar smoking but may increase cigarette smoking.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN 38152, United States
| | - Eric N. Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC 20001, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32608, United States
| | - Kenneth D. Ward
- School of Public Health, University of Memphis, Memphis, TN 38152, United States
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13
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Cigarette, E-Cigarette and Waterpipe Use among Young Adults: Differential Cognitions about These Three Forms of Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113787. [PMID: 32471046 PMCID: PMC7312077 DOI: 10.3390/ijerph17113787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
Background: Polytobacco use is common among young adults. The purpose of the present study was to investigate a number of cognitions related to the use of three tobacco products (cigarettes, e-cigarettes and waterpipes) among young adults. Methods: Participants (n = 799, 59.4% women) aged 18–25 years old (M = 21.8, SD = 1.7) completed an online tobacco cognitions questionnaire. Results: For all three tobacco products, there was significantly more agreement with the cognition “I would smoke if my best friend offered” among tobacco users (used one or more tobacco products) than among non-users. For e-cigarettes and waterpipes, there was significantly more agreement with the cognition “It would be easy to quit these products” than was reported by non-users. Polytobacco users (three tobacco products) endorsed the cognitions scale (the six cognition items were combined to form a single cognitions scale for each tobacco product) significantly more than non-users for cigarettes and e-cigarettes. Furthermore, waterpipe users, polytobacco users, dual users and single users all endorsed the combined cognitions scales more strongly than non-users. Conclusions: Efforts to prevent polytobacco use should ensure that young adults have the necessary self-efficacy to resist peer pressure and provide them with clear information about the health risks associated with using alternative tobacco products.
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14
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Mays D, Phan L, Johnson AC, Tercyak KP, Snow K, Luta G, Rehberg K, Lipkus I. Results of a Single Arm Pilot Study of a Mobile Messaging Intervention for Hookah Tobacco Cessation in Young Adults. Tob Use Insights 2020; 13:1179173X20915200. [PMID: 32440243 PMCID: PMC7225829 DOI: 10.1177/1179173x20915200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants' hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant (P < .05) increases in risk perceptions (d's = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.
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Affiliation(s)
- Darren Mays
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Lilianna Phan
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kylie Snow
- Department of Human Science, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn Rehberg
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
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15
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El Hourani M, Salman R, Talih S, Saliba NA, Shihadeh A. Does the Bubbler Scrub Key Toxicants from Waterpipe Tobacco Smoke?: Measurements and Modeling of CO, NO, PAH, Nicotine, and Particulate Matter Uptake. Chem Res Toxicol 2020; 33:727-730. [PMID: 31957423 DOI: 10.1021/acs.chemrestox.9b00521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Waterpipe tobacco smoking is a global epidemic. A persistent perception among users is that the water bubbler filters the smoke, reducing its risk profile. The objectives of this study were to quantify the purported filtering effect by comparing toxicant yield when a waterpipe was machine smoked with and without the smoke passing through the water bubbler. We found that the water bubbler did not reduce CO, NO, polycyclic aromatic hydrocarbons (PAHs), or dry particulate matter (DPM) yields but did reduce nicotine and carbonyl compounds (CCs) yields by approximately 50%. These mixed results were consistent with theoretical simulations of the mass transport processes involved.
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Affiliation(s)
- Mario El Hourani
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Rola Salman
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Soha Talih
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Najat Aoun Saliba
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Chemistry Department, American University of Beirut, Beirut, Lebanon
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
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16
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Abstract
Objectives Philip Morris International's heated tobacco product, Marlboro IQOS, is available internationally and will soon be marketed in the U.S. We examined correlates of curiosity, interest, and likelihood to use IQOS among U.S. young adults. Methods Young adults ages 18 - 30 years (N = 346) were recruited online, viewed a description of IQOS, and completed measures of sociodemographic characteristics, perceived risks, curiosity, interest, and likelihood to use IQOS. Results Males had greater curiosity, interest, and likelihood to use IQOS than females. Individuals with household income of $50,000 - $75,000 were more curious than those with household income of greater than $75,000. Cigarette smokers, e-cigarette and dual users had greater curiosity, interest, and likelihood of use than non-tobacco users. Non-white individuals and older young adults had greater likelihood of use. Greater perceived risks of IQOS were negatively associated with curiosity, interest, and likelihood of use. Conclusions Among young adults, IQOS has greater appeal among males, non-white individuals, those who are older, those with household income of $50,000-$75,000, cigarette smokers, e-cigarette and dual users, and those with less perceived risks of IQOS. Research on public education communicating the potential risks of IQOS to vulnerable young adults is warranted.
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17
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Mays D, Johnson AC, Phan L, Tercyak KP, Rehberg K, Lipkus I. Effect of risk messages on risk appraisals, attitudes, ambivalence, and willingness to smoke hookah in young adults. Health Psychol Behav Med 2020; 8:96-109. [PMID: 33033657 PMCID: PMC7540838 DOI: 10.1080/21642850.2020.1730844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: We examined effects of hookah tobacco risk messages on risk appraisals, attitudes towards hookah, ambivalence about hookah use, and willingness to smoke in young adults aged 18–30 years (n = 234). Design: In an online experiment, participants completed pre-exposure measures and were randomized to hookah tobacco risk messages or to a no message control condition. Main Outcome Measures: Risk appraisals, attitudes, ambivalence, and willingness to smoke hookah. Results: Those who viewed risk messages reported greater risk appraisals (M 4.50, SD 1.17 vs. M 3.87, SD 1.16, p < .001), less positive attitudes (M −0.56, SD 1.24, vs. M 0.39, SD 1.35, p < .001), greater ambivalence (M 3.86, SD 1.26, vs. M 3.08, SD 1.32, p < .001), and less willingness to smoke than controls (M 4.48, SD 1.27, vs. M 4.85, SD 1.37, p = .034). Structural equation modeling demonstrated messages reduced willingness to smoke by evoking less positive attitudes (b = −0.15, 95% CI −0.32, −0.05) and by the effect of heightened risk appraisals on less positive attitudes (b = −0.14, 95% CI −0.30, −0.07). Conclusions: Honing messages and understanding their mechanisms of action are necessary to produce more effective interventions to address hookah and other tobacco use in young adults.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn Rehberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
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18
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Calabro KS, Khalil GE, Chen M, Perry CL, Prokhorov AV. Pilot study to inform young adults about the risks of electronic cigarettes through text messaging. Addict Behav Rep 2019; 10:100224. [PMID: 31828203 PMCID: PMC6889374 DOI: 10.1016/j.abrep.2019.100224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings. METHODS A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure. RESULTS Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02). CONCLUSIONS This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.
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Affiliation(s)
- Karen S. Calabro
- Department of Behavioral Science, The University of Texas (UT) MD Anderson Cancer Center, Houston, TX, United States
| | - Georges E. Khalil
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Cheryl L. Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX, United States
| | - Alexander V. Prokhorov
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, United States
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Johnson AC, Lipkus I, Tercyak KP, Luta G, Rehberg K, Phan L, Abroms LC, Mays D. Development and Pretesting of Risk-Based Mobile Multimedia Message Content for Young Adult Hookah Use. HEALTH EDUCATION & BEHAVIOR 2019; 46:97-105. [PMID: 31742460 PMCID: PMC6886357 DOI: 10.1177/1090198119874841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. Hookah is one of the most commonly used tobacco products among U.S. young adults due in part to widespread misperceptions that it is not harmful or addictive. There is growing evidence that hookah tobacco is associated with health harms and can lead to addiction. Research on interventions to address these misperceptions by communicating the harms and addictiveness of hookah use is needed. Aims. This study developed and pretested mobile multimedia message service (MMS) message content communicating the risks of hookah tobacco use to young adult hookah smokers. Method. Message content, delivery, and pretesting were tailored to participants' risk beliefs, hookah use frequency, and responses to simulated text message prompts. Participants viewed 4 of 12 core MMS messages randomized within-subjects and completed postexposure measures of message receptivity and emotional response (e.g., worry). Results. The sample included 156 young adult (age 18-30 years) hookah smokers; 31% smoked hookah monthly and 69% weekly/daily. Prior to viewing messages, a majority endorsed beliefs reflecting misperceptions about the risks of hookah tobacco. Postexposure measures showed participants were receptive to the messages and the messages evoked emotional response. As anticipated, messages produced similar receptivity and there were few differences in emotional response between the messages tested. Discussion. Young adult hookah tobacco smokers were receptive to tailored mobile MMS messages and messages evoked emotional response, two critical precursors to behavior change. Conclusion. Findings indicate that research testing the efficacy of tailored MMS messaging as a strategy for reducing hookah tobacco use in young adults is warranted.
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Affiliation(s)
- Andrea C Johnson
- Georgetown University Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
| | | | - George Luta
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Lilianna Phan
- Georgetown University Medical Center, Washington, DC, USA
- University of Maryland, College Park, MD, USA
| | | | - Darren Mays
- Georgetown University Medical Center, Washington, DC, USA
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