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Atem FD, Bluestein MA, Chen B, Harrell MB, Messiah SE, Kuk AE, Pérez A. Application of inverse weighting analysis to assess the association of youth perceptions with the age of initiation of tobacco products. Front Public Health 2024; 12:1203631. [PMID: 38450147 PMCID: PMC10915753 DOI: 10.3389/fpubh.2024.1203631] [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: 04/11/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction To examine if perceptions of harmfulness and addictiveness of hookah and cigarettes impact the age of initiation of hookah and cigarettes, respectively, among US youth. Youth (12-17 years old) users and never users of hookah and cigarettes during their first wave of PATH participation were analyzed by each tobacco product (TP) independently. The effect of perceptions of (i) harmfulness and (ii) addictiveness at the first wave of PATH participation on the age of initiation of ever use of hookah was estimated using interval-censoring Cox proportional hazards models. Methods Users and never users of hookah at their first wave of PATH participation were balanced by multiplying the sampling weight and the 100 balance repeated replicate weights with the inverse probability weight (IPW). The IPW was based on the probability of being a user in their first wave of PATH participation. A Fay's factor of 0.3 was included for variance estimation. Crude hazard ratios (HR) and 95% confidence intervals (CIs) are reported. A similar process was repeated for cigarettes. Results Compared to youth who perceived each TP as "a lot of harm", youth who reported perceived "some harm" had younger ages of initiation of these tobacco products, HR: 2.53 (95% CI: 2.87-4.34) for hookah and HR: 2.35 (95% CI: 2.10-2.62) for cigarettes. Similarly, youth who perceived each TP as "no/little harm" had an earlier age of initiation of these TPs compared to those who perceived them as "a lot of harm", with an HR: 2.23 (95% CI: 1.82, 2.71) for hookah and an HR: 1.85 (95% CI: 1.72, 1.98) for cigarettes. Compared to youth who reported each TP as "somewhat/very likely" as their perception of addictiveness, youth who reported "neither likely nor unlikely" and "very/somewhat unlikely" as their perception of addictiveness of hookah had an older age of initiation, with an HR: 0.75 (95% CI: 0.67-0.83) and an HR: 0.55 (95% CI: 0.47, 0.63) respectively. Discussion Perceptions of the harmfulness and addictiveness of these tobacco products (TPs) should be addressed in education campaigns for youth to prevent early ages of initiation of cigarettes and hookah.
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Affiliation(s)
- Folefac D. Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Consultant with Litigation Involving the Vaping Industry, Austin, TX, United States
| | - Sarah E. Messiah
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
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Bhargava SS, Das S, Priya H, Mishra D, Shivabasappa S, Sood A, Hazarika CR, Gupta PC, Chakma JK, Swasticharan L, Sinha P, Munish VG, Gupta SR. The Burden and Correlates of Waterpipe (Hookah) Smoking among Adolescents and Youth: A Systematic Review. Subst Use Misuse 2023; 59:29-40. [PMID: 37907086 DOI: 10.1080/10826084.2023.2257320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations. METHODS PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10-24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982). RESULTS A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10-24 years age group was noted to be 18.16% (95% CI, 18.03-18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34-6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers. CONCLUSION Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.
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Affiliation(s)
- Stuti Sharad Bhargava
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Saibal Das
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Harsh Priya
- Department of Public Health Dentistry, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
| | - Santhosh Shivabasappa
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Eductaion and Research, Puducherry, India
| | - Anubhuti Sood
- Translational Health Science and Technology Institute, Faridabad, India
| | - Chaya Rani Hazarika
- Socio-Behavioral Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India
| | | | - Joy Kumar Chakma
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Leimapokpam Swasticharan
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | | - Shalini R Gupta
- Department of Oral Medicine and Radiology, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
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Bluestein MA, Kuk AE, Harrell MB, Chen B, Hébert ET, Pérez A. Longitudinal Transition Patterns of Tobacco Use Among Youth and Young Adults Never Tobacco Product Users: Findings From the Population Assessment of Tobacco and Health Study, 2014-2019. Tob Use Insights 2023; 16:1179173X231161314. [PMID: 36923154 PMCID: PMC10009036 DOI: 10.1177/1179173x231161314] [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: 03/11/2023] Open
Abstract
Aims To identify, visualize, and describe the prevalence of within-product patterns of tobacco use behaviors for e-cigarettes, cigarettes, and hookah (TP) by 3 age groups (ie, 12-14-year-old, 15-17-year-old, and 18-20-year-old) with U.S. nationally representative data. Methods In 2014-2015, never users of each (TP) and age group were followed-up longitudinally between 2015-2019 using five transition states: non-susceptible to (TP) use, susceptible to (TP) use, ever (TP) use, past 30-day (TP) use, and discontinued past 30-day (TP) use. Sankey diagrams were used to graphically visualize patterns in tobacco use behaviors across time. Results Among 12-14-year-old who were never users and susceptible to each TP from 2014-2017, 7% initiated ever e-cigarette use and 9.4% first reported past 30-day use by 2018-2019; 5.8% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Among 15-17-year-old who were never users and susceptible to each TP from 2014-2017, 4.2% initiated ever e-cigarette use and 9.0% first reported past 30-day use by 2018-2019; 4.5% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 2.4% first reported past 30-day hookah use by 2018-2019. Among 18-20-year-old who were never users and susceptible to each TP from 2014-2017, 3.2% initiated ever e-cigarette use and 3.6% first reported past 30-day e-cigarette use by 2018-2019; 3.0% initiated ever cigarette use and 2.3% first reported past 30-day cigarette use; and, 2.8% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Conclusions From 2014 to 2019, onset and progression of e-cigarette, cigarette, and hookah use occurred more frequently in 12-14 and 15-17-year-old than in young adults 18-20-year-old.
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Affiliation(s)
- Meagan A Bluestein
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Arnold E Kuk
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin Campus, Austin, TX, USA
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Emily T Hébert
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Health Promotion and Behavioral Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
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Bluestein MA, Harrell MB, Hébert ET, Chen B, Kuk AE, Spells CE, Pérez A. Associations Between Perceptions of e-Cigarette Harmfulness and Addictiveness and the Age of E-Cigarette Initiation Among the Population Assessment of Tobacco and Health (PATH) Youth. Tob Use Insights 2022; 15:1179173X221133645. [PMID: 36276166 PMCID: PMC9585561 DOI: 10.1177/1179173x221133645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Youth perceptions of harmfulness and addictiveness of e-cigarettes may impact the age that they initiate e-cigarette use, but this has not been investigated previously. Methods Youth (12-17 years old) never e-cigarette users at their first wave of PATH participation (waves 1-3, 2013-2016) were included. PATH questions on absolute perceptions of e-cigarette harmfulness and addictiveness were used as exposures. Interval-censored Cox proportional hazards models were used to estimate the impact of perceptions of harmfulness, and perceptions of addictiveness on (i) the age of initiation of e-cigarette use and (ii) age of first reporting past 30-day e-cigarette use, while controlling for covariates. Results Youth who perceive e-cigarettes as having no/little harm had increased risk of initiating both ever e-cigarette use (AHR = 2.04; 95%CI = 1.74-2.40) and past 30-day e-cigarette use (AHR = 2.64; 95%CI = 2.07-3.37) at earlier ages compared to youth who perceive e-cigarettes as having a lot of harm. Youth who perceive the likelihood of becoming addicted to e-cigarettes to be very/somewhat unlikely had increased risk of an earlier age of both ever (AHR = 1.28; 95%CI = 1.07-1.52) and past 30-day (AHR = 1.36; 95%CI = 1.04-1.79) e-cigarette initiation compared to youth who perceived the likelihood of becoming addicted to e-cigarettes to be somewhat/very likely. Conclusion These results highlight the importance of communicating to youth the potential for health harms and addiction from e-cigarette use in prevention and intervention campaigns, as those with the lowest perceptions of harmfulness and addictiveness had the earliest ages of e-cigarette initiation.
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Affiliation(s)
- Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Emily T. Hébert
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA,Department of Health Promotion and Behavioral Sciences, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA,Department of Biostatistics and Data Science, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA
| | - Charles E. Spells
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA,Department of Biostatistics and Data Science, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX, USA,Adriana Pérez, Department of Biostatistics and Data Science, School of Public Health, the University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX 78701, USA.
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Atem FD, Bluestein MA, Harrell MB, Chen B, Messiah SE, Kuk AE, Sterling KL, Spells CE, Pérez A. Precise Estimation for the Age of Initiation of Tobacco Use Among U.S. Youth: Finding from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2017. BIOSTATISTICS AND BIOMETRICS OPEN ACCESS JOURNAL 2022; 11:555801. [PMID: 36777448 PMCID: PMC9912413 DOI: 10.19080/bboaj.2022.11.555801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context Youth tobacco use remains a prominent United States public health issue with a high economic and health burden. Method We pooled never and ever users at youth's first wave of PATH participation (waves 1-3) to estimate age of initiation for hookah, e-cigarettes, cigarettes, traditional cigars, cigarillos, and smokeless tobacco prospectively (waves 2-4). Age of initiation of each tobacco product was estimated using weighted interval-censored survival analyses. Weighted interval censoring Cox-proportional hazards regression models were used to assess the association of ever use of the TP at the first wave of PATH participation, sex, and race/ethnicity on the age of initiation of ever use of each tobacco product. Sensitivity analyses were performed to understand the impact of the recalled age of initiation for the left-censored participants by replacing the recalled age of initiation with a uniform "6" years lower bound. Results The proportion of those who ever used each tobacco product at the first wave of PATH participation ranged from 1.8% for traditional cigars to 10.4% for cigarettes. There was a significant increase in ever use of each tobacco product after the age of 14, with e-cigarettes and cigarettes showing the highest cumulative incidence of initiation by age 21, while smokeless and cigarillos recorded the lowest cumulative incidence by age 21. The adjusted Cox models showed boys initiated at earlier ages for all of these tobacco products except for hookah, which showed no difference. Similarly, apart from ever use of hookah, non-Hispanic White youth were more likely to initiate each tobacco product at earlier ages compared to Hispanic, non-Hispanic Black, and non-Hispanic Other youth. Conclusion The increased sample size and the inclusion of ever users yielded greater precision for age of initiation of each tobacco product than analyses limited to never users at the first wave of PATH participation. These analyses can help elucidate population selection criteria for estimating the age of initiation of tobacco products.
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Affiliation(s)
- Folefac D. Atem
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Meagan A. Bluestein
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701,Consultant with litigation involving the vaping industry, Austin TX
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Arnold E. Kuk
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Kymberle L. Sterling
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Charles E. Spells
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Adriana Pérez
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
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Kuk AE, Bluestein MA, Chen B, Harrell M, Spells CE, Atem F, Pérez A. The Effect of Perceptions of Hookah Harmfulness and Addictiveness on the Age of Initiation of Hookah Use among Population Assessment of Tobacco and Health (PATH) Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5034. [PMID: 35564430 PMCID: PMC9105245 DOI: 10.3390/ijerph19095034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
Despite the negative health consequence of hookah, hookah risk perceptions are misguided among youth. Secondary data analysis of 12-17-year-old never hookah users at their first wave of PATH participation (2013-2019) was performed. The effect of perceptions of hookah harmfulness and addictiveness on the age of initiation ever, past 30-day, and fairly regular hookah use were estimated using interval-censored Cox proportional hazards models. The distribution of the age of initiation of hookah outcomes by perception levels of harmfulness and addictiveness are reported as cumulative incidence and 95% CI. Youth who perceived hookah to be neither harmful nor addictive were 173% more likely to initiate ever, 166% more likely to first report past 30-day use, and 142% more likely to first report fairly regular hookah use at earlier ages compared to youth who considered hookah to be both harmful and addictive. By age 18, 25.5% of youth who perceived hookah as neither harmful nor addictive were estimated to initiate ever hookah use while 9.3% of youth who perceived hookah as harmful and addictive were estimated to initiate ever hookah use. These findings indicate the need to provide prevention and education campaigns to change perceptions of the harmfulness and addictiveness of hookah to delay the age of initiation of hookah use.
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Affiliation(s)
- Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
| | - Melissa Harrell
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
| | - Charles E. Spells
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Folefac Atem
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX 75207, USA;
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
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Pérez A, Bluestein MA, Kuk AE, Chen B, Sterling KL, Harrell MB. Age of Onset of Susceptibility to Different Tobacco Products Among Non-Susceptible US Young Adults: Findings from the Population Assessment of Tobacco and Health Study Waves 2-4 (2014-2017). Tob Use Insights 2021; 14:1179173X211065643. [PMID: 34924777 PMCID: PMC8671673 DOI: 10.1177/1179173x211065643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Initiation of tobacco products is increasing in young adulthood. This study prospectively estimated the age of onset of susceptibility to cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos among young adults, which is a cognitive precursor to initiation. METHODS Secondary data analyses of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative longitudinal cohort study of US adults. Young adults (18-24 years) who were non-susceptible to each tobacco product (cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos) at waves 2 or 3 were followed-up into waves 3-4 to prospectively estimate the age of onset of susceptibility to each tobacco product. Weighted interval-censored survival methods and interval-censored Cox regression models were implemented to estimate the age of onset of susceptibility, and to estimate differences in the hazard function by sex and by race/ethnicity, while controlling for the total number of other tobacco products ever used at their first wave of participation in PATH. RESULTS By age 21, 16.5%, 16.0%, 12.6%, 12.4%, and 5.9% of young adults reported onset of susceptibility to hookah, e-cigarettes, cigarillos, cigarettes, and smokeless tobacco, respectively. Among young adults who were non-susceptible to each tobacco product at waves 2 or 3, the highest increase in onset of susceptibility occurred between ages 18 and 19 for cigarettes, e-cigarettes, and hookah, while the highest increase in onset of susceptibility occurs between ages 22 and 23 for cigarillos. Young adult males had increased risk of onset of susceptibility to cigarillos and smokeless tobacco at earlier ages than young adult females. Differences in onset of susceptibility to each tobacco product were also observed by race/ethnicity among young adults. CONCLUSIONS With the changing landscape of tobacco products, monitoring the age of onset of susceptibility of tobacco product use among non-susceptible young adults longitudinally is critical to prevent initiation. Communication and education campaigns tailored to address differences in susceptibility among young adults by tobacco product and sociodemographic factors will be useful.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Adriana Pérez, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX 78701, USA.
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
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Pérez A, Kuk AE, Bluestein MA, Chen B, Sterling KL, Harrell MB. Age of initiation of hookah use among young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017. PLoS One 2021; 16:e0258422. [PMID: 34637482 PMCID: PMC8509879 DOI: 10.1371/journal.pone.0258422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- * E-mail:
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Baojiang Chen
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Dallas, Texas, United States of America
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin Campus, Austin, Texas, United States of America
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