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Tamim H, Beyhum A, Alzaghoul A, Kesibi D, Alghalyini B, Yunis K. Prevalence and characteristics of smoking cigarette and narghile among Syrian refugee parents in Ontario, Canada. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003176. [PMID: 38701042 PMCID: PMC11068169 DOI: 10.1371/journal.pgph.0003176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
This study aimed to explore the prevalence and associated sociodemographic, migration, and health-related factors of smoking cigarettes and narghile among Syrian refugee parents resettled in Ontario, Canada since 2015. A total of 540 Syrian refugee parents, with at least one child less than 18 years of age, were interviewed. Multivariate logistic regression analysis was performed to assess the independent relationship between each of the associated sociodemographic, migration, and health-related factors and smoking cigarettes and narghile. The overall prevalence of smoking was 43% (cigarette = 22%, narghile = 25.6%). The average number of cigarettes smoked per day was 15.4 (SD = 10.1). With regard to smoking narghile, 18.2% of the sample smoked daily, while 35.5% and 52.9% smoked at least once weekly and occasionally, respectively. Results from multivariate logistic regression analysis showed that more fathers were at increased odds of smoking cigarettes than mothers OR (95% CI) = 6.6 (3.7-11.9), while no such difference was found for narghile smokers OR (95% CI) = 1.5 (0.9-2.6). Results showed that smoking cigarettes was associated with lower education levels and being Muslim, whereas smoking narghile was associated with younger age and alcohol use. Poor perceived mental health was significant/approached significance for both types of smoking. Greater understanding of smoking patterns of resettled refugees is needed to direct healthcare providers to offer targeted interventions for those who are most at risk.
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Affiliation(s)
- Hala Tamim
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Aliya Beyhum
- Department of Archeology, University of Cambridge, Cambridge, United Kingdom
| | - Aseel Alzaghoul
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Durmalouk Kesibi
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | | | - Khalid Yunis
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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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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Alalwan MA, Keller-Hamilton B, Long L, Lipkus I, Wagener TL, Mays D. Correlates of motivation to quit waterpipe tobacco smoking among US young adults: implications for cessation interventions. HEALTH EDUCATION RESEARCH 2023; 38:338-349. [PMID: 36880171 PMCID: PMC10558042 DOI: 10.1093/her/cyad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Waterpipe tobacco smoking is a public health concern that poses many of the same health risks as cigarette smoking, especially among young adults-a subpopulation characterized by the highest prevalence of waterpipe tobacco smoking. Nevertheless, it remains understudied relative to other forms of tobacco use. We examined sociodemographic, behavioral and cognitive factors associated with young adults' motivation to quit waterpipe smoking using a theory-informed approach. We completed a secondary analysis of baseline data on waterpipe tobacco smoking beliefs and behavior collected from 349 US young adults aged 18-30 years. We analyzed sociodemographics, tobacco use and cessation behaviors and perceptions, and theory-related constructs associated with motivation to quit waterpipe tobacco smoking using linear regression. Overall, participants reported low motivation (mean = 2.68, SD = 1.56, scale range 1-7) and high self-efficacy (mean = 5.12, SD = 1.79) to quit waterpipe tobacco smoking. In multivariable analysis, prior quit attempts (β = 1.10, P < 0.01), greater perceived risks of waterpipe tobacco smoking (β = 0.42, P < 0.01) and increasingly negative attitudes toward waterpipe tobacco smoking (β = 0.29, P < 0.01) were associated with higher motivation to quit. These findings highlight the importance of those factors as potential cessation determinants. These findings can help guide the development and refinement of interventions targeting young adult waterpipe tobacco smoking.
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Affiliation(s)
- Mahmood A Alalwan
- Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Brittney Keller-Hamilton
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, Suite 410/420, Columbus, OH 43214, USA
| | - Lauren Long
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, Suite 410/420, Columbus, OH 43214, USA
| | - Isaac Lipkus
- Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, USA
| | - Theodore L Wagener
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, Suite 410/420, Columbus, OH 43214, USA
| | - Darren Mays
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, Suite 410/420, Columbus, OH 43214, USA
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Angeles D, Kurtek S, Klein E, Brinkman M, Ferketich A. Geometric framework for statistical analysis of eye tracking heat maps, with application to a tobacco waterpipe study. J Appl Stat 2023; 51:1191-1209. [PMID: 38628449 PMCID: PMC11018012 DOI: 10.1080/02664763.2023.2233143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/17/2023] [Indexed: 04/19/2024]
Abstract
Health warning labels have been found to increase awareness of the harmful effects of tobacco products. An eye tracking study was conducted to determine the optimal placement and type of a health warning label on tobacco waterpipes. Participants viewed images that contained one of (1) four waterpipes, (2) three different types of warning labels, (3) placed in three locations. Typically, statistical analysis of eye tracking data is conducted based on summary statistics such as total dwell time, duration score, and number of visits to an area of interest. However, these summary statistics fail to capture the complete variability in a participant's eye movement. Instead, we propose to estimate heat maps defined on the entire image domain using the raw two-dimensional coordinates of eye movement via kernel density estimation. For statistical analysis of heat maps, we adopt the Fisher-Rao Riemannian geometric framework, which enables computationally efficient comparisons of heat maps, statistical summarization and exploration of variability in a sample of heat maps, and metric-based hierarchical clustering. We apply this framework to eye tracking data from the tobacco waterpipe study and comment on the results in the context of the optimal placement and type of health warning labels on tobacco waterpipes.
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Affiliation(s)
- David Angeles
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Sebastian Kurtek
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Elizabeth Klein
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Marielle Brinkman
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Amy Ferketich
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Cohn AM, Elmasry H. First use of cannabis compared to first use of alcohol and tobacco: Associations with single and poly-substance use behavior. Drug Alcohol Depend 2023; 248:109904. [PMID: 37269777 DOI: 10.1016/j.drugalcdep.2023.109904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Young adults report high rates of current cannabis use. The proliferation of legalized cannabis in the US has led to greater access and availability, causing cannabis to become the new "gateway" drug. This study examined the prevalence of trying cannabis before alcohol or tobacco and the association of initiation with cannabis first with single and poly-substance use in young adults. METHODS METHODS: Data were analyzed from young adults (n=8062) in Waves 1 through 5 (2013-2019) of the Population Assessment of Tobacco and Health study who had ever tried alcohol, cannabis, or tobacco and provided age at first use of these substances. Weighted multivariable models examined associations between cannabis initiation before, at the same age, or after initiating alcohol or tobacco use with past 30-day substance use (alcohol, cannabis, tobacco, poly-substance use) in a subsequent wave (Waves 2-5). RESULTS Initiating cannabis before alcohol and tobacco (6%) was rare. In adjusted regression models, initiating cannabis before alcohol and tobacco was associated with increased odds of past 30-day cannabis use, past 30-day tobacco use, and past 30-day polysubstance use and decreased odds of past 30-day alcohol use. Initiating cannabis at the same age as either alcohol or tobacco, or trying cannabis after these substances was associated with increased odds of all substance use outcomes. CONCLUSIONS Cannabis initiation before alcohol and tobacco is uncommon and may even protect against future alcohol use. Deterring cannabis initiation with multiple substances could have public health benefits.
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Affiliation(s)
- Amy M Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73014, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, A1 12602, Oklahoma City, OK, 73104, USA.
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Dadipoor S, Heydari G, Abu-Rmeileh NM, Mohseni S, Kakhaki HES, Aghamolaei T, Shahabi N. A predictive model of waterpipe smoking cessation among women in southern Iran: application of the theory of planned behavior. BMC Public Health 2023; 23:1151. [PMID: 37316841 DOI: 10.1186/s12889-023-16053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Today, waterpipe (WT) smoking is a rising issue worldwide, and has taken a significant and growing share of tobacco consumption in the world. Present study aimed to explore the predictors of WT cessation in the light of the theory of planned behavior (TPB). METHODS This cross-sectional analytical study was conducted in 2021-2022 using a multi-stratified cluster sampling on 1,764 women in Bandar Abbas, southern Iran. Data were collected through a reliable and valid questionnaire. The three-part questionnaire includes demographic information, behavioral information of WT smoking, and the constructs of the TPB along with an additional habit construct. Multivariate logistic regression analysis was run to model the predictor constructs of WT smoking. The data were analyzed statistically in STATA14.2. RESULTS With an increase in one attitude score, the odds of cessation increased by 31% (p < 0.001). Also, with an increase of one score in knowledge, the odds of cessation are increased by 0.05% (0.008). With an increase of one score for intention, the odds of cessation are 26% (0.000). in social norms, the odds of cessation are 0.02% (0.001). With an increase of one score in perceived control, the odds of cessation increased by 16% (0.000) and inhabit score, the odds of cessation decrease by 37% (0.000). In the model where the habit construct was present, the accuracy, sensitivity, and pseudo R2 indices were 95.69%, 77.31%, and 65%, respectively and after removing the habit construct, the so-called indices changed to 90.7%, 50.38% and 0.44%, respectively. CONCLUSIONS The present research confirmed the effectiveness of the TPB model in predicting waterpipe cessation behavior. The knowledge obtained from this research can help develop a systematic and effective intervention to facilitate waterpipe cessation. Focusing on the habit variable can play a critical role in waterpipe cessation in women.
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Affiliation(s)
- Sara Dadipoor
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shokrollah Mohseni
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadi Eshaghi Sani Kakhaki
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nahid Shahabi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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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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West JC, Burt KB, Klemperer EM, Chen HL, Villanti AC. Latent Classes of Perceived Addictiveness Predict Marijuana, Alcohol, and Tobacco Use in Youth and Young Adults. Subst Use Misuse 2023; 58:454-464. [PMID: 36692093 PMCID: PMC10227722 DOI: 10.1080/10826084.2023.2167497] [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: 01/25/2023]
Abstract
Background: Mass media substance use prevention efforts target addiction perceptions in young people. This study examined youth and young adults' (YAs) perceived addictiveness across several substances and the associations between addiction perceptions and substance use. Methods: Data were collected in 2019 in an online cohort study of Vermonters aged 12-25. Latent class analyses grouped participants by perceived addictiveness of nicotine, caffeine, alcohol, marijuana, cigarettes, electronic vapor products (EVPs), and opioids. Bivariate multinomial logistic and modified Poisson regression estimated associations between sociodemographics, substance use correlates, and subsequent use across latent classes. Results: Four latent classes captured addiction perceptions: high perceived addictiveness of EVPs, cigarettes, marijuana, and alcohol (Class 1: n = 317; 31.3%), low perceived addictiveness of marijuana, alcohol, and caffeine (Class 2: n = 151; 14.3%), low perceived addictiveness of marijuana (Class 3: n = 581; 46.5%), and low perceived addictiveness of nicotine, cigarettes, and EVPs (Class 4: n = 83; 7.9%). For each year increase in age, there was a 36% increased likelihood of being in Class 2 (vs. Class 1) and a 148% increased likelihood of belonging to Class 3 (vs. Class 1). Low perceived addictiveness classes were associated with ever and past 30-day marijuana and alcohol use and predicted past 30-day alcohol use at three-month follow-up. Membership in Classes 2 and 3 also predicted past 30-day marijuana use at Wave 3. Discussion: The strong association between age and latent classes defined by low perceived addictiveness suggests age group differences in addiction perceptions. Findings suggest that YAs may benefit from prevention messaging on addictiveness.
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Affiliation(s)
- Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Keith B Burt
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Harry L Chen
- Department of Family Medicine, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
- Rutgers Center for Tobacco Studies; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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Cooper M, Day HR, Ren C, Oniyide O, Corey CG, Ambrose BK, Michael Cummings K, Sargent J, Niaura R, Pierce JP, Kaufman A, Choi K, Goniewicz ML, Stanton CA, Villanti A, Kasza K, Bansal-Travers M, Silveira ML, Kimmel HL, Hull LC, Koblitz A, Poonai K, Paredes A, Taylor K, Borek N, Hyland AJ. Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018). Addict Behav 2022; 134:107396. [PMID: 35749867 PMCID: PMC9726988 DOI: 10.1016/j.addbeh.2022.107396] [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: 12/15/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults. METHODS Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4. RESULTS Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation. CONCLUSIONS Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.
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Affiliation(s)
- Maria Cooper
- US Food and Drug Administration, Center for Tobacco Products, United States.
| | - Hannah R Day
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Chunfeng Ren
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Olusola Oniyide
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Catherine G Corey
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Bridget K Ambrose
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - K Michael Cummings
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, United States
| | - James Sargent
- Dartmouth Medical School, Data Sciences Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, United States
| | - Ray Niaura
- New York University, College of Global Public Health, United States
| | - John P Pierce
- University of California, San Diego, Herbert Wertheim School of Public Health, United States
| | - Annette Kaufman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, United States
| | | | | | | | - Karin Kasza
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Marushka L Silveira
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States; Kelly Government Solutions, United States
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Lynn C Hull
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Amber Koblitz
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Karl Poonai
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Antonio Paredes
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Kristie Taylor
- Westat, Behavioral Health and Health Policy, United States
| | - Nicolette Borek
- US Food and Drug Administration, Center for Tobacco Products, United States
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Lee DN, Liu J, Keller-Hamilton B, Patterson JG, Wedel AV, Vázquez-Otero C, Stevens EM. Associations between perceived source credibility, e-cigarettes, and e-cigarette ad perceptions. Prev Med Rep 2022; 28:101862. [PMID: 35733610 PMCID: PMC9207267 DOI: 10.1016/j.pmedr.2022.101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 10/28/2022] Open
Abstract
The use of e-cigarettes among U.S. adults remains high, and aggressive industry advertising is a contributor. Consumer opinions of the e-cigarette industry's credibility can influence e-cigarette product and ad perceptions. The purpose of this study was to examine the association of perceived source credibility of e-cigarette ads and consumer attitudes toward e-cigarette ads and product use. In October 2021, we conducted a survey using an online convenience sample (N = 497, Mage = 31.9). Participants viewed two randomly selected e-cigarette ads and were asked questions regarding source credibility, perceptions of the ads, and e-cigarette use. Linear mixed effects models with random intercepts were used to estimate associations between perceived source credibility with perceived ad relevance, effectiveness, liking, product use interest, and e-cigarette harms perceptions. We also tested whether associations between perceived source credibility and ad and e-cigarette perceptions were moderated by e-cigarette use. Models controlled for cigarette smoking status, age, sex, race, ethnicity, sexual orientation, and income. Perceived source credibility was positively associated with increased perceived ad relevance, effectiveness, liking, and product use interest (ps < 0.001). E-cigarette use moderated associations of perceived source credibility and perceived ad relevance, perceived ad effectiveness, and interest in using e-cigarettes, with associations being strongest among never users. Findings suggest that tobacco control messaging aiming to reduce the credibility of the e-cigarette industry might be most effective among adults who have never used e-cigarettes.
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Affiliation(s)
- Donghee N. Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Jessica Liu
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, 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, USA
| | - Joanne G. Patterson
- Division of Epidemiology, The Ohio State University College of Public Health, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Amelia V. Wedel
- Department of Clinical Psychology, Syracuse University, Syracuse, NY, USA
| | - Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
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11
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Caner A, Özcebe H. Water pipe smoking among public versus private university students in Ankara, Turkey: an online survey. BMC Public Health 2022; 22:1256. [PMID: 35752829 PMCID: PMC9233815 DOI: 10.1186/s12889-022-13616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Water pipe smoking has become a global public health problem as its popularity increased over time, especially among youth. The objective of our study was to estimate water pipe tobacco smoking prevalence and to assess socioeconomic factors associated with ever water pipe smoking by public and private university students in Ankara, Turkey. Methods This descriptive study was based on a survey conducted among public (n=2685) and private (n=2485) university students via an online questionnaire on demographics and water pipe consumption patterns. For every student in the sample, a socioeconomic status index was calculated using principal component analysis. Binary logistic regressions for the outcome variable of ever-using water pipe yielded estimates of adjusted odds ratios (aORs) for the associated factors such as the respondent’s age, gender, university type, and socioeconomic status. Results The prevalence of ever use of water pipe was 69.1% (95% CI: 67.2-70.9%) among private and 59.1% (95% CI: 57.2-60.9%) among public university students. A substantial share of ever users were current users (25.5% in private versus 21.6% in public, p=0.008). On average, private university students had higher socioeconomic status than public university students (for example, access to a car (51.7% versus 35.8%, p=0.008), financial support from family (71.5% versus 65.1%, p<0.001)), also demonstrated by a higher socioeconomic status index. Being a private university student (aOR 1.57, 95% CI: 1.38-1.79), older (aORs 1.50 to 2.39, p<0.001), male (aOR 2.36, 95% CI:2.06-2.70), as well as having greater financial resources, such as having access to a car (aOR 1.24, 95% CI:1.07-1.42), or having income support from family (aOR 1.32, 95% CI:1.13-1.54), were associated with ever-using water pipe. A higher SES index was significantly associated with higher odds of ever using water pipe among both private (aOR 1.13, 95% CI:1.06,1.20) and public university (aOR 1.12, 95% CI:1.06,1.19) students. Conclusions Water pipe smoking was common in both public and private universities; however, private university students had higher odds of ever using water pipe. There is an urgent need to implement evidence-based interventions, taking into account the socioeconomic status of young adults, to prevent them from water pipe smoking. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13616-9.
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Affiliation(s)
- Asena Caner
- Department of Economics, TOBB University of Economics and Technology, 06560, Ankara, Turkey.
| | - Hilal Özcebe
- Department of Public Health, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
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12
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Dadipoor S, Heyrani A, Mirzaei-Alavijeh M, Aghamolaei T, Ghaffari M, Ghanbarnejad A. Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation. Addict Sci Clin Pract 2022; 17:18. [PMID: 35287728 PMCID: PMC8919552 DOI: 10.1186/s13722-022-00287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran. Methods In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants’ characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations. Results The results showed no significant difference between women enrolled in control and intervention groups regarding participants’ characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively. Conclusions HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings. Trial registration: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129 Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00287-5.
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Affiliation(s)
- Sakineh Dadipoor
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amin Ghanbarnejad
- Department of Epidemiology And Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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13
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Stroud LR, Papandonatos GD, Sharma E, Jao NC, Goldman S, Vergara-Lopez C, Scott-Sheldon LA. Flavored waterpipe tobacco preferences, perceptions, and use in pregnant women: A latent factor mapping approach. Addict Behav 2022; 126:107194. [PMID: 34864479 PMCID: PMC8926392 DOI: 10.1016/j.addbeh.2021.107194] [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: 06/21/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
Waterpipe tobacco (WPT) use is increasingly common in young adults including pregnant and reproductive-age women. Sweet flavors contribute to the appeal of WPT and are a promising regulatory target. The present study utilized correspondence analysis of contingency tables, a latent factor mapping technique, to investigate preferences and perceptions of WPT flavors in a sample of racially/ethnically diverse, low-income pregnant women. One hundred pregnant women (mean age = 26 years, 65% racial/ethnic minorities) completed a detailed interview regarding their use, preferences, and perceptions of WPT flavors. Eighty-three percent of participants reported lifetime WPT use; 11% reported prenatal WPT use. Pregnant women reported greatest use of and stronger preferences for sweet (fruit, candy, alcohol) and menthol/mint flavors, and weaker preferences for tobacco flavored WPT. Latent factor mapping revealed clustering of preferred sweet (fruit, candy, alcohol) and menthol/mint flavors versus tobacco flavors, with pungent flavors (coffee, chocolate, spice) clustering between sweet and tobacco flavors. Preferences for sweet and menthol/mint flavors distinguished pregnant women who reported lifetime WPT versus no lifetime WPT use, and prenatal WPT use versus no prenatal WPT use. Harm perceptions did not vary by flavor. Regulations to restrict the availability of WPT flavors may reduce the appeal and use of WPT, especially among pregnant women.
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Affiliation(s)
- Laura R. Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
| | - George D. Papandonatos
- Department of Biostatistics, School of Public Health, Brown University, 121 South Main Street, Room 703, Providence, RI 02903, United States
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA.
| | - Nancy C. Jao
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
| | - Samantha Goldman
- Department of Psychology, Adelphi University, Hy Weinberg Center, Room 308, Garden City, NY 11530, USA.
| | - Chrystal Vergara-Lopez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Lori A.J. Scott-Sheldon
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
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14
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Gautam P, Sharma E, Ebrahimi Kalan M, Li W, Ward KD, Sutherland MT, Cano MA, Li T, Maziak W. Prevalence and predictors of waterpipe smoking initiation and progression among adolescents and young adults in waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Nicotine Tob Res 2022; 24:1281-1290. [PMID: 35196383 DOI: 10.1093/ntr/ntac051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/14/2022]
Abstract
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.
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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
| | - Mohammad Ebrahimi Kalan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Wei Li
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Tishreen Street, Sheehan, Aleppo, P.O.Box: 16542, Syria.,School of Public Health, University of Memphis, 3720 Alumni Ave, Memphis, TN 38152, USA
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11101 S.W. 13 ST., Miami, FL 33199, USA
| | - Miguel Angel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8thSt AHC5, 4thFloor, Miami, FL, 33199, 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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15
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Lipkus IM, Mays D, Sheeran P, Pan W, Cameron LD, De Brigard F. Effects of mental simulation of future waterpipe tobacco smoking on attitudes, perceived harms and intended use among young adults. J Behav Med 2022; 45:76-89. [PMID: 34406549 PMCID: PMC8821143 DOI: 10.1007/s10865-021-00245-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/09/2021] [Indexed: 02/03/2023]
Abstract
The desire to engage in waterpipe tobacco smoking (WTS) may occur when smokers and nonsmokers conjure positive mental simulations of WTS. However, effects of these simulations on desire to smoke waterpipe tobacco and potential mediators are unexplored. This research addressed these effects among young adult waterpipe tobacco smokers and nonsmokers. Two online studies were conducted with adults ages 18-30. In Study 1, 200 smokers, 190 susceptible nonsmokers, and 182 nonsusceptible nonsmokers were randomized to mentally simulate or not WTS in the future. In Study 2, 234 smokers and 241 susceptible nonsmokers were randomized to four arms: no simulation or simulations that varied valence of experience (positive, negative or no valence provided). Main outcomes were immediate desire to smoke waterpipe tobacco, cognitive and affective attitudes, and perceived harms. In Study 1, mental simulations increased the desire to smoke waterpipe tobacco among smokers. In Study 2, asking participants to simulate WTS positively or with no valence instruction increased desire to smoke relative to negative valence instruction or no simulation. Negative simulations reduced perceived probability of smoking within a month compared to positive simulations. Effects on desire to engage in WTS were mediated by cognitive and affective attitudes among susceptible nonsmokers and by cognitive attitudes among smokers. These findings suggest that exploring when and how often mental simulations about WTS are evoked and their potency for promoting prevention and cessation of WTS merit further attention.
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Affiliation(s)
| | - 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, USA
| | | | - Wei Pan
- Duke University School of Nursing
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16
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Leshner G, Phan L, Stevens EM, Johnson AC, Villanti AC, Kim N, Kim S, Ma H, Seo J, Sun F, Keller-Hamilton B, Wagener TL, Mays D. Psychophysiological responses to hookah tobacco public education messages among young adults. Health Psychol 2021; 40:569-577. [PMID: 34843319 DOI: 10.1037/hea0001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hookah tobacco use among young adults may be driven by misperceptions of health harms and addictiveness, appealing flavors, and social use. This study examined the effects of hookah prevention messages on participants' cognitive and emotional processing in a lab setting. METHOD One hundred twenty participants (61 susceptible never-users, 59 current users) were exposed to messages representing six categories: health risks only, health risks of social use, health risks of flavors, addiction risks only, addiction risks of social use, and addiction risks of flavors. Guided by the Limited Capacity Model of Motivated Mediated Message Processing, participants' psychophysiological responses (heart rate, skin conductance, facial action coding) were recorded while participants viewed the messages. Recognition memory and counterarguing were measured postexposure. RESULTS The combination of heart rate, skin conductance, both positive and negative facial action coding, and recognition memory indicated that social themed messages were more defensively processed than the other message types. Addiction-social messages, in particular, were least likely to be encoded. Further, defensive processing indicated by the psychophysiological and recognition data did not vary according to user status. Counterarguing was higher for users than for never-users across all message themes and risks. DISCUSSION Messages about health risks and addiction, whether or not they included information on flavors, evoked relatively similar responses. But social themed messages stand out as potentially problematic, especially addiction-social messages. Using psychophysiological and self-report measures extend opportunities to identify optimal hookah tobacco public education message features. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Glenn Leshner
- Gaylord College of Journalism and Mass Communication, Center for Applied Social Research, University of Oklahoma
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, Larner College of Medicine, University of Vermont
| | - Narae Kim
- Gaylord College of Journalism and Mass Communication, Center for Applied Social Research, University of Oklahoma
| | - Seunghyun Kim
- Department of Marketing and Advertising, University of Arkansas-Little Rock
| | - Haijing Ma
- Department of Communication, University of Oklahoma
| | - Jinhee Seo
- Gaylord College of Journalism and Mass Communication, Center for Applied Social Research, University of Oklahoma
| | - Fuwei Sun
- Department of Journalism, Fu Hsing Kang College, National Defense University
| | | | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center
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17
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Cohn AM, Blount BC, Hashibe M. Nonmedical Cannabis Use: Patterns and Correlates of Use, Exposure, and Harm, and Cancer Risk. J Natl Cancer Inst Monogr 2021; 2021:53-67. [PMID: 34850898 DOI: 10.1093/jncimonographs/lgab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Cannabis has certain health benefits, but some people may experience harms from use. Co-use of tobacco and cannabis is common. Smoke from cannabis contains many of the same carcinogens and toxicants as the smoke from tobacco, raising concerns that cannabis smoking may be a risk factor for cancer. With growing access to and acceptance of medical and nonmedical cannabis, there is an urgent need to understand the risks and benefits of the current modes of cannabis use and how cannabis may be associated with cancer risk. This monograph summarizes a session from a National Cancer Institute Symposium on nonmedical cannabis use and cancer risk. We had 3 objectives: describe the relation between nonmedical cannabis use and cancer risk, delineate patterns and correlates of cannabis co-use with tobacco, and document potentially harmful inhalational exposure resulting from smoked and vaped cannabis. Methodological limitations in the literature and future research recommendations are provided.
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Affiliation(s)
- Amy M Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Stephenson Center, Oklahoma City, OK, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT, USA
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18
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Stevens EM, Villanti AC, Leshner G, Wagener TL, Keller-Hamilton B, Mays D. Integrating Self-Report and Psychophysiological Measures in Waterpipe Tobacco Message Testing: A Novel Application of Multi-Attribute Decision Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11814. [PMID: 34831571 PMCID: PMC8617707 DOI: 10.3390/ijerph182211814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Waterpipe (i.e., hookah) tobacco smoking (WTS) is one of the most prevalent types of smoking among young people, yet there is little public education communicating the risks of WTS to the population. Using self-report and psychophysiological measures, this study proposes an innovative message testing and data integration approach to choose optimal content for health communication messaging focusing on WTS. METHODS In a two-part study, we tested 12 WTS risk messages. Using crowdsourcing, participants (N = 713) rated WTS messages based on self-reported receptivity, engagement, attitudes, and negative emotions. In an in-lab study, participants (N = 120) viewed the 12 WTS risk messages while being monitored for heart rate and eye-tracking, and then completed a recognition task. Using a multi-attribute decision-making (MADM) model, we integrated data from these two methods with scenarios assigning different weights to the self-report and laboratory data to identify optimal messages. RESULTS We identified different optimal messages when differently weighting the importance of specific attributes or data collection method (self-report, laboratory). Across all scenarios, five messages consistently ranked in the top half: four addressed harms content, both alone and with themes regarding social use and flavors and one addiction alone message. DISCUSSION Results showed that the self-report and psychophysiological data did not always have the same ranking and differed based on weighting of the two methods. These findings highlight the need to formatively test messages using multiple methods and use an integrated approach when selecting content.
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Affiliation(s)
- Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Andrea C. Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA;
| | - Glenn Leshner
- Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK 73019, USA;
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
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19
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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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20
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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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21
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Mays D, Johnson AC, Phan L, Sanders C, Shoben A, Tercyak KP, Wagener TL, Brinkman MC, Lipkus IM. Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial. Am J Public Health 2021; 111:1686-1695. [PMID: 34436927 PMCID: PMC8589064 DOI: 10.2105/ajph.2021.306389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.
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Affiliation(s)
- Darren Mays
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Johnson
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lilianna Phan
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Camilla Sanders
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Abigail Shoben
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kenneth P Tercyak
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Theodore L Wagener
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marielle C Brinkman
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Isaac M Lipkus
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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22
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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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23
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Leavens ELS, Carpenter MJ, Smith TT, Nollen NL. Exploratory evaluation of online brief education for JUUL pod-mod use and prevention. Addict Behav 2021; 119:106942. [PMID: 33866224 DOI: 10.1016/j.addbeh.2021.106942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Initiation of e-cigarette use by young adults is a significant public health issue within the debate on vaping. The current study is an exploratory evaluation of brief educational information among young adults and investigated outcomes as a function of JUUL use and smoking status. METHODS Participants (N = 947) were young adults (<30 years old) recruited from Amazon's Mechanical Turk based on smoking and JUUL use status. Participants completed baseline assessments, viewed a brief JUUL educational handout, and completed post-assessments. RESULTS There was a significant Time X Group interaction for JUUL-related knowledge (p < .001), with never JUUL/never smokers showing the greatest increase in knowledge. Brief education increased JUUL-related knowledge and risk perceptions and had a modest impact on commitment to quitting and readiness to quit JUUL (all p ≤ 0.001; ds = 0.06-0.74; time × group p > .05 for all contrasts except JUUL-related knowledge). Participants showed modest decreases in interest in future JUUL use, interest in purchasing, and interest in future regular use (all p ≤ 0.001; ds = 0.07-0.08; time × group p > .05 for all contrasts). In terms of smoking outcomes, participants reported reduced perceived harm to others (p < .001; d = 0.09) and decreased intentions to smoke regularly (p = .001; d = 0.07). CONCLUSIONS Brief education was effective in increasing knowledge and risk perceptions while showing a modest effect on intentions for future use. The information was most effective in increasing knowledge among non-users, suggesting that brief education may be useful for preventing initiation. Analysis of group differences suggest current JUUL use status is more important in informing JUUL-related attitudes than smoking status.
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Affiliation(s)
- Eleanor L S Leavens
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States; University of Kansas School of Medicine, Department of Population Health, United States.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Tracy T Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, United States
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24
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Stamates AL, Roberts R, Lau-Barraco C. Alcohol, cannabis, and tobacco polysubstance use: A latent profile analysis of age of onset. Subst Abus 2021; 43:531-538. [PMID: 34283703 PMCID: PMC9661874 DOI: 10.1080/08897077.2021.1949777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite understanding the long-term risks associated with early substance use, less is known about the specific patterns of the age of onset (AO) across multiple substances and whether these patterns of early exposure are linked to substance use later in young adulthood. Consequently, the present study sought to (1) identify distinct classes regarding AO for alcohol, cannabis, and tobacco and (2) compare these classes on patterns of individual and simultaneous alcohol, cannabis, and tobacco use, other substance use, and mental health symptoms. METHODS Participants were 510 emerging adults (Mage = 21.35; 88.6% men) who reported past-year use of alcohol, cannabis, and tobacco. RESULTS Latent profile analysis was used to identify classes based on three indicators: AO for alcohol, cannabis, and tobacco. Results revealed that four classes best fit the data: Earliest AO for Alcohol (19.8%); Latest AO for Substances (6.5%); Late AO for Substances (67.8%); Earliest AO for Cannabis and Tobacco (5.9%). Classes varied on current patterns of individual substance use, co-use of substances, other illicit drug use, and mental health symptomology. The Latest AO of Substances class reported the lowest alcohol use, cannabis use, other illicit drug use, and mental health symptomology than the other classes. The Earliest AO for Alcohol and the Late AO of Substances reported a lower frequency of tobacco compared to the other classes. The Late AO of Substance class reported the highest past-year frequency of simultaneous alcohol and cannabis use. CONCLUSIONS The current study contributed to the larger polysubstance literature by identifying profiles that may signify risky patterns of use. Findings may help guide prevention and intervention work with adolescents and young adults.
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Affiliation(s)
- Amy L. Stamates
- University of Rhode Island, 142 Flagg Road, Chafee Hall, Department of Psychology, Kingston, RI, 02881, USA
- Old Dominion University, 5115 Hampton Boulevard., Mills Godwin Building, Department of Psychology, Norfolk, VA, 23529, USA
| | - Rhiannon Roberts
- The George Washington University, 801 22 Street NW, Phillips Hall, Department of Sociology, Washington, DC, 20052, USA
| | - Cathy Lau-Barraco
- Old Dominion University, 5115 Hampton Boulevard., Mills Godwin Building, Department of Psychology, Norfolk, VA, 23529, USA
- Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA
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25
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Edwards KC, Kasza KA, Tang Z, Stanton CA, Sharma E, Halenar MJ, Taylor KA, Donaldson EA, Hull LC, Bansal-Travers M, Limpert J, Zandberg I, Gardner LD, Borek N, Kimmel HL, Compton WM, Hyland A. Correlates of tobacco product reuptake and relapse among youth and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016). Tob Control 2021; 29:s216-s226. [PMID: 32321855 DOI: 10.1136/tobaccocontrol-2020-055660] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examines sociodemographic and tobacco use correlates of reuptake and relapse to tobacco use across a variety of tobacco products (cigarettes, electronic nicotine delivery systems, cigars, hookah and smokeless tobacco) among the US population. 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 youth (ages 12-17) and adults (ages 18+). Reuptake (past 30-day use among previous tobacco users) and relapse (current use among former established users; adults only) were examined among previous users of at least one type of tobacco product at Wave 1 (W1) or Wave 2 (W2) (n=19 120 adults, n=3039 youth). Generalised estimating equations were used to evaluate the association between demographic and tobacco use characteristics at baseline, with reuptake/relapse at follow-up, over two 1-year periods (W1-W2 and W2-Wave 3). RESULTS Any tobacco product reuptake occurred in 7.8% of adult previous users and 30.3% of youth previous users. Correlates of any tobacco reuptake included being male, non-Hispanic black and bisexual in adults, but race and sexual orientation were not consistent findings in youth. Among recent former users, relapse rates were greater (32.9%). Shorter time since last use and greater levels of tobacco dependence showed the strongest association with any tobacco relapse. DISCUSSION Continued clinical and public health efforts to provide adults with tools to cope with tobacco dependence symptoms, especially within the first year or two after quitting, could help prevent relapse.
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Affiliation(s)
- Kathryn C Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Zhiqun Tang
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States.,Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Michael J Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Kristie A Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Lynn C Hull
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Izabella Zandberg
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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26
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Stroup AM, Branstetter SA. Comparing Immediate Physiological Responses and Future Intentions of Use between Combustible and Electronic Waterpipe Users. Addict Behav 2021; 115:106741. [PMID: 33387978 DOI: 10.1016/j.addbeh.2020.106741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/28/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
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27
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Makvandi Z, Mostafavi F, Bashirian S, Zamani-Alavijeh F, Kelishadi R. Sociocultural factors contributing to waterpipe tobacco smoking among adolescents and young adult women: a qualitative study in Iran. Int J Qual Stud Health Well-being 2021; 16:1857043. [PMID: 33435855 PMCID: PMC7808745 DOI: 10.1080/17482631.2020.1857043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods: This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13–30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants’ preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results: The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion: A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS.Abbreviation WTS: Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco
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Affiliation(s)
- Zeinab Makvandi
- Student Research Committee, School of Heath, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical sciences , Hamadan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
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Abstract
Background: Hookah is a device commonly employed for the use of tobacco, which is becoming popular in Western countries, especially among young people. In fact, its use has become a public health problem worldwide. Few Brazilian studies have researched its use, in this way, hookah culture has not been adequately examined in the country. Objective: This study aimed to investigate in depth the culture of hookah use in the city of São Paulo, Brazil. Methods: To do so, a cross-sectional, observational qualitative study was conducted. An intentional sample made by 29 subjects was selected through key informants and the snowball sampling technique. Participants were asked to engage in a semi-structured individual interview, which was recorded with the participant's prior consent. The interviews were analyzed according to Bardin's content analysis method. Results: Most of the participants were young, single men. The use of hookah is predominantly done in groups and during festive situations. Public places such as lounges, snack bars, and on the street were most often reported locations for hookah use. Interviewees have reported using hookah for long periods of time, for instance, from 1 to 10 hours continuously. Physical and psychological effects were reported, especially unpleasant ones. Engagement in polydrug use was reported for coping with the hookah effects. Participating in games was the main reason to use hookah. Conclusions: It is worrisome that a health risk behavior such as hookah use is conducted as an entertainment activity among young people, and thus it deserves a different approach and evaluation from the appropriate authorities.
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Affiliation(s)
- Thais Vidal Salles
- Department of Neuroscience, School of Medicine, Fundaçao do ABC, Santo Andre, Sao Paulo, Brazil
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29
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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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Dadipoor S, Mirzaei-Alavijeh M, Aghamolaei T, Heyrani A, Ghaffari M, Ghanbarnejad A. Predictors of hookah smoking frequency among women in the South of Iran: A cross-sectional study. J Ethn Subst Abuse 2020; 21:1-19. [PMID: 33135955 DOI: 10.1080/15332640.2020.1836703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prevalence of hookah smoking has grown over the past decades in Iran especially in the south of the country. This study aimed to determine the behavioral and socio-demographic predictors of the hookah smoking frequency among women in southern Iran. This research was conducted on 400 women hookah smokers selected through multi-stage sampling method. Data were collected from October 2018 to September 2019 using a questionnaire guided by literature. Ordinal logistic regression analysis was run to determine the influential behavioral and socio-demographic predictors involved in the frequency of hookah smoking. Variables with a P-value of less than 0.05 in the final fitting model were associated with the outcome variable (frequency of hookah smoking per day1 = once a day, 2 = twice a day, 3 = three times a day, 4 = more than three times a day). We found that the longer duration of hookah smoking, family usage of hookah smoking, beginning to smoke hookah with peers, absence of either parent in family (single-parent families and a lack of prior intention to cease smoking), ever-married women and low socio-economic status (SES) predicted the frequency of hookah smoking. To prevent the behavior and make effective interventions to reduce hookah smoking, policy-makers should stay focused on factors other than internal motivations. Focus on the companies surrounding women smokers, quitting the habit of hookah smoking and effective interventions to decrease one's intention to smoke hookah can help reduce such unhealthy behaviors.
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Affiliation(s)
- Sakineh Dadipoor
- Student Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Ghanbarnejad
- Tobacco and Health Research center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Hair E, Niaura RS, Rath JM. Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults. Prev Med 2020; 140:106285. [PMID: 33068605 PMCID: PMC7779116 DOI: 10.1016/j.ypmed.2020.106285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, United States of America
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences, Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, United States of America
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, United States of America
| | - Elizabeth Hair
- Schroeder Institute at Truth Initiative, United States of America
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, United States of America
| | - Jessica M Rath
- Schroeder Institute at Truth Initiative, United States of America
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Higgins ST. Behavior change, health, and health disparities 2020: Some current challenges in tobacco control and regulatory science. Prev Med 2020; 140:106287. [PMID: 33068603 PMCID: PMC8364292 DOI: 10.1016/j.ypmed.2020.106287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 7th in a series on behavior change, health, and health disparities. This series focuses on personal behavior patterns, including substance use disorders, physical inactivity/obesity, and non-adherence with medical regimens, which are among the most important modifiable causes of chronic disease and premature death. This 7th issue includes 17 commentaries, reviews, and original empirical studies, 16 of which are devoted to current tobacco control and regulatory science research and policy, topics critically important to protecting the public health from the longstanding and devastating harms of tobacco use. The challenge of balancing efforts to protect youth from e-cigarettes while allowing for evidence-based evaluation of their potential to reduce the harms of cigarette smoking among adults features prominently in many of these contributions, complemented by original studies on rural-urban disparities, tobacco harm perceptions, use patterns and toxin exposure, modeling of tobacco-related mortality, novel tobacco research methods, and reducing cigarette smoking through regulatory policies, including nicotine reduction in cigarettes, and novel clinical interventions. Continuing to give space in this series to the U.S. opioid epidemic, we also include an original empirical report on longitudinal trends of non-medical use of opioids from 2008 to 2020 in rural Appalachia, an epicenter in this epidemic. Across each of these topics we have recruited contributions from well-regarded investigators, clinicians, and policymakers to acquaint readers with recent advances and accomplishments while also noting knowledge gaps and unresolved challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, 1 S. Prospect St., UHC, MS482, Burlington, VT 05401, USA.
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El Shahawy O, Park SH, Rogers ES, Shearston JA, Thompson AB, Cooper SC, Freudenberg N, Ball SA, Abrams D, Shelley D, Sherman SE. Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:65. [PMID: 32859230 PMCID: PMC7453717 DOI: 10.1186/s13011-020-00283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Omar El Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY, USA. .,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates. .,School of Global Public Health, New York University, New York, USA.
| | - Su Hyun Park
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Erin S Rogers
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,VA New York Harbor Healthcare System, New York, USA
| | - Jenni A Shearston
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.,School of Global Public Health, New York University, New York, USA.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Azure B Thompson
- Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Spring C Cooper
- City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Nicholas Freudenberg
- City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Samuel A Ball
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - David Abrams
- School of Global Public Health, New York University, New York, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,School of Global Public Health, New York University, New York, USA
| | - Scott E Sherman
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.,School of Global Public Health, New York University, New York, USA.,VA New York Harbor Healthcare System, New York, USA
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Stevens EM, Hébert ET, Tackett AP, Leavens ELS, Wagener TL. Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4755. [PMID: 32630647 PMCID: PMC7369803 DOI: 10.3390/ijerph17134755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products. METHODS Participants (N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon's Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions. RESULTS Overall, participants rated JUUL as significantly less harmful than all other tobacco products (p < 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers (p < 0.05). JUUL was rated as more harmful by women compared to men (p < 0.05). CONCLUSIONS Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs.
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Affiliation(s)
- Elise M. Stevens
- Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard University, Boston, MA 02115, USA
| | - Emily T. Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.H.); (A.P.T.)
| | - Alayna P. Tackett
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.H.); (A.P.T.)
| | - Eleanor L. S. Leavens
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA;
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
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Elton-Marshall T, Driezen P, Fong GT, Cummings KM, Persoskie A, Wackowski O, Choi K, Kaufman A, Strong D, Gravely S, Taylor K, Kwan J, Bansal-Travers M, Travers M, Hyland A. Adult perceptions of the relative harm of tobacco products and subsequent tobacco product use: Longitudinal findings from waves 1 and 2 of the population assessment of tobacco and health (PATH) study. Addict Behav 2020; 106:106337. [PMID: 32145496 PMCID: PMC7441471 DOI: 10.1016/j.addbeh.2020.106337] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/07/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine: (1) How perceptions of harm for seven non-cigarette tobacco products predict subsequent use; (2) How change in use is associated with changes in perceptions of product harm; (3) Whether sociodemographic variables moderate the association between perceptions and use. METHODS Data are from the adult sample (18+) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal cohort survey conducted September 2013-December 2014 (Wave 1 (W1) n = 32,320) and October 2014-October 2015 (Wave 2 (W2) n = 28,362). RESULTS Wave 1 users and non-users of e-cigarettes, filtered cigars, cigarillos, and pipes, who perceived these products as less harmful had greater odds of using the product at W2. For the other products, there was an interaction between W1 perceived harm and W1 use status in predicting W2 product use. At W2, a smaller percentage of U.S. adults rated e-cigarettes as less harmful than cigarettes compared to W1 (41.2% W1, 29.0% W2). Believing non-cigarette products to be less harmful than cigarettes was more strongly associated with subsequent product use in the oldest age group (55+ years) while weaker effects were observed in the youngest age group (18-24 years). This moderating effect of age was significant for e-cigarettes, hookah, traditional cigars, and cigarillos. CONCLUSIONS Strategies to prevent initiation and promote cessation of these products may benefit from understanding and addressing perceptions of these products.
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Affiliation(s)
- Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Ontario Tobacco Research Unit, Toronto, Ontario, Canada.
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander Persoskie
- United States Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD, USA
| | - Olivia Wackowski
- Rutgers School of Public Health, Center for Tobacco Studies, Piscataway, NJ, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - David Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, San Diego, CA, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jonathan Kwan
- United States Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mark Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
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Abstract
Objectives Health warning messages could be an effective means of communicating the health risks associated with waterpipe (WP) smoking. The objective of this study was to select a message that conveyed the risks associated with WP smoking. Methods A mixed-methods approach was used to explore the effectiveness of the Food and Drug Administration's (FDA's) mandated message, and others, among young adults using focus groups and surveys. Two focus group studies and one convenience survey were conducted to examine the FDA's mandated message and 11 other WP warning messages. The final study, conducted with a random sample of first-year university students, examined the effectiveness and reactance of the chosen message using previously validated items (scored on a 1-5 scale). Results The FDA's mandated message did not resonate well with focus group participants. In the random sample of students, the top message (WARNING: Hookah smoke contains poisons that cause lung and oral cancers) had high effectiveness (M = 4.49) and a low reactance (M = 2.12). Conclusions Our studies suggest that other messages are more effective for communicating the risks associated with WP smoking than the FDA's message for WP tobacco.
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Kasza KA, Edwards KC, Tang Z, Stanton CA, Sharma E, Halenar MJ, Taylor KA, Donaldson E, Hull LC, Day H, Bansal-Travers M, Limpert J, Zandberg I, Gardner LD, Hammad HT, Borek N, Kimmel HL, Compton WM, Hyland A. Correlates of tobacco product initiation among youth and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016). Tob Control 2020; 29:s191-s202. [PMID: 32321853 PMCID: PMC7517709 DOI: 10.1136/tobaccocontrol-2020-055671] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To report on demographic and tobacco product use correlates of tobacco product initiation (cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah and smokeless tobacco) among the US population. DESIGN Data were from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth (aged 12-17 years) and adults (aged 18+ years). Never users of at least one type of tobacco product at Wave 1 (W1, 2013/14) or Wave 2 (W2, 2014/15) were included (n=12 987 youth; n=25 116 adults). Generalised estimating equations were used to evaluate the association between demographic and tobacco product use characteristics at baseline, and tobacco product initiation at follow-up (ever, past 30 day (P30D), frequent (use on 20 or more of thepast 30 days)) over two 1-year periods (W1-W2 and W2-Wave 3). RESULTS Youth aged 15-17 years were more likely than youth aged 12-14 years and adults aged 18-24 years were more likely than older adults to initiate P30D tobacco use across products; non-heterosexuals were more likely than heterosexuals to initiate P30D cigarette and ENDS use. Older adults were more likely than young adults, and males were more likely than females, to be frequent users of ENDS on initiation. Ever use of another tobacco product predicted P30D initiation of each tobacco product. DISCUSSION Other tobacco product use and age predict P30D tobacco initiation across products whereas associations with other demographic characteristics vary by product. Continued contemporary evaluation of initiation rates within the changing tobacco product marketplace is important.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kathryn C Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Zhiqun Tang
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Michael J Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Kristie A Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Elisabeth Donaldson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Lynn C Hull
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Hannah Day
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Izabella Zandberg
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Hoda T Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Darawad MW, Rezk-Hanna M, Alhussami M, Lee J, Mostafa A, Abu-Rmeileh N, Kheirallah K, Salama M, Nakkash R, Saleh Z, Salloum R. Poly-Tobacco Use among Young Adult Waterpipe Smokers: Insights from University Students in Three Eastern Mediterranean Countries. Subst Use Misuse 2020; 55:2099-2108. [PMID: 32666880 DOI: 10.1080/10826084.2020.1790010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is a tendency of waterpipe smokers to advance their practice toward concurrent use (poly-tobacco use) of other tobacco products and nicotine delivery systems. This study investigated poly-tobacco use among waterpipe smokers, and its effect on their quit intention. METHODS Descriptive cross-sectional design was utilized to recruit a convenience sample of university students who used waterpipe in three East Mediterranean countries. Using an internet-based survey, data were collected regarding participants' demographics, use of alternative tobacco products and nicotine delivery systems, and waterpipe quitting profile. Results: A total of 2290 students agreed to participate, among which 1116 (45.3%) reported using at least one tobacco product beside waterpipe. Poly-tobacco use was highest (61.1%) in Egypt, followed by Jordan (45.1%) and Palestine (33.1%). Across countries, cigarettes were the most common product (45.2%, n = 924) followed by cigar (18.6%, n = 374) and e-shisha (17.5%, n = 353). Conversely, the least reported product was smokeless tobacco (7.5%, n = 151) preceded by regular pipe (9.5%, n = 193). Participants who were males (OR = 2.83, 95% CI: 2.18-3.65), older (22-29 years) (OR = 1.15, 95% CI: 1.09-1.22), unemployed (OR = 1.58, 95% CI: 1.22-2.04), and those who initiated waterpipe at a younger age (OR = 0.87, 95% CI: 0.87-0.91) had higher odds of being poly-smokers. Poly-tobacco users were significantly more resistant to quit waterpipe. Conclusion: This study demonstrates poly-tobacco use as a rising phenomenon among waterpipe smokers and highlights the necessity for initiating advanced interventions to help waterpipe poly-tobacco users quit this dangerous type of addiction. Various country-specific programs are needed considering the various products used by the users.
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Affiliation(s)
| | - Mary Rezk-Hanna
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | | | - Juhan Lee
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aya Mostafa
- Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Khalid Kheirallah
- Department of Public Health-Medical School, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammed Salama
- Clinical Nursing Department, Mansoura University, Mansoura, Egypt
| | - Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeyad Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Ramzi Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
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Brinkman MC, Kim H, Buehler SS, Adetona AM, Gordon SM, Clark PI. Evidence of compensation among waterpipe smokers using harm reduction components. Tob Control 2020; 29:15-23. [PMID: 30377243 PMCID: PMC7350613 DOI: 10.1136/tobaccocontrol-2018-054502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined two waterpipe tobacco smoking components advertised to reduce harm to determine if they result in lower levels of biomarkers of acute exposure. METHODS We conducted a crossover study of 34 experienced waterpipe smokers smoking a research-grade waterpipe in three configurations ad libitum in a controlled chamber: control (quick-light charcoal), electric (electric heating) and bubble diffuser (quick-light charcoal and bubble diffuser). We collected data on smoking topography, environmental carbon monoxide (CO), subjective effects, heart rate, plasma nicotine and exhaled CO and benzene. RESULTS Smokers' mean plasma nicotine, heart rate, and exhaled benzene and CO boost were all significantly lower for electric compared with control. However, smokers puffed more intensely and took significantly more and larger volume puffs for a larger total puffing volume (2.0 times larger, p<0.0001) when smoking electric; machine yields indicate this was likely due to lower mainstream nicotine. Smokers rated electric smoking experience less satisfying and less pleasant. For charcoal heating, the mean mass of CO emitted into the chamber was ~1 g when participants smoked for a mean of 32 minutes at a typical residential ventilation rate (2.3 hr-1). CONCLUSION Waterpipe smokers engaged in compensation (i.e., increased and more intense puffing) to make up for decreased mainstream nicotine delivery from the same tobacco heated two ways. Waterpipe components can affect human puffing behaviours, exposures and subjective effects. Evidence reported here supports regulation of waterpipe components, smoking bans in multifamily housing and the use of human studies to evaluate modified or reduced risk claims.
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Affiliation(s)
- Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| | - Hyoshin Kim
- Battelle Public Health Center for Tobacco Research, Battelle, Seattle, Washington, USA
| | - Stephanie S Buehler
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Anna M Adetona
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Sydney M Gordon
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Pamela I Clark
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
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Villanti AC, Byron MJ, Mercincavage M, Pacek LR. Misperceptions of Nicotine and Nicotine Reduction: The Importance of Public Education to Maximize the Benefits of a Nicotine Reduction Standard. Nicotine Tob Res 2019; 21:S88-S90. [PMID: 31867645 PMCID: PMC6939783 DOI: 10.1093/ntr/ntz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
| | - M Justin Byron
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lauren R Pacek
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Niaura RS, Hair E, Rath JM. Prevalence and correlates of nicotine and nicotine product perceptions in U.S. young adults, 2016. Addict Behav 2019; 98:106020. [PMID: 31238235 PMCID: PMC6947657 DOI: 10.1016/j.addbeh.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Nicotine is not a human carcinogen and combustion compounds in tobacco smoke, rather than nicotine, cause tobacco-related cardiovascular disease. Few recent studies examine the public's beliefs about nicotine in relation to smoking. METHODS Participants aged 18-40 (n = 4,091) in Wave 10 (Fall 2016) of the Truth Initiative Young Adult Cohort Study responded to nineteen items on nicotine and nicotine product perceptions, including addictiveness and health harms of nicotine patch/gum and e-cigarettes compared to cigarettes. Analyses conducted in 2018 examined prevalence of perceptions and sociodemographic and tobacco use correlates of selected perceptions. RESULTS The majority of young adults reported that nicotine was responsible for a "relatively" or "very large" part of the health risks (66%) and cancer (60%) caused by smoking. More than half of young adults (55%) believed that nicotine is a cause of cancer. Between 23% and 43% of young adults responded "don't know" to items on nicotine. Females, blacks, Hispanics, and those with less than some college education were more likely to report true or "don't know" vs. false to "nicotine is a cause of cancer" and had higher odds of believing that nicotine was responsible for a "relatively" or "very large" part of the health risks of smoking and cancer caused by smoking. Past 30-day tobacco users had lower odds of reporting these beliefs. CONCLUSIONS Misperceptions of nicotine are widespread in young adults. Public education is needed to maximize the public health impact of FDA's required nicotine warning label and proposed nicotine reduction policies.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jennifer L Pearson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Social and Behavioral Sciences/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, Piscataway, NJ, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth Hair
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Jessica M Rath
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
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Sakuma KLK, Dolcini MM, Seifert J, Bean MM, Fagan P, Wilson M, Felicitas-Perkins JQ, Blanco L, Trinidad DR. Hookah and Electronic Inhalant Device Use and Perceptions Among African American Youth and Young Adults: Are We Asking the Right Questions? HEALTH EDUCATION & BEHAVIOR 2019; 47:391-401. [PMID: 31595788 PMCID: PMC10406164 DOI: 10.1177/1090198119876977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. Survey items used in surveillance systems to assess the use of emerging products like hookah and electronic inhalant devices (EIDs) may not match definitions used by high-risk populations. This qualitative study explored how African American youth and young adults (YYAs) (1) use hookah and EIDs and (2) identify patterns in the ways they describe and organize these products. Design. Individual in-person interviews were conducted among a sample of continuation high school and vocational school students in southern California. Participation was limited to those who had ever tried at least one tobacco product, self-identified as African American, and were between the ages of 14 and 26 years (n = 28). We conducted a content analysis to identify patterns in perceptions and use of these products. Results. African American YYAs recognized and described traditional hookah based on physical attributes, but for EIDs, including e-cigarettes, e-hookah, and vape pens, YYAs focused on reasons for using the product. Three primary categories emerged for reasons YYA used specific products: nicotine content and quitting, social facilitation, and use with marijuana. E-cigarettes were identified as quitting aids and as having nicotine but were not considered addictive. The term hookah recalled both the traditional and electronic pen-type products for YYAs. The terms vapes, hookah, wax pens, and others are used in the context of describing product use with marijuana. Conclusions. A better understanding of why African American YYAs use these products is needed to develop better measures for accurate rates of use, uncover differences in use between product types, and to develop effective prevention messaging.
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Affiliation(s)
| | | | | | | | - Pebbles Fagan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Bashirian S, Barati M, Sharma M, Abasi H, Karami M. Predicting to reduce water pipe smoking in male adolescents: using multi theory model (MTM). JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Manoj Sharma
- Behavioral & Environmental Health School of Public Health, Jackson State University (Challenging Minds, Changing Lives), Jackson, MS, USA
| | - Hamid Abasi
- Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Manoochehr Karami
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Dadipoor S, Kok G, Aghamolaei T, Heyrani A, Ghaffari M, Ghanbarnezhad A. Factors associated with hookah smoking among women: A systematic review. Tob Prev Cessat 2019; 5:26. [PMID: 32411889 PMCID: PMC7205165 DOI: 10.18332/tpc/110586] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The present study aimed to determine factors associated with hookah smoking among women on a global scale based on a systematic review of related literature. Intervention Mapping was the guiding framework for this review. METHODS Searches were performed in Web of Science, PubMed, Iranian databases, Elsevier, Embase, Scopus, Medline, Google Scholar, and the World Health Organization (WHO) website, using keywords related to hookah and associated terms. Studies in English or Persian, published between 1990 and 2018, were included in this review if they were available in full text and had a target population of women. Determinants of hookah smoking at the intrapersonal, interpersonal, institutional/organizational, community, and political levels, were extracted. RESULTS Positive attitude, social-psychological needs, low perceived risk, social-cultural acceptance of hookah, easy access and lack of laws were among the reasons given for consuming hookah. Because hookah smoking is a multifactorial issue, the qualitative method alone was not sufficient to identify the determinants of hookah smoking among women. The opinions of experts in the field of smoking control had been largely neglected in the obtained studies, and most quantitative studies lacked a theoretical framework. CONCLUSIONS To reduce the rate of hookah consumption, actions to be taken include changing women’s positive attitude toward hookah, learning to resist friends’ pressure to smoke, highlighting the unpleasantness of hookah smoking by segregating places with transparent walls within public places, showing in the virtual world that hookah smoking is socially unacceptable, limiting access to hookah tobacco products, and effectively implementing rules that restrict hookah smoking in public places.
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Affiliation(s)
- Sakineh Dadipoor
- Health Education and Health Promotion, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Gerjo Kok
- Department of Work and Social Psychology, School of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Heyrani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Centre, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Ghanbarnezhad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Stroud L, Werner E, Matteson K, Carey M, Helen GS, Eissenberg T, Scott-Sheldon LAJ. Waterpipe (hookah) tobacco use in pregnancy: use, preferences and perceptions of flavours. Tob Control 2019; 29:s62-s71. [PMID: 31320397 DOI: 10.1136/tobaccocontrol-2019-054984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Waterpipe tobacco (WPT; hookah) use is common in pregnant and reproductive-age women. Sweet flavours contribute to the appeal of WPT and are a potential regulatory target. This study investigated use, preferences and perceptions of WPT flavours in pregnant WPT users, and the impact of flavour preferences on preconception/prenatal WPT use and exposure biomarkers. METHODS 58 pregnant WPT users (mean age=27 years) completed a detailed interview regarding their WPT flavours use, preferences and perceptions. Biomarkers of nicotine and carcinogen exposure (eg, cotinine, benzene, butadiene) were also collected. RESULTS 55% of participants were dual/poly WPT users (ie, reported use of one or more other tobacco products in addition to WPT). Pregnant WPT users reported nearly exclusive use of flavoured WPT, with greater use of menthol/mint (68%) followed by fruit flavours (48%) (p<0.001), and greater preferences for fruit followed by menthol/mint flavours (ps<0.05). Harm perceptions did not differ among flavours. Compared with dual/poly WPT users, WPT-only users reported more total WPT use events, greater use of and preference for menthol/mint flavoured WPT (ps<0.001), and decreased exposure biomarkers (ps≤0.040). Preference for menthol/mint and fruit flavours predicted more flavoured WPT use events during preconception and pregnancy; preference for menthol/mint predicted detectable cotinine and benzene levels but not butadiene. CONCLUSIONS This is the first study of WPT flavour use, preferences and perceptions in pregnant women. Use of and preference for menthol/mint and fruit WPT flavours in this vulnerable population could be considered in regulating WPT flavours to protect the health of women and children.
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Affiliation(s)
- Laura Stroud
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA .,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Erika Werner
- Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Kristen Matteson
- Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Michael Carey
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Gideon St Helen
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lori A J Scott-Sheldon
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA .,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Bashirian S, Mahmoodi H, Barati M, Mohammadi Y. Effectiveness of Educational Program Based on Planned Behavior Theory on Decreasing Intention of Hookah and Tobacco Supply among the Handlers of Public Places and Food Centers in Arak City. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2019. [DOI: 10.29252/jech.6.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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47
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Cohn AM, Johnson AL, Rose SW, Pearson JL, Villanti AC, Stanton C. Population-level patterns and mental health and substance use correlates of alcohol, marijuana, and tobacco use and co-use in US young adults and adults: Results from the population assessment for tobacco and health. Am J Addict 2019; 27:491-500. [PMID: 30152111 DOI: 10.1111/ajad.12766] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/06/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study identified the most common patterns of current alcohol and marijuana use with the spectrum of tobacco products (cigarettes, hookah, e-cigarettes, cigars/little cigars, and other products), among US young adults and older adults and examined associations of mental health and substance use problems with each pattern. METHODS Wave 1 adult dataset (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses estimated the prevalence of the top 10 patterns of current alcohol, marijuana, and tobacco use and co-use separately by young adults aged 18-24 (n = 9,112) and adults 25+ years (n = 23,208). Multivariable models examined associations of substance use and mental health problems to patterns of use, adjusting for demographics. RESULTS Across both age groups, alcohol-only use was the most popular use pattern (20.7% for young adults and 32.2% older adults) however poly-substance use patterns were more frequent than single use patterns. Cigarettes were the only tobacco product used exclusively; all other tobacco products were used with together, or with alcohol or marijuana. Only one young adult pattern emerged containing e-cigarettes, and this pattern included co-use with alcohol and cigarettes (1.3%). Mental health and substance use problems were most strongly correlated with dual and poly-substance use patterns, regardless of age. SCIENTIFIC SIGNIFICANCE Prevention and intervention campaigns should focus on multiple product use, as single substance use is uncommon. Alcohol is common in all patterns, suggesting it should also gain more focus in marijuana and tobacco prevention and intervention programs. (Am J Addict 2018;27:491-500).
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Affiliation(s)
- Amy M Cohn
- Battelle, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, DC, District of Columbia
| | - Amanda L Johnson
- Truth Initiative Schroeder Institute, Washington, DC, District of Columbia
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, DC, District of Columbia
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea C Villanti
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Psychiatry, University of Vermont, Vermont Center on Behavior and Health, Burlington, Vermont
| | - Cassandra Stanton
- Department of Oncology, Georgetown University Medical Center, Washington, DC, District of Columbia.,Westat, Rockville, Maryland
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Patterns and correlates of the co-use of marijuana with any tobacco and individual tobacco products in young adults from Wave 2 of the PATH Study. Addict Behav 2019; 92:122-127. [PMID: 30623805 DOI: 10.1016/j.addbeh.2018.12.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/22/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Past-month marijuana use has increased significantly among US young adults (aged 18-24) and marijuana use often overlaps with tobacco use. This study investigated the relative prevalence and correlates of individual tobacco product use among young adult marijuana and tobacco users to determine if unique typologies could be identified. METHOD Data were from young adults (18-24) in Wave 2 of the Population Assessment of Tobacco and Health (PATH) Study. Analyses examined the prevalence of different patterns of past 30-day marijuana and tobacco use and co-use. Weighted adjusted models were used to examine correlates of different marijuana and individual tobacco co-use profiles (compared to no-use of either product). RESULTS Prevalence estimates showed that 30.9% of young adults report past month tobacco-only use, 21.3% report past-month co-use of marijuana and at least one tobacco product, and 4.5% report past 30-day marijuana-only use. Correlates of co-use differed by tobacco product. Using 3+ tobacco products and frequency of past 30-day alcohol use were robustly and consistently associated with each marijuana and individual tobacco co-use profile and any co-use of marijuana with tobacco. CONCLUSIONS Among US young adults between 2014 and 2015, co-use of marijuana and tobacco was common, and there was heterogeneity in correlates associated with use of different tobacco products among those who used marijuana. Different correlates suggest different targets for marijuana and tobacco prevention and intervention in this age group.
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Stevens EM, Kim S, Leshner G, Leavens ELS, Vidrine JI, Frank-Pearce SG, Hale JJ, Wagener TL. The Attitudinal and Motivational Effects of Anti-waterpipe Messages. Am J Health Behav 2019; 43:478-489. [PMID: 31046879 PMCID: PMC6692900 DOI: 10.5993/ajhb.43.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: Waterpipe smoking can lead to negative health outcomes. In this study, we examined responses to anti-waterpipe smoking public service announcements (PSAs). Methods: In a pilot study, current waterpipe smokers (N = 20) and susceptible waterpipe never smokers (N = 25) were randomized to view either 3 anti-waterpipe PSAs, created by the Truth campaign, or 3 control videos. Participants answered questions pertaining to message acceptance at 3 time-points and perceived risk and motivation to quit or avoid waterpipe at 4 time-points. Results: Participants were recruited from the community (N = 45; Mage = 22.4 years). Whereas waterpipe smokers and never smokers who viewed the PSAs significantly increased in acceptance of (p < .05) and positive attitudes towards (p < .05) the messages with increased viewing of the mes- sages, waterpipe never smokers did so at a significantly higher rate (p < .05). Waterpipe never smokers who viewed the PSAs had increased perceived severity and susceptibility of health harms of waterpipe compared to the control (ps < .05). We also found gender differences. Conclusions: The 3 tested PSAs from the Truth campaign show evidence of effectiveness against waterpipe use.
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Owens VL, Ha T, Soulakova JN. Widespread use of flavored e-cigarettes and hookah tobacco in the United States. Prev Med Rep 2019; 14:100854. [PMID: 30976489 PMCID: PMC6441788 DOI: 10.1016/j.pmedr.2019.100854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022] Open
Abstract
In 2009, the U.S. Food and Drug Administration banned the sale of flavored cigarettes (excluding menthol) in the U.S. However, the sale of flavored e-cigarettes (FE) and flavored hookah tobacco (FHT) is still legal. In this study (conducted in the US in the period from October 2018 to February 2019), we estimated the prevalence of use of FE and FHT across users' sociodemographic characteristics (e.g., age, sex, race/ethnicity) and identified the key characteristics of tobacco users associated with use of FE and FHT. We analyzed the 2014–2015 Tobacco Use Supplement to the Current Population Survey data for current e-cigarette (n = 3691) and hookah tobacco (n = 658) users. Among e-cigarette users, 65.5% used FE; and among hookah tobacco users, 87.3% used FHT. Among e-cigarette users, the prevalence of use of FE was significantly higher for 18–24 year-old than 45+ year-old adults; women than men; Southern than Northeastern residents; and never smokers of regular cigarettes than current smokers of regular cigarettes (all adjusted p's < 0.05). Among hookah tobacco users, the rates of FHT use were significantly higher for women than men, and never smokers of regular cigarettes than current smokers (all adjusted p's < 0.05). Because availability and accessibility of flavored tobacco products may promote tobacco use, revising regulatory guidelines concerning manufacturing and distribution of FE and FHT may help reduce the popularity of emerging tobacco products. Implications Among users of emerging tobacco products such as e-cigarettes and hookah tobacco, use of flavored products is very common. Among e-cigarette users, 66% consumed flavored e-cigarettes; and among users of hookah tobacco, 87% consumed flavored hookah tobacco. Use of flavored products was especially common among users who were young adults, women, or never and former smokers of regular cigarettes. Availability of emerging tobacco products in many different flavors could be a reason for tobacco use initiation and continued use of tobacco after cessation of regular-cigarette smoking.
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Affiliation(s)
- Victoria L Owens
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Trung Ha
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
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