University students' perceived risk of and intention to use waterpipe tobacco

'It's like if a vape pen and a cigarette had a baby': a mixed methods study of perceptions and use of IQOS among US young adults

Young adults' perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions.

Does waterpipe smoking increase the risk of Helicobacter pylori infection?

Background:

In this study, we aimed to evaluate whether waterpipe smoking can be associated with the transmission of Helicobacter pylori infection or not.

Materials and Methods:

Between March 2018 and April 2019, 445 patients aged over 18 years old who were admitted to outpatient clinics with dyspeptic complaints were recruited for the study. Patients are divided into two groups – Group 1 is H. pylori-positive patients and Group 2 is negative. Waterpipe smoking, smoking, age, gender, and educational status were compared among groups.

Results:

Two hundred and sixty-one women (58%) and 184 men (42%), totally 445 patients, tested for H. pylori infection. Seventy-nine of 261 (30%) women and 60 of 184 (32%) men had H. pylori positive. One hundred and sixty-two of 445 (36%) patients were smoking cigarette and 66 of 445 (14%) patients were using waterpipe tobacco. Waterpipe smoking individuals were found to be associated with the H. pylori positivity (P < 0.001); whereas, age, gender, educational level, and smoking were not found to be statistically significant (all P > 0.05). In binary logistic regression analysis, waterpipe tobacco smoking was found to be the only independent predictor of H. pylori infection (P < 0.001, odds ratio = 5.51, confidence interval: 3.158–9.617).

Conclusion:

Waterpipe smoking seems to be an important risk factor for H. pylori infection and may be one of the reasons of high prevalence of H. pylori infection.

Health Information on Waterpipe Lounge Menus to Educate Young Adults: Pilot Study Findings

BACKGROUND

For years, tobacco risk communication has largely focused on cigarette smoking. New strategies must be developed to adapt to emerging tobacco products, such as waterpipe tobacco smoking (WTS).

AIMS

The purpose of this pilot study was to determine the preliminary effects of health information on waterpipe lounge menus on the perceptions of harm and risk from WTS and inform future efficacy interventions for health communication (i.e., educating populations on the risks, harms, and health consequences of WTS).

METHOD

Participants aged 18 to 24 years (n = 213) who smoked waterpipe at least monthly were randomized to one of four waterpipe lounge menu groups using a two-by-two experimental design with "warning message" and "nicotine content" as factors.

RESULTS

Those who viewed waterpipe lounge menus that included a warning message had greater perceived relative harm to health and perceived risk of decreased lung function from WTS. Those who viewed waterpipe lounge menus that included nicotine content had greater perceived risk of heart attack from WTS.

DISCUSSION

Participants who were exposed to health warnings of WTS and information on the nicotine content of waterpipe tobacco increased on measures of perceived relative harm and risk of health consequences.

CONCLUSION

The pilot test results indicate promise for providing health information on waterpipe lounge menus to educate young adults on the harms and risks of WTS.

Knowledge, attitudes and preventive behaviors toward COVID-19: a study among higher education students in Portugal

Purpose

The purpose of this study was to assess knowledge, attitudes and behaviors about COVID-19 among Portuguese higher education students.

Design/methodology/approach

In May 2020, all students from a Portuguese University were invited to participate in completing an online questionnaire. A total of 262 students participated. COVID-19 related knowledge, attitudes toward COVID-19 and preventive behaviors were assessed. Differences between outcomes and sociodemographics were analyzed through independent t-tests and the ANOVA. A generalized linear model was calculated to determine the predictive variables of preventive behaviors.

Findings

Students revealed good knowledge about COVID-19, correctly answering 13.06 (SD = 1.25) questions in a total of 14 and favorable attitudes toward preventive behaviors (M = 32.73, SD = 2.88). Students reported always engaging in, on average, 5.81 (SD = 2.61) of the 12 behavior analyzed. Females presented higher levels of knowledge, more positive attitudes and engaged in more preventive behaviors than males. Being a bachelor's (Exp (β) = 8.213, 95% CI: 1.791–37.670, p < 0.01) or a master's degree student (Exp (β) = 7.568, 95% CI: 1.598–35.835, p < 0.05) and having positive attitudes toward preventive behavior of COVID-19 predicted the adoption of those preventive behavior (Exp (β) = 1.340, 95% CI: 1.189–1.510, p < 0.001).

Originality/value

This study provides useful data to plan health education programs about COVID-19 among higher education students. The continuous investment by universities in preventive campaigns is essential to promote good preventive behaviors in the next academic year.

Beliefs about the Harmfulness of Heated Tobacco Products Compared with Combustible Cigarettes and Their Effectiveness for Smoking Cessation among Korean Adults

Heated tobacco products (HTPs) have been widely used in Korea since their introduction in 2017. In this study, we investigated the perceptions of their relative harmfulness and smoking cessation effects. We performed an online survey in 7000 Koreans in 2018 (2300 males and 4700 females aged 20-69 years) by matching their age, sex, and provincial distribution. To investigate the factors causing HTPs to be perceived as less harmful than combustible cigarettes (CCs) and helpful for smoking cessation, we used multivariable logistic regression analyses. HTPs were less harmful than CCs in 16.8% of participants, particularly among HTP-only users and dual and triple users of HTPs, electronic cigarettes (ECs), or CCs than among CC-only users, those who were aged ≤ 34 years, males, and those with higher incomes. HTPs were reportedly helpful for smoking cessation in 11.2% of participants. Similar perceptions were more likely among HTP-only users, as well as dual and triple users than among CC-only users and adults with higher education/incomes. Although Korean adults generally had negative perceptions of the harmfulness and smoking cessation effects of HTPs compared with CCs, dual and triple users were more likely to have positive perceptions. Monitoring the use of multiple tobacco products and HTPs is a new challenge for Korean policymakers.

Knowledge and attitudes toward cigarette and narghile smoking among previous smokers in Lebanon

To evaluate the proportions of current cigarette smokers (CCS) and current narghile smokers (CNS) as well as previous cigarette smokers (PCS) and previous narghile smokers (PNS) and to assess smoking knowledge and attitudes toward supporting smoking ban or cessation among previous compared with current smokers. This cross-sectional study took place between May and December 2018, and enrolled a sample of 1598 exclusive cigarette smokers (ECS) and 2091 exclusive narghile smokers (ENS), representative of all Lebanese governorates. A questionnaire designed specifically for this study was used to collect data. Among ECS, 45.2% were CCS and 54.8% were PCS. Among ENS, 83.5% were CNS and 16.5% were PNS. Higher age (adjusted odds ratio (aOR) (95% confidence interval (CI)) = 1.02 (1.01; 1.03)), higher knowledge (1.05 (1.02; 1.08)), and attitude scores (1.11(1.09; 1.13)) were significantly associated with higher odds of being PCS. Higher age (1.02 (1.01; 1.03)), being employed (1.32 (1.004; 1.72)), higher knowledge (1.04 (1.02; 1.07)), and attitude scores (1.09 (1.07; 1.12)) were significantly associated with higher odds of being PNS. Previous smokers have higher knowledge and better attitude toward supporting smoking cessation compared with current smokers. A better knowledge along with effective interventions, might lead to a positive attitude toward supporting smoking ban or smoking cessation among the general population.

Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review

BACKGROUND

Despite evidence for the harms of waterpipe tobacco smoking (WTS), its use is increasing amongst college and university students worldwide. This systematic review aims to assess the knowledge of, attitudes towards and perceptions of WTS among college or university students.

METHODS

We electronically searched MEDLINE, EMBASE, CINAHL, PSYCHINFO and ISI the Web of Science in October 2018, restricting our search to studies published since January 1990. We included studies among university or college students that used qualitative or quantitative methods, and addressed either knowledge, attitudes, or perceptions towards WTS. We excluded studies where WTS could not be distinguished from other forms of tobacco use and studies reported as abstracts where the full text could not be identified. Data were synthesised qualitatively and analysed data by region (global north/ south), and by reasons for use, knowledge of health hazards, how knowledge influences use, perceptions towards dependence, and policy knowledge.

RESULTS

Eighty-six studies were included; 45 from the global north and 41 from the global south. Socio-cultural and peer influences were major contributing factors that encouraged students to initiate WTS. Furthermore, WTS dependence had two components: psychological and social. This was compounded by the general perception that WTS is a less harmful, less addictive and more sociable alternative to cigarette smoking. Knowledge of WTS harms failed to correlate with a reduced risk of WTS use, and some students reported symptoms of WTS addiction. A large proportion of students believed that quitting WTS was easy, yet few were able to do so successfully. Finally, students believed current public health campaigns to educate on WTS harms were inadequate and, particularly in the global north, were not required.

CONCLUSION

Reasons for WTS amongst university students are multi-faceted. Overall, interventions at both the individual and community level, but also policy measures to portray a message of increased harm amongst students, are required. Additional studies are necessitated to understand temporal changes in students' beliefs, thus allowing for better targeted interventions.

Hookah Use Among College Students: Recent Use, Knowledge of Health Risks, Attitude and Reasons for Use

Notwithstanding the efforts of health educators and other health professionals regarding tobacco and smoking cessation, research indicates that hookah smoking among college students remains a health concern. Research shows an upward trend in college students' hookah use. The purpose of this study was to identify and describe potential patterns/differences in college students' hookah use, and the relations among attitudes toward and knowledge about hookah use and use of this drug. A four-page, 20-item survey was used to collect data from participants (N = 403) and to measure participants 'recent use, knowledge of health risks, attitudes and reasons for hookah use among college students. Results indicated increased prevalence rates (53.8%) among participants of this study. Participants' recent hookah use was consistent with that of current research. Study findings supports current research, which found that college students have low negative perceptions of the health risks (addictive and detrimental properties) of hookah use. Analyses also determined that college students' attitudes toward hookah was associated with use of this drug. Regarding reasons why students may use hookah, data analysis indicated statistical significance in lifetime hookah use based on reasons for use. Study provide information for health educators creating hookah risk awareness educational programs aimed at reducing rates of hookah smoking among college students.

Comparing harm beliefs and risk perceptions among young adult waterpipe tobacco smokers and nonsmokers: Implications for cessation and prevention

Introduction

Very little is known about how waterpipe tobacco smokers and nonsmokers compare on harm beliefs about waterpipe tobacco smoking (WTS) and how these beliefs are related to risk appraisals and intentions to engage in WTS. We investigated these issues among young adult waterpipe tobacco smokers, susceptible nonsmokers, and non-susceptible nonsmokers.

Methods

Young adults ages 18 to 30 who smoked waterpipe tobacco during the last 30 days or never used waterpipe tobacco were recruited online through Turkprime. Nonsmokers were grouped as susceptible or not. Participants completed measures of harm beliefs, risk appraisals (i.e., perceived risks and worry), and desire to quit among smokers or willingness/curiosity to try waterpipe among nonsmokers.

Results

Analyses were based on 247 smokers and 418 nonsmokers. Smokers endorsed most strongly harm beliefs that portrayed WTS as safe, followed by susceptible and then non-susceptible nonsmokers. Most harm beliefs were significantly related to risk appraisals, yet weakly associated with desire to quit or willingness/curiosity to try waterpipe tobacco, except among susceptible nonsmokers.

Conclusions

Greater efforts are needed to correct maladaptive beliefs about WTS harms, especially among smokers. Among susceptible nonsmokers, harm beliefs may be more influential in predicting willingness to try WTS than risk appraisals.

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Waterpipe tobacco smokers view waterpipe tobacco smoking as safer than nonsmokers.

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Perceived risk correlates with many harm beliefs about waterpipe tobacco smoking.

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Among smokers, desire to quit is related more with perceived risk than harm beliefs.

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Among susceptible nonsmokers, intent to try waterpipe relates to many harm beliefs.