1
|
Alalwan MA, Long L, Stevens EM, Keller-Hamilton B, Villanti AC, Leshner G, Wagener TL, Mays D. Correlates of susceptibility to waterpipe tobacco smoking in young adults. PLoS One 2024; 19:e0307058. [PMID: 39012868 PMCID: PMC11251594 DOI: 10.1371/journal.pone.0307058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Many US young adults are susceptible to waterpipe (i.e., hookah) tobacco smoking (WTS) initiation, but research on factors associated with WTS susceptibility is limited. We examined sociodemographic, other tobacco and substance use, and attitudes and perceptions correlates of WTS susceptibility among young adults. METHODS Baseline data from a randomized trial testing WTS risk messages was collected in US young adults aged 18 to 30 years who never used waterpipe tobacco but were susceptible to WTS (n = 294). Extent of susceptibility to WTS was defined using the average score of a valid scale with higher scores indicating higher susceptibility. Correlates were sociodemographics, other tobacco and substance use, and attitudes and perceptions. Multiple linear regression models identified correlates of greater WTS susceptibility. RESULTS Participants averaged 25 (SD 3.2) years of age, 60% were male, 22% were Black non-Hispanic, 47% completed some college education, and 66% were employed. Our models consistently showed that more positive attitudes toward WTS (β = -0.08, p<0.01), lower perceived addictiveness relative to cigarettes (β = -0.09, p = 0.04), and greater perceived social acceptability of WTS (β = 0.05, p<0.01) were positively correlated with WTS susceptibility. Additionally, young adults who smoked cigarillos (β = 0.53, p<0.01), used cannabis (β = 0.14, p = 0.02), and Black non-Hispanic versus White non-Hispanic young adults (β = 0.18, p = 0.03) also had higher WTS susceptibility. CONCLUSIONS Findings suggest that WTS prevention efforts require multicomponent interventions including targeting subpopulations at greater risk based on race/ethnicity and other tobacco and substance use. These interventions should consider attitudes and social acceptability of WTS as modifiable targets to maximize public health benefits.
Collapse
Affiliation(s)
- Mahmood A. Alalwan
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Lauren Long
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Elise M. Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - 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, Ohio, United States of America
| | - Andrea C. Villanti
- Department of Health, Behavior, Society, and Policy, Rutgers School of Public Health, Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Glenn Leshner
- Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Theodore L. Wagener
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Darren Mays
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| |
Collapse
|
2
|
Jehi T, Sabado P, Beeson L, Matta D, Herring P, Sharma A, Emory K, Serban P. Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study. J Community Health 2024:10.1007/s10900-024-01374-1. [PMID: 39003669 DOI: 10.1007/s10900-024-01374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/15/2024]
Abstract
Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.
Collapse
Affiliation(s)
- Tony Jehi
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA.
| | - Parichart Sabado
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Lawrence Beeson
- Department of Nutrition & Dietetics, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Dania Matta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Patti Herring
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Archana Sharma
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Kristen Emory
- School of Public Health and Health Sciences, Cal State University Dominguez Hills, Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA
| | - Pamela Serban
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
3
|
Bluestein MA, Kuk AE, Harrell MB, Chen B, Hébert ET, Pérez A. Longitudinal Transition Patterns of Tobacco Use Among Youth and Young Adults Never Tobacco Product Users: Findings From the Population Assessment of Tobacco and Health Study, 2014-2019. Tob Use Insights 2023; 16:1179173X231161314. [PMID: 36923154 PMCID: PMC10009036 DOI: 10.1177/1179173x231161314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Aims To identify, visualize, and describe the prevalence of within-product patterns of tobacco use behaviors for e-cigarettes, cigarettes, and hookah (TP) by 3 age groups (ie, 12-14-year-old, 15-17-year-old, and 18-20-year-old) with U.S. nationally representative data. Methods In 2014-2015, never users of each (TP) and age group were followed-up longitudinally between 2015-2019 using five transition states: non-susceptible to (TP) use, susceptible to (TP) use, ever (TP) use, past 30-day (TP) use, and discontinued past 30-day (TP) use. Sankey diagrams were used to graphically visualize patterns in tobacco use behaviors across time. Results Among 12-14-year-old who were never users and susceptible to each TP from 2014-2017, 7% initiated ever e-cigarette use and 9.4% first reported past 30-day use by 2018-2019; 5.8% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Among 15-17-year-old who were never users and susceptible to each TP from 2014-2017, 4.2% initiated ever e-cigarette use and 9.0% first reported past 30-day use by 2018-2019; 4.5% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 2.4% first reported past 30-day hookah use by 2018-2019. Among 18-20-year-old who were never users and susceptible to each TP from 2014-2017, 3.2% initiated ever e-cigarette use and 3.6% first reported past 30-day e-cigarette use by 2018-2019; 3.0% initiated ever cigarette use and 2.3% first reported past 30-day cigarette use; and, 2.8% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Conclusions From 2014 to 2019, onset and progression of e-cigarette, cigarette, and hookah use occurred more frequently in 12-14 and 15-17-year-old than in young adults 18-20-year-old.
Collapse
Affiliation(s)
- Meagan A Bluestein
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Arnold E Kuk
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin Campus, Austin, TX, USA
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Emily T Hébert
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Health Promotion and Behavioral Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| |
Collapse
|
4
|
Persoskie A, O'Brien EK. Predicting tobacco product initiation from intentions to use: Comparing the validity of item analysis methods. Prev Med Rep 2022; 28:101855. [PMID: 35789624 PMCID: PMC9249798 DOI: 10.1016/j.pmedr.2022.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
Items measuring tobacco use intentions are used to predict future use. Researchers combine items using different methods; however, no research has compared these methods’ predictive validity. Here, we compare how well six methods of analyzing four intention items predict initiation of cigarettes, e-cigarettes, snus pouches, and other smokeless tobacco one year later. We analyzed youth and young adult never users from the US Population Assessment of Tobacco and Health Study. We compared six methods of analyzing Wave 3 intention items in predicting Wave 4 use: susceptibility scoring (susceptible is not answering “definitely no” to all items); dichotomizing the four-item average using two cut-points on the 1–4 response scale; and dichotomizing one item (next year use intention) with three cut-points. Analyses (1) tested whether each single-item predicted initiation; and (2) compared each method’s (a) true positive rate (rate of correctly identifying future initiators), (b) true negative rate (rate of correctly identifying future non-initiators), and (c) model fit. Results were similar across products and age groups. Averaging items best predicted initiation in regression. Susceptibility scoring had the highest true positive rate but lowest true negative rate. False positives (incorrectly identifying someone as a future initiator) were best minimized by averaging items with a cutoff of 3, or using the single item with a 3 or 4 cutoff. Findings suggest researchers predicting tobacco use initiation using regression should average the four items; and researchers seeking to identify likely initiators should use different analytic methods depending on if they seek to maximize true positives or minimize false positives.
Collapse
Affiliation(s)
- Alexander Persoskie
- Corresponding author at: Building 71, Room G335, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | | |
Collapse
|
5
|
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.
Collapse
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
| | | | | |
Collapse
|
6
|
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).
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Isaac Lipkus
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Camilla Sanders
- Duke University School of Nursing, Durham, North Carolina, USA
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Soneji S, Knutzen KE, Gravely S, Elton-Marshall T, Sargent J, Lambert E, Hilmi N, Sharma E, Jackson KJ, Wang B, Robinson J, Driezen P, Bover Manderski M, Bansal-Travers M, Hyland A, Travers M, Yang DH, Dang R, Fong GT. Transitions in frequency of hookah smoking among youth and adults: findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, 2013-15. Addiction 2021; 116:936-948. [PMID: 32896050 DOI: 10.1111/add.15250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/01/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self-reported reasons for hookah smoking cessation and transition to or maintenance of high-frequency hookah smoking among current hookah smokers. DESIGN Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at wave 1 (2013-14); frequency of hookah smoking and past-year cessation were ascertained at wave 2 (2014-15). Weighted multivariable logistic and ordinal logistic regression models were fitted to predict hookah smoking cessation and frequency of hookah smoking at wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking and frequency of hookah smoking at wave 1. SETTING United States. PARTICIPANTS A total of 693 youth and 4400 adult past-year hookah smokers. MEASUREMENTS Self-reported tobacco-use patterns and associated health behaviors were measured via audio computer-assisted self-interviews (ACASI). FINDINGS At wave 1, 5.9% of youth and 7.5% of adults were past-year hookah smokers. Among all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, the availability of appealing flavors and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors [adjusted odds ratio (aOR) = 0.40; 95% confidence interval (CI) = 0.26-0.62] compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly or more frequent hookah smoking at wave 2, compared with cessation or less than monthly smoking, were higher for adults who liked hookah flavors [adjusted proportional odds ratio (aPOR) = 2.10; 95% CI = 1.48-2.99 and enjoyed socializing while smoking hookah (aPOR = 1.82; 95% CI =1.13-2.94) compared with adults who did not like hookah flavors or socializing. CONCLUSION The availability of appealing flavors, affordability and socialization while smoking hookah in the United States are associated with reduced likelihood of cessation and increased likelihood of high-frequency hookah smoking.
Collapse
Affiliation(s)
- Samir Soneji
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Kristin E Knutzen
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - James Sargent
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth Lambert
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Nahla Hilmi
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | | | - Kia J Jackson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Baoguang Wang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Joelle Robinson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Michelle Bover Manderski
- Center for Tobacco Studies, School of Public Health, Rutgers, State University of New Jersey, Piscataway, NJ, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Mark Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | | | - Rui Dang
- University of Information Science and Technology, Ohrid, North Macedonia
| | - Geoffrey T Fong
- Center for Tobacco Studies, School of Public Health, Rutgers, State University of New Jersey, Piscataway, NJ, USA
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
10
|
Osuh ME, Fagbule OF, Olatunji YD. Prevalence and predictors of susceptibility and future intention to smoke cigarettes among school-going adolescents in Ibadan, Nigeria. Pan Afr Med J 2021; 37:230. [PMID: 33520069 PMCID: PMC7821788 DOI: 10.11604/pamj.2020.37.230.24174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction the tobacco control interventions targeted at preventing the initiation of tobacco habits are crucial to effective control of tobacco use among adolescents. An understanding of the predictors of smoking susceptibility and future intention to smoke is important in developing effective intervention programmes. This study, therefore, assessed the prevalence and predictors of susceptibility and future intention to smoke cigarettes among school-going adolescents in Ibadan, Nigeria. Methods a cross-sectional study among 830 school-going, non-smoking adolescents, who were randomly selected from 18 secondary schools in Ibadan, Nigeria. Using a self-administered, structured questionnaire, information on socio-demography, tobacco attitudes and habits were collected and analyzed using SPSS version 25. Results the prevalence of susceptibility and future intention to smoke cigarette were 25.9% and 6.3%, respectively. Predictors of susceptibility were low social-class (aOR:1.68; 95%CI:1.01-2.80); cigarette sale near schools (aOR:2.04; 95%CI:1.16-3.61); poor attitude (aOR:1.93; 95%CI:1.29-2.89); no harm-perception to smoking (aOR:3.55; 95%CI:2.13-5.92), exposure to secondhand smoke (SHS) (aOR:2.31; 95%CI:1.52-3.50) and perceived safety of short-term smoking (aOR:1.59; 95%CI:1.02-2.44). Predictors of future intention to smoke were: ever-tobacco smoking (aOR:2.05; 95%CI:1.003-4.170); cigarette sale near schools (aOR:1.79; 95%CI:1.09-2.94); poor attitude (aOR:1.95; 95%CI:1.31-2.88), no harm perception to smoking (aOR:3.87; 95%CI:2.38-6.31), exposure to SHS (aOR:2.45; 95%CI:1.64-3.67) and perceived safety of short-term smoking (aOR:1.59; 95%CI:1.05-2.44). Conclusion a significant proportion of the population had high susceptibility to smoke as well as high future intention to smoke. Sales of cigarettes near schools, poor attitude and poor perception about the harm from smoking and exposure to SHS were important predictors of both susceptibility and future intention to smoke among respondents.
Collapse
Affiliation(s)
- Mary Ebelechukwu Osuh
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria
| | - Omotayo Francis Fagbule
- Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria.,Cephas Health Research Initiative Incorporated (CEPHAS), Ibadan, Nigeria
| | | |
Collapse
|
11
|
Bold KW, Buta E, Simon P, Kong G, Morean M, Camenga D, Krishnan-Sarin S. Using Latent Class Analysis to Examine Susceptibility to Various Tobacco Products Among Adolescents. Nicotine Tob Res 2020; 22:2059-2065. [PMID: 31758190 DOI: 10.1093/ntr/ntz216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Most tobacco use is initiated during adolescence and susceptibility is an important predictor of initiation. Research is needed to understand susceptibility across tobacco products among youth to inform prevention efforts. AIMS AND METHODS We surveyed 2945 students from four Southeastern Connecticut high schools in 2017. We assessed susceptibility to future use of seven different tobacco products (ie, cigarettes, e-cigarettes, hookah, cigars, cigarillos, blunts, and smokeless tobacco) among youth who had never used a tobacco product. Susceptibility was coded as any response other than "definitely not" to three items assessing (1) curiosity, (2) willingness to experiment with the product in the future, and (3) willingness to try if offered by a friend. Latent class analysis was used to identify patterns of susceptibility across multiple tobacco products and sociodemographic predictors of these classes. RESULTS Among n = 1246 youth who had never tried a tobacco product, 51.2% (n = 638) were susceptible to at least one product and 29.1% (n = 363) were susceptible to two or more products (average among susceptible youth: M = 2.4 products, SD = 1.7, range 1-7). Latent class analysis identified three classes: youth who were: (1) susceptible to all products (5.6%), (2) susceptible to e-cigarettes, hookah, and blunts (23.6%), and (3) mostly non-susceptible to all products (70.8%). In a multivariable model, demographic variables and peer tobacco use predicted class membership. CONCLUSIONS We observed high rates of susceptibility to non-traditional tobacco products among youth, and many youth were susceptible to more than one product. Targeting susceptibility across multiple tobacco products may be important for reducing youth tobacco use. IMPLICATIONS Patterns of polytobacco use susceptibility were identified among youth who had never previously used tobacco products. Many youth were susceptible to more than one product and we observed three distinct classes of susceptibility among youth: those who were mostly non-susceptible, those who were susceptible to alternative or non-traditional tobacco products (e-cigarettes, hookah, and blunts), and those who were susceptible to all tobacco products. These findings suggest the importance of addressing susceptibility across multiple tobacco products.
Collapse
Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Eugenia Buta
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Patricia Simon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Meghan Morean
- Department of Psychology, Oberlin College, Oberlin, OH
| | - Deepa Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Waterpipe Tobacco Smoking and Associated Risk Factors among Bangladeshi University Students: An Exploratory Pilot Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractOver the past two decades, there has been a global rise in the prevalence of waterpipe tobacco smoking. Waterpipe tobacco smoking involves the inhalation of heated tobacco smoke after passing through water, and it has been associated with an identified dependence effect similar to that found with cigarette smoking. Despite the popularity of waterpipe tobacco among youth (and in particular, university students) in many countries, detailed data of its usage are lacking in Bangladesh. Therefore, the present study was conducted to explore waterpipe tobacco smoking behavior and normative beliefs among university students in Bangladesh and to assess the factors associated with waterpipe tobacco use. A quantitative cross-sectional survey was carried out among 340 Bangladeshi university students (64.4% male; mean age 21.6 years). Among participants, 13.5% reported they had ever smoked tobacco from a waterpipe and 9.4% had it in past 30 days. Among past 30-day users, 72% were categorized as having waterpipe smoking dependence (n = 23). No females in the sample had ever smoked using a waterpipe. Maternal occupation, monthly expenditure, and regular smoking status were major predominant factors associated with waterpipe smoking behavior of the students. The study is of existential value given that there are no prior studies ever carried out in Bangladesh previously. Recommendations are provided based on the study’s findings, particularly in relation to what action is needed from universities in Bangladesh.
Collapse
|
14
|
Orlan EN, Queen TL, Ribisl KM, Sutfin EL. One-item susceptibility measure predicts waterpipe and little cigar/cigarillo uptake in a national sample of adolescents and young adults in the United States. Tob Prev Cessat 2020; 5:17. [PMID: 32411881 PMCID: PMC7205113 DOI: 10.18332/tpc/108554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Adolescents and young adults in the United States (US) are increasingly using non-cigarette tobacco products such as waterpipe (WP) and little cigars/cigarillos (LCC). One way to predict which non-user adolescents and young adults are most likely to use these products is through measuring their susceptibility or openness to using the products. METHODS We conducted a national phone survey (baseline) and an internet survey (follow-up) of adolescents and young adults (ages 13–25 years), who, at baseline, had never used WP (N=1002) or LCC (N=990). At baseline, we measured susceptibility using a single item, asking participants whether they would try WP or LCC if their best friend offered it to them, and subsequently measured uptake at follow-up. We conducted multivariate regression analyses to determine whether product-specific susceptibility was a significant predictor of uptake at follow-up. RESULTS Participants who were susceptible and participants who had ever used another tobacco product had higher odds of using WP (AOR=3.5, AOR=4.2) and LCC (AOR=3.2, AOR=5.3) at follow-up than those who were not susceptible to those products, and had not ever used tobacco products respectively, controlling for sociodemographic factors. The one-item measure had adequate sensitivity (WP=51.4%, LCC=40.2%) and specificity (WP=84.9%, LCC=87.9%). CONCLUSIONS Our national study of US adolescents and young adults shows that a one-item susceptibility measure at baseline was a significant predictor of WP and LCC uptake at follow-up, even after controlling for other predictors. Future research should assess the predictive validity of the one-item compared to the multi-item scale.
Collapse
Affiliation(s)
- Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, United States
| |
Collapse
|
15
|
Roberts ME, Ferketich AK. Hookah Susceptibility and Transitions Over the First Year of College. J Stud Alcohol Drugs 2020; 81:195-202. [PMID: 32359049 PMCID: PMC7201208 DOI: 10.15288/jsad.2020.81.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/21/2019] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE There has been a growth in popularity of hookah (or waterpipes) among American college students, despite the health risks. This study investigated factors that predict hookah susceptibility and whether hookah susceptibility predicts hookah initiation and continued use. METHOD The study established a cohort of 529 incoming college freshmen (51.6% female) who completed an online survey approximately 1 week before their arrival to a large U.S. university. Students were sent four follow-up surveys throughout the 2016-2017 academic year; 90.5% completed at least one follow-up survey. RESULTS A total of 13.2% of the sample had used hookah at baseline and 9.9% initiated hookah use over the course of their freshman year. Among the nonusers who had no hookah susceptibility at baseline, 30.0% came to indicate some susceptibility. Multivariable logistic regression indicated that the personality construct conscientiousness was protective against becoming susceptible, whereas coming from a rural part of the state was a risk factor. Susceptibility predicted both continued use among the baseline ever-users and initiation among the baseline never-users. CONCLUSIONS These findings highlight the role of susceptibility in the trajectory of hookah use among U.S. college students.
Collapse
Affiliation(s)
- Megan E. Roberts
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Amy K. Ferketich
- College of Public Health, The Ohio State University, Columbus, Ohio
| |
Collapse
|
16
|
Peng S, Yu L, Yang T, Wu D, Bottorff JL, Barnett R, Jiang S. Susceptibility to smoking and determinants among medical students: A representative nationwide study in China. Tob Induc Dis 2019; 17:36. [PMID: 31516479 PMCID: PMC6662903 DOI: 10.18332/tid/106188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/28/2019] [Accepted: 04/05/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The rationale behind why the majority of medical students are non-smokers, but some initiate smoking after becoming physicians is not fully understood in China. Exploring factors that may increase susceptibility to smoking initiation among medical students is an essential first step in assessing preventative actions. METHODS Participants were 11954 students, who were identified through a multistage survey sampling process that included 50 universities in China. Subsequent analysis focused on 8916 non-smokers among medical students. Both unadjusted and adjusted logistic methods were considered in the data analyses. RESULTS The prevalence of susceptibility to smoking was 23.0%. Multivariate logistic regression analyses found that exposure to secondhand smoke (SHS) in domestic places (OR= 1.63) and in public places (OR=1.78), cigarette advertising (OR=1.91) and promotional activities on campus (OR=1.90) were positively associated with susceptibility to smoking. In contrast, positive attitudes toward tobacco control on the part of health professionals, HPs, (OR=0.52) were negatively associated with susceptibility to smoking. Those who received information about the dangers of smoking (OR=0.75) and did not agree that light cigarettes are less harmful to health (OR=0.79) were less susceptible to smoke. Caring about exposure to secondhand smoke (OR=0.68 care, and OR=0.33 very) and advising family members to stop smoking (OR=0.81) were negatively associated with susceptibility to smoking. CONCLUSIONS These findings underscore the importance of tobacco control training and establishing smoke-free campuses for reducing susceptibility to smoking among medical students.
Collapse
Affiliation(s)
- Sihui Peng
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingwei Yu
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingzhong Yang
- Children's Hospital/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Wu
- Department of Psychology, Guangdong Medical University, Dongguan, China
| | - Joan L Bottorff
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Ross Barnett
- Department of Geography, University of Canterbury, Christchurch, New Zealand
| | - Shuhan Jiang
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
17
|
Arshad A, Matharoo J, Arshad E, Sadhra SS, Norton-Wangford R, Jawad M. Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review. BMC Public Health 2019; 19:439. [PMID: 31029118 PMCID: PMC6487066 DOI: 10.1186/s12889-019-6680-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Adam Arshad
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Jaideep Matharoo
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Ebrahim Arshad
- University Hospitals of North Midlands, Stoke on Trent, UK
| | - Simardeep Singh Sadhra
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Rosemary Norton-Wangford
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College, London, UK
| |
Collapse
|
18
|
Gentzke AS, Wang B, Robinson JN, Phillips E, King BA. Curiosity About and Susceptibility Toward Hookah Smoking Among Middle and High School Students. Prev Chronic Dis 2019; 16:E04. [PMID: 30629485 PMCID: PMC6341822 DOI: 10.5888/pcd16.180288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hookah smoking has increased among young people. Curiosity and susceptibility may be associated with experimentation or established use. Because tobacco use behaviors are established primarily during adolescence, our objective was to examine factors that may increase the risk of future tobacco product use among youth. METHODS We analyzed data from the 2016 National Youth Tobacco Survey, a nationally representative survey of US students. Analyses were restricted to youth who had never smoked a hookah and stratified by their ever having used other tobacco products. The prevalence of hookah curiosity and susceptibility was assessed by sociodemographic characteristics, perceptions of harmfulness and addictiveness of hookahs, and peer use of hookahs. Associations between covariates and curiosity and susceptibility were assessed by using multivariable-adjusted regression. RESULTS Overall, 29.1% of students reported any hookah curiosity or susceptibility. Curiosity was reported by 14.6% of those who never used tobacco products and by 45.9% of those who ever used tobacco products. Hookah susceptibility was reported by 15.6% of never-users and 52.5% of ever-users. Regardless of ever having used other tobacco products, odds of curiosity and susceptibility were higher among students with perceptions of reduced hookah harmfulness and addictiveness and among those who perceived high levels of hookah use among peers. CONCLUSION Nearly 3 in 10 youth who never smoked a hookah (6.9 million) reported hookah curiosity or susceptibility, and prevalence was highest among those who had ever used other tobacco products. These findings reinforce the importance of educating youth about the dangers of all tobacco products and dispel misperceptions about the harmfulness and addictiveness of hookah smoking. Continued surveillance of youth curiosity, susceptibility, and use of hookahs can inform public health policy and practice.
Collapse
Affiliation(s)
- Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341. E-mail:
| | - Baoguang Wang
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Joelle N Robinson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Elyse Phillips
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
19
|
Delk J, Carey FR, Case KR, Creamer MR, Wilkinson AV, Perry CL, Harrell MB. Adolescent Tobacco Uptake and Other Substance Use: A Latent Class Analysis. Am J Health Behav 2019; 43:3-14. [PMID: 30522562 DOI: 10.5993/ajhb.43.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The purpose of this study was to identify patterns of tobacco uptake and other substance use, from early to late adolescence. Methods: We used weighted latent class analysis, conducted separately for 7th, 9th, and 11th graders, to assess patterns of susceptibility, ever and current use of combustible tobacco and e-cigarettes, and other substance use (ie, current alcohol, binge drinking, and marijuana). Data were from Wave 3 of the Texas Adolescent Tobacco and Marketing Surveillance System (n = 2733; N = 461,069), collected in fall 2015. Multinomial regression was used to examine differences in class membership by demographic factors. Results: Two latent classes were identified in 7th grade, 3 classes in 9th grade, and 4 classes in 11th grade models. In each grade, classes included both a "no risk" and a "tobacco susceptible" class. For 9th grade, there was an additional "tobacco ever use" class, and 11th grade had the same additional class as well as an "all products use" class. Conclusion: Distinct patterns of polysubstance use emerged as grade level increased, supporting a stage-sequential model of onset and progression across developmental age groups. Future research can examine other factors affecting transitions across these stages.
Collapse
Affiliation(s)
- Joanne Delk
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Felicia R. Carey
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Kathleen R. Case
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - MeLisa R. Creamer
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Anna V. Wilkinson
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Cheryl L. Perry
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX;,
| |
Collapse
|
20
|
Carey FR, Wilkinson AV, Harrell MB, Cohn EA, Perry CL. Measurement and predictive value of susceptibility to cigarettes, e-cigarettes, cigars, and hookah among Texas adolescents. Addict Behav Rep 2018; 8:95-101. [PMID: 30140729 PMCID: PMC6104349 DOI: 10.1016/j.abrep.2018.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
Susceptibility to cigarette smoking, defined as the lack of a firm commitment not to smoke in the future, begins in childhood and is a phase in the transition from never to ever use of cigarettes. While a consistent and validated predictor of cigarette use, little research has assessed whether the susceptibility construct applies equally well across other tobacco products. Baseline data were collected in 2014–2015 from a representative sample of (n = 2844) middle and high school students in five counties surrounding the four largest cities in Texas, (49% female and mean age 13.13 years, with subsequent waves at 6, 12, and 18 months. Confirmatory factor analysis examined the appropriateness of a three-item susceptibility measure (product-specific curiosity, intention to use, and peer influence) across product types and ethnic groups (Hispanic versus non-Hispanic). Logistic regression examined whether product specific susceptibility at baseline predicted future product initiation. At baseline, 11.5%, 17.0%, 17.4% and 29.4%, of adolescent never users were susceptible to cigars, cigarettes, hookah and e-cigarettes, respectively; significantly more Hispanic than non-Hispanic adolescents were susceptible to e-cigarettes (32.4% versus 26%, p < 0.01) and cigarettes (19.9% versus 13.9%, p < 0.05). Product-specific items were significantly and consistently associated with the respective underlying susceptibility product construct and across ethnic groups (p < 0.001 for all). Susceptibility to e-cigarettes (AOR = 2.28–6.64) or any combustible product (cigarettes, hookah, cigars; AOR = 3.38–5.20) significantly predicted subsequent ever use. This study confirms the appropriateness of the susceptibility construct across four tobacco product types and ethnic groups, and the utility of susceptibility in predicting future product use among adolescents. Susceptibility to e-cigarettes and combustible tobacco products is robustly measured by the same three product-specific items Product-specific susceptibility constructs predicted use of respective tobacco products at 6, 12, and 18 months post-baseline Susceptibility to e-cigarettes and combustible tobacco products can be measured reliably in Hispanic and non-Hispanic youth
Collapse
Affiliation(s)
- Felicia R Carey
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Anna V Wilkinson
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Elisabeth A Cohn
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Cheryl L Perry
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| |
Collapse
|
21
|
Abudayyeh HS, Glasser AM, Johnson AL, Cohn AM, Wagener TL, Mays D, Villanti AC. Social and substance use correlates of adult hookah use, 2016. Addict Behav 2018; 79:39-44. [PMID: 29245025 PMCID: PMC5807119 DOI: 10.1016/j.addbeh.2017.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/24/2022]
Abstract
Introduction Hookah prevalence has been increasing in U.S. adults. This study examines correlates and frequency of hookah use in a national sample of U.S. adults (18–44 years). Methods Data were drawn from Wave 10 (October 2016) respondents aged 18–44 years from the Truth Initiative Young Adult Cohort Study (n=4,085). Weighted bivariate analyses were used to estimate correlates and frequency of hookah use, and differences between past 30-day and noncurrent hookah users on social and substance use (alcohol, marijuana, and other drugs) correlates. Results Twenty percent of the sample ever used hookah, and 2% used hookah in the past 30 days. Compared to never users and non-current users, a significantly greater proportion of ever and past 30-day hookah users reported past 30-day e-cigarette, tobacco, and substance use (p’s<0.01). Eighty-one percent of past 30-day hookah users had at least one close friend who also used hookah, and 35% self-identified as social/occasional smokers. The majority (68%) of past 30-day users reported hookah use on fewer than five of the past 30 days, and 58% engaged in two or more hookah sessions on those days. Conclusions Ever and past 30-day hookah use are associated with concurrent tobacco, e-cigarette, and substance use. They are also correlated with peer hookah use and self-identification as a social/occasional smoker. Even infrequent hookah sessions can expose users to health risks. Research identifying contexts in which hookah is used and how it is used with other substances is needed to inform interventions to reduce hookah use.
Collapse
Affiliation(s)
- Haneen S Abudayyeh
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G St NW, Fourth Floor, Washington, DC 20001, USA; Battelle Memorial Institute, 2111 Wilson Blvd, #1000, Arlington, VA 22201, USA.
| | - Allison M Glasser
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G St NW, Fourth Floor, Washington, DC 20001, USA
| | - Amanda L Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G St NW, Fourth Floor, Washington, DC 20001, USA
| | - Amy M Cohn
- Battelle Memorial Institute, 2111 Wilson Blvd, #1000, Arlington, VA 22201, USA; Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20057, USA
| | - Theodore L Wagener
- Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Ave, Suite 14000, Oklahoma city, OK 73104, USA; Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Pkwy #400, Oklahoma City, OK 73104, USA
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20057, USA
| | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G St NW, Fourth Floor, Washington, DC 20001, USA; Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA
| |
Collapse
|
22
|
Comparing harm beliefs and risk perceptions among young adult waterpipe tobacco smokers and nonsmokers: Implications for cessation and prevention. Addict Behav Rep 2018; 7:103-110. [PMID: 29892704 PMCID: PMC5993879 DOI: 10.1016/j.abrep.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
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. Waterpipe tobacco smokers view waterpipe tobacco smoking as safer than nonsmokers. Perceived risk correlates with many harm beliefs about waterpipe tobacco smoking. Among smokers, desire to quit is related more with perceived risk than harm beliefs. Among susceptible nonsmokers, intent to try waterpipe relates to many harm beliefs.
Collapse
|
23
|
Lipkus IM, Mays D, P Tercyak K. Characterizing Young Adults' Susceptibility to Waterpipe Tobacco Use and Their Reactions to Messages About Product Harms and Addictiveness. Nicotine Tob Res 2018; 19:1216-1223. [PMID: 27799355 DOI: 10.1093/ntr/ntw251] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/28/2017] [Indexed: 12/14/2022]
Abstract
Introduction There is very little insight into the psychosocial characteristics of young adults susceptible to waterpipe tobacco use and their reactions to messages about harms of waterpipe tobacco smoking (WTS). We investigated how young adults who were or were not susceptible to WTS differed on various characteristics and their reactions to messages about WTS harms. Methods Young adults ages 18 to 30 who had never used waterpipe tobacco were recruited through an online crowdsourcing site. Participants were stratified on susceptibility status (susceptible or not) and randomized to receive messages about harms and addictiveness of WTS or a control condition that received no messages. Participants' perceptions of risk and worry, their attitudes toward, and willingness/curiosity to try WTS were assessed. Results Compared to nonsusceptible participants, susceptible participants perceived themselves to be at lower risk and worried less about harms and addictiveness of WTS, had more positive attitudes toward use, and expressed a greater willingness and curiosity to try it. Among susceptible participants, messages decreased willingness/curiosity to try WTS; messages had no effect on nonsusceptible participants. The message effects among susceptible participants were explained by more negative attitudes and less ambivalence toward WTS. Conclusions Susceptible young adults' psychosocial characteristics place them at high risk for future uptake of WTS. Brief public health messages about harm and addiction may deter susceptible young adults' willingness to try WTS and prevent WTS initiation and progression. Implications Findings suggest that in order to curb the initiation of WTS among susceptible young adults, interventions should target risk appraisals and attitudes toward WTS.
Collapse
Affiliation(s)
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| |
Collapse
|
24
|
Rayens MK, Ickes MJ, Butler KM, Wiggins AT, Anderson DG, Hahn EJ. University students' perceived risk of and intention to use waterpipe tobacco. HEALTH EDUCATION RESEARCH 2017; 32:306-317. [PMID: 28854575 PMCID: PMC5914365 DOI: 10.1093/her/cyx049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 04/20/2016] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50-0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported 'to socialize' as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts.
Collapse
Affiliation(s)
- Mary Kay Rayens
- University of Kentucky College of Nursing, 543 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Melinda J. Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, 111 Seaton Building, Lexington, KY 40506-0219, USA
| | - Karen M. Butler
- University of Kentucky College of Nursing, 423 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Amanda T. Wiggins
- University of Kentucky College of Nursing, 501 E2 CON, 751 Rose Street, Lexington, KY 40526-0232, USA
| | - Debra G. Anderson
- University of Kentucky College of Nursing, 551 CON, 751 Rose Street, Lexington, KY 40526-0232, USA
| | - Ellen J. Hahn
- University of Kentucky College of Nursing, 2265 Harrodsburg Road, Suite 202, Lexington, KY 40504, USA
| |
Collapse
|
25
|
Soneji S, Pierce JP, Choi K, Portnoy DB, Margolis KA, Stanton CA, Moore RJ, Bansal-Travers M, Carusi C, Hyland A, Sargent J. Engagement With Online Tobacco Marketing and Associations With Tobacco Product Use Among U.S. Youth. J Adolesc Health 2017; 61:61-69. [PMID: 28363720 PMCID: PMC5483203 DOI: 10.1016/j.jadohealth.2017.01.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Youth who engage with online tobacco marketing may be more susceptible to tobacco use than unengaged youth. This study examines online engagement with tobacco marketing and its association with tobacco use patterns. METHODS Cross-sectional analysis of youths aged 12-17 years who participated in wave 1 of the Population Assessment of Tobacco and Health Study (N = 13,651). Engagement with tobacco marketing was based on 10 survey items including signing up for email alerts about tobacco products in the past 6 months. Logistic regression was used to examine the association of online engagement with tobacco marketing and susceptibility to use any tobacco product among never-tobacco users, ever having tried tobacco, and past 30-day tobacco use. RESULTS An estimated 2.94 million U.S. youth (12%) engaged with ≥ one forms of online tobacco marketing. Compared with no engagement, the odds of susceptibility to the use of any tobacco product among never-tobacco users was independently associated with the level of online engagement: adjusted odds ratio (AOR) = 1.48 (95% confidence interval [CI], 1.24-1.76) for one form of engagement and AOR = 2.37 (95% CI, 1.53-3.68) for ≥ two forms of engagement. The odds of ever having tried tobacco were also independently associated with the level of online engagement: AOR = 1.33 (95% CI: 1.11-1.60) for one form of engagement and AOR = 1.54 (95% CI, 1.16-2.03) for ≥ two forms of engagement. The level of online engagement was not independently associated with past 30-day tobacco use. CONCLUSIONS Online engagement with tobacco marketing may represent an important risk factor for the onset of tobacco use in youth.
Collapse
Affiliation(s)
- Samir Soneji
- Norris Cotton Cancer Center, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - John P Pierce
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - David B Portnoy
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Katherine A Margolis
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Cassandra A Stanton
- Westat, Rockville, Maryland; Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Washington, DC
| | - Rhonda J Moore
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Andrew Hyland
- Westat, Rockville, Maryland; Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - James Sargent
- Norris Cotton Cancer Center, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| |
Collapse
|
26
|
Cohn AM, Ehlke SJ, Cobb CO, Soule EK. Hookah tobacco smoking in a large urban sample of adult cigarette smokers: Links with alcohol and poly-tobacco use. Addict Behav 2017; 68:1-5. [PMID: 28086138 PMCID: PMC5293175 DOI: 10.1016/j.addbeh.2016.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
Hookah tobacco smoking (HTS) has been increasing, particularly among young adults and has similar health effects compared to cigarette smoking. The link between HTS and poly-tobacco use is well documented, but fewer show an association between HTS and alcohol use. It is essential to identify factors that increase the risk for or addictiveness and consequences of HTS, given its growing prevalence. This study examined whether the association between HTS and poly-tobacco use differed as a function of age and alcohol consumption within in a sample of 1223 adult cigarette smokers. Approximately 20% of participants reported HTS. Compared to non-users, hookah users were more likely to be male, highly educated, and to report drug and alcohol use, binge drinking, and poly-tobacco use but were less likely to be heavy smokers (≥10 cigarettes per day). Regression analyses predicting number of tobacco products used (excluding cigarettes and HTS) indicated a three-way interaction of HTS, frequency of alcohol use, and age such that the association between HTS and number of tobacco products used was strongest for younger respondents who consumed alcohol more frequently. As observed in previous studies, alcohol is an important risk factor in the relationship between HTS and poly-tobacco use, particularly among younger cigarette smokers. The links between alcohol, HTS, and poly-tobacco use should be considered when developing HTS education and prevention materials directed toward younger cigarette smokers. Findings provide information relevant to FDA's interest in the addiction potential of HTS and its link to poly-tobacco use.
Collapse
Affiliation(s)
- Amy M Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, USA; Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW, Washington, DC, USA.
| | - Sarah J Ehlke
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, USA
| | - Caroline O Cobb
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric K Soule
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
27
|
Sidani JE, Shensa A, Naidu MR, Yabes JG, Primack BA. Initiation, Progression, and Sustained Waterpipe Use: A Nationally Representative Longitudinal Study of U.S. Young Adults. Cancer Epidemiol Biomarkers Prev 2017; 26:748-755. [PMID: 28082346 DOI: 10.1158/1055-9965.epi-16-0687-t] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Waterpipe tobacco smoking (WTS) is increasing in popularity despite evidence of harm and potential for dependence. Intervention development has been hampered by a lack of longitudinal, nationally representative data on usage patterns and factors independently associated with WTS initiation. Therefore, we aimed to characterize key transitions between WTS states in a nationally representative group of young adults, with particular attention to factors independently associated with initiation.Methods: Participants were randomly selected from a national probability-based panel representing 97% of the United States. A total of 1,785 adults ages 18 to 30 at baseline completed two Web-based surveys 18 months apart in 2013 and 2014. Assessments included knowledge of waterpipe tobacco smoke composition, positive and negative attitudes toward WTS, normative beliefs, intention to use waterpipe, and WTS behavior. We used multivariable logistic regression to assess the association between predictive factors and subsequent WTS initiation.Results: In fully adjusted models, overall knowledge about toxicants associated with WTS was not associated with subsequent WTS initiation. Similarly, negative attitudes and normative beliefs were not associated with WTS uptake. However, baseline positive attitudes were strongly and significantly associated with WTS initiation [adjusted OR (AOR) = 1.7; 95% confidence interval (CI), 1.2-2.3]. Similarly, baseline intention to use WTS was strongly associated with subsequent initiation (AOR = 7.0; 95% CI, 3.5-13.7).Conclusions: Prevention efforts may be most successful if they target individuals with clear intentions to use WTS and challenge positive attitudes surrounding WTS.Impact: Surveillance of WTS trajectories will help inform health care and policy surrounding this emerging risk behavior among U.S. young adults. Cancer Epidemiol Biomarkers Prev; 26(5); 748-55. ©2017 AACR.
Collapse
Affiliation(s)
- Jaime E Sidani
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania. .,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ariel Shensa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maharsi R Naidu
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan G Yabes
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian A Primack
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania.,Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
28
|
Wiseman KD, Cornacchione J, Wagoner KG, Noar SM, Moracco KE, Teal R, Wolfson M, Sutfin EL. Adolescents' and Young Adults' Knowledge and Beliefs About Constituents in Novel Tobacco Products. Nicotine Tob Res 2016; 18:1581-7. [PMID: 26764259 DOI: 10.1093/ntr/ntw009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/05/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Novel tobacco products, such as little cigars, cigarillos, hookah, and e-cigarettes, and their smoke or aerosol contain chemicals which the FDA has determined to be Harmful or Potentially Harmful Constituents. We explored adolescents' and young adults' knowledge and beliefs about constituents in novel tobacco products and their smoke or aerosol, in order to inform risk communication messages. METHODS Seventy-seven adolescents and young adults (ages 13-25) participated in 10 focus groups, including 47 novel tobacco product users and 30 susceptible nonusers. Participants were asked to discuss 10 pre-selected constituents found in novel tobacco products and their smoke or aerosol. The first author analyzed the discussion for emergent themes. RESULTS Participants were generally familiar with arsenic, carbon monoxide, formaldehyde, and nicotine, but unfamiliar with acetaldehyde, acrolein, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanon (NNK), and N-nitrosonornicotine (NNN). All participants had negative beliefs about most constituents, although users had positive beliefs about nicotine. "Unfamiliar" constituents were associated with similarly-sounding words (eg, acetaldehyde sounds like acetaminophen), and some participants recognized words in the chemical names of NNK/NNN (eg, "nitro"). "Familiar" constituents were associated with negative health effects and other common products the constituents are found in. All participants wanted more information about the constituents' health effects, toxicity, and other common products. Most participants were unaware the constituents discussed are in novel tobacco products and their smoke or aerosol. CONCLUSIONS Risk communication messages could capitalize on negative associations with familiar constituents, or attempt to educate about unfamiliar constituents, to discourage novel tobacco product use among adolescents and young adults. IMPLICATIONS The results of this study have implications for how the FDA and other agencies can communicate about the risks of novel tobacco products to the general public, which will be particularly important once the Deeming Rule is finalized. Our findings suggest it may be effective to capitalize on the public's negative beliefs about and associations with familiar constituents, or to educate about unfamiliar constituents and their health effects, their concentration and toxicity in novel tobacco products and their smoke or aerosol, and other products they are found in.
Collapse
Affiliation(s)
- Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC;
| | - Jennifer Cornacchione
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathryn E Moracco
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
29
|
Soule EK, Lipato T, Eissenberg T. Waterpipe tobacco smoking: A new smoking epidemic among the young? CURRENT PULMONOLOGY REPORTS 2015; 4:163-172. [PMID: 26756025 PMCID: PMC4706079 DOI: 10.1007/s13665-015-0124-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Waterpipe (hookah, narghile) tobacco smoking (WTS) is becoming prevalent worldwide and is one of the most popular forms of tobacco use among youth. WTS prevalence has increased dramatically among youth in the United States within the past decade. Misperceived as less harmful than cigarette smoking, WTS is associated with many of the same chronic health effects such as lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, bronchitis, and asthma. Much of this risk is due to the fact that a single WTS session exposes users to large volumes of smoke that contain toxic chemicals such as carbon monoxide, cancer-causing polycyclic aromatic hydrocarbons, and volatile aldehydes. Unlike cigarette smoking, WTS poses unique risks of acute negative health outcomes including carbon monoxide poisoning and the spread of communicable diseases such as herpes and tuberculosis. Because waterpipe tobacco smoke contains the addictive chemical nicotine, youth who smoke tobacco from a waterpipe may be at risk for dependence. As a result, many youth may initiate WTS and continue to use despite negative health effects. Considering many of the potential negative health effects associated with WTS affect the pulmonary system, pulmonologists and primary care providers may treat patients who are waterpipe tobacco smokers and should be aware of the risk associated with WTS. The purpose of this review is to describe a waterpipe, the prevalence and correlates of WTS, the toxicants found in waterpipe tobacco smoke, the health effects of WTS, and implications for pulmonologists and other clinicians.
Collapse
Affiliation(s)
- Eric K. Soule
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298, USA, Phone: 804-827-3562
| | - Thokozeni Lipato
- Virginia Commonwealth University, School of Medicine, PO Box 980102, Richmond, VA 23298, USA, Phone: 804-628-3626
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298, Phone: 804-827-4617, Fax: 804-828-7862
| |
Collapse
|