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Lund L, Andersen S, Ritz C, Bast LS. Predicting longitudinal changes in patterns of tobacco and nicotine product use among adolescents: A Latent Transition Analysis based on the X:IT study. Soc Sci Med 2024; 352:117029. [PMID: 38843676 DOI: 10.1016/j.socscimed.2024.117029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Understanding factors influencing the transition from non-use to tobacco and nicotine product initiation among adolescents is crucial for designing and implementing effective preventive strategies. This study explores transition patterns among 13-15-year-old adolescents in lower secondary school, focusing on the transition from non-use to tobacco and nicotine product initiation and the influence of individual, social, risk behavioral, and mental health factors on this transition. METHODS Based on data from a Danish smoking prevention trial between 2017 and 2019, this study employed questionnaire surveys at three time points: baseline (start of seventh grade, n = 1,990, response rate = 86.3%), eight-month follow-up (end of seventh grade, n = 1,666, response rate = 74,8%), and 20-month follow-up (end of eighth grade, n = 1,149, response rate = 70,6%). Tobacco and nicotine use indicators included current and lifetime use of cigarettes and lifetime use of e-cigarettes, smokeless tobacco, and hookah. A latent transition analysis was applied to identify longitudinal transition patterns across waves and to explore predictors of these patterns. RESULTS Three user classes emerged across all waves: none-use, lifetime e-cigarette and cigarette use, and poly-tobacco use. While the most prevalent class was the non-user class (71%-86%), the proportion of the lifetime e-cigarette and cigarette class increased over time (from 12% to 17%). Similarly, the poly-tobacco user class increased from 2% to 12%. The probability of transitioning from non-use to lifetime e-cigarette and cigarette use increased from 0.5% at baseline to 12% by the second follow-up, while the probability of transitioning from lifetime e-cigarette and cigarette use remained stable over time (12%-15%). Across all waves, elevated risk behavior predicted this transition. For instance, binge-drinking (OR = 3.76, 95% CI: 1.51-9.34), susceptibility to smoking (OR = 7.63, 95% CI: 3.68-16.83), and truancy (OR = 7.00, 95% CI: 1.98-24.59) influenced the transition from non-use at baseline to lifetime e-cigarette and cigarette use at first follow-up. Additionally, boys, adolescents with low socioeconomic status, low life satisfaction, and those with smoking friends or parents were more likely to transition from non-use to lifetime e-cigarette and cigarette use. CONCLUSION This study demonstrates that sociodemographic, social risk, behavioral, and mental health factors impact the transition from non-use to lifetime e-cigarette and cigarette use. The findings provide valuable insights for developing targeted preventive strategies focusing on these influencing factors.
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Affiliation(s)
- Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
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Laroussy K, Castellano Y, Fu M, Baena A, Feliu A, Peruga A, Margalef M, Aldazabal J, Tigova O, Galimany J, Puig M, Moreno C, Bueno A, López A, Roca J, Saura J, Fernández E, Martínez C. Transitions in smoking status in nursing students: A prospective longitudinal study. J Adv Nurs 2023; 79:3456-3472. [PMID: 36978253 DOI: 10.1111/jan.15665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
AIM To describe transitions in smoking status and their determining factors among nursing students between baseline (2015-2016) and follow-up (2018-2019). DESIGN Observational prospective longitudinal study of 4381 nursing students in Catalonia (Spain). METHODS We examined transitions in smoking status from: (i) current smokers to recent quitters, (ii) never smokers to new smokers and (iii) former smokers to quitters who relapsed. We fitted logistic regression models to assess the predictors of quitting smoking. RESULTS The proportion of current smokers decreased from 29.7% at baseline to 23.6% at follow-up, with a cumulative incidence rate of quitting of 28.3% during follow-up. Nondaily smokers were more likely to quit than daily smokers. Of those who were never smokers at baseline, 4.6% were smokers at follow-up, and 23.2% of former smokers at baseline had relapsed at follow-up. CONCLUSIONS Nondaily smokers were more likely to have quit smoking at follow-up among this cohort of nursing students. The early implementation of a comprehensive tobacco control program that includes tobacco-free campus policies, tobacco prevention interventions and cessation support during college years may decrease tobacco use among nursing students. IMPACT Nursing students' tobacco use is concerning, as they are the future workforce of nurses who have a key role in tobacco product use prevention and cessation. During college years, nursing students have a greater likelihood of experimenting with several smoking status changes as well as to consolidate smoking behaviors. This is the first longitudinal study to highlight the factors associated with quitting smoking among a cohort of Spanish nursing students. Being a nondaily smoker at baseline predicted quitting at follow-up. Our findings support the early implementation of a comprehensive tobacco control program that includes tobacco-free campus policies, tobacco prevention interventions and tobacco cessation support during college years to decrease tobacco product use prevalence among nursing students. REPORTING METHOD We have adhered to STROBE guidelines. No Patient or Public Contribution. This observational study has not been registered.
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Affiliation(s)
- Kenza Laroussy
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Yolanda Castellano
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marcela Fu
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Antoni Baena
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of e-Health, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla de Poblenou 156, 08018, Barcelona, Spain
| | - Ariadna Feliu
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Armando Peruga
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Faculty of Medicine, Center for Epidemiology and Health Policy, Clínica Alemana, Universidad del Desarrollo, Región Metropolitana, Lo Barnechea, Chile
| | - Mercè Margalef
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Jon Aldazabal
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Olena Tigova
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Jordi Galimany
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Montserrat Puig
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Carmen Moreno
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Albert Bueno
- Nursing Care Management, EAP Roses, Institut Català de Salut, Crta Mas Oliva no. 23, Roses, 17480, Alt Empordà, Spain
| | - Antonio López
- Nursing Care Management, EAP Valls Urbano, c/ Vallvera no. 8, 43800, Tarragona, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig 2, 25198, Lleida, Spain
| | - Judith Saura
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Esteve Fernández
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Clincial Science, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Cristina Martínez
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of the Medicine and Health Sciences, University of Barcelona, C. Feixa llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
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Huang S, Chen Q, Griffin P, Liu G, Azagba S. Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5. Addict Behav 2023; 138:107548. [PMID: 36444788 DOI: 10.1016/j.addbeh.2022.107548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. METHODS Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. RESULTS Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. CONCLUSIONS The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.
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Affiliation(s)
- Siyi Huang
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA.
| | - Paul Griffin
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA; Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA, USA; Department of Psychiatry and Behavioral Health, The Pennsylvania State University, Hershey, PA, USA
| | - Sunday Azagba
- Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA; Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
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Ozga-Hess JE, Romm KF, Felicione NJ, Dino G, Blank MD, Turiano NA. Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020; 163:110076. [PMID: 34321706 PMCID: PMC8313022 DOI: 10.1016/j.paid.2020.110076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.
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Affiliation(s)
| | - Katelyn F. Romm
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | | | - Geri Dino
- WV Prevention Research Center, West Virginia University, Morgantown, WV, USA
- WV Clinical and Translational Sciences Institute, West Virginia University, Morgantown, WV, USA
| | - Melissa D. Blank
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Ruglass LM, Espinosa A, Fitzpatrick S, Meyer MK, Cadet K, Sokolovsky A, Jackson KM, White HR. Prevalence and Correlates of Concurrent and Simultaneous Cannabis and Cigarette Use among Past-Year Cannabis-Using US College Students. Subst Use Misuse 2020; 55:329-336. [PMID: 31573377 PMCID: PMC6980755 DOI: 10.1080/10826084.2019.1668015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Cannabis and tobacco use are significant public health concerns among young adults, with concurrent (in the same time period) and simultaneous (at the same time so the effects overlap) use of both substances on the rise. Few studies have examined these behaviors among college students. Objective: We examined the prevalence of concurrent and simultaneous cannabis and cigarette (combustible or electronic) use among a sample of college students and characterized the psychosocial predictors of concurrent and simultaneous use compared to using cannabis alone. Methods: Data on past-3 months cannabis and cigarette use were collected on 1352 college students who were past-year cannabis and alcohol users yielding four groups: cannabis-only users (n = 686), concurrent cannabis and cigarette users (CCAC; n = 235), simultaneous cannabis and cigarette users (SCAC; n = 293), and non-recent users of either substance (n = 138). Multinomial logistic regression analyses were utilized to predict group membership. Results: Relative to the cannabis-only group, White, compared to Non-White students, males, compared to females, frequent, compared to infrequent, alcohol users, including those who used alcohol simultaneously with cigarettes, and illicit drug users were more likely to belong to the CCAC or SCAC group. Conclusions: Findings suggest the need for unique intervention efforts to prevent onset or reduce co-use among male and White students as well as illicit drug users and frequent alcohol users.
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Affiliation(s)
- Lesia M Ruglass
- Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
| | - Adriana Espinosa
- Department of Psychology, City College of New York, CUNY, New York, NY, USA
| | | | - M Kamran Meyer
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Kechna Cadet
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Helene R White
- Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
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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.
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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
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