The global epidemiology of waterpipe smoking.

PubMed

Maziak, Wasim; Taleb, Ziyad Ben; Bahelah, Raed; Islam, Farahnaz; Jaber, Rana; Auf, Rehab; Salloum, Ramzi G

2015-03-01

In the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become a global phenomenon. In this review, we provide an updated picture of the main epidemiological trends in waterpipe smoking globally. Peer-reviewed publications indexed in major biomedical databases between 2004 and 2014. Search keywords included a combination of: waterpipe, hookah, shisha along with epidemiology, patterns, prevalence and predictors. We also used different spellings of waterpipe terms commonly used. The focus was on studies with large representative samples, national data or high-quality reports that illuminated aspects of the epidemiology and trends in waterpipe smoking. Multiple researchers extracted the data independently and collectively decided on the most important and pertinent studies to include in the review. Waterpipe smoking has become a global phenomenon among youth. The global waterpipe epidemic is likely driven by (1) the introduction of manufactured flavoured tobacco (Maassel); (2) the intersection between waterpipe's social dimension and thriving café culture; (3) the evolution of mass communication media; (4) the lack of regulatory/policy framework specific to the waterpipe. Waterpipe smoking is becoming the most popular tobacco use method among youth in the Middle East, and is quickly gaining popularity elsewhere. Important patterns of waterpipe smoking include the predominance among younger, male, high socioeconomic, and urban groups. Intermittent and social use are also noted patterns. Waterpipe smoking has become a global public health problem. Developing surveillance, intervention and regulatory/policy frameworks specific to the waterpipe has become a public health priority. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Acrolein Exposure in Hookah Smokers and Non-Smokers Exposed to Hookah Tobacco Secondhand Smoke: Implications for Regulating Hookah Tobacco Products.

PubMed

Kassem, Nada O F; Kassem, Noura O; Liles, Sandy; Zarth, Adam T; Jackson, Sheila R; Daffa, Reem M; Chatfield, Dale A; Carmella, Steven G; Hecht, Stephen S; Hovell, Melbourne F

2018-03-06

Acrolein is a highly ciliatoxic agent, a toxic respiratory irritant, a cardiotoxicant, and a possible carcinogen present in tobacco smoke including hookah tobacco. 105 hookah smokers and 103 non-smokers attended exclusively hookah smoking social events at either a hookah lounge or private home, and provided urine samples the morning of and the morning after the event. Samples were analyzed for 3-hydroxypropylmercapturic acid (3-HPMA), a metabolite of acrolein. Geometric mean (GM) urinary 3-HPMA levels in hookah smokers and non-smokers exposed to secondhand smoke (SHS) increased significantly, 1.41 times, 95% CI = 1.15 to 1.74 and 1.39 times, 95% CI = 1.16 to 1.67, respectively, following a hookah social event. The highest increase (1.68 times, 95% CI = 1.15 to 2.45; p = 0.007) in 3-HPMA post a hookah social event was among daily hookah smokers (GM, from 1991 pmol/mg to 3348 pmol/mg). Pre-to-post event change in urinary 3-HPMA was significantly positively correlated with pre-to-post event change in urinary cotinine among hookah smokers at either location of hookah event, (ρ = 0.359, p = 0.001), and among non-smokers in hookah lounges (ρ = 0.369, p = 0.012). Hookah tobacco smoke is a source of acrolein exposure. Findings support regulating hookah tobacco products including reducing humectants and sugar additives, which are precursors of acrolein under certain pyrolysis conditions. We suggest posting health warning signs for indoor smoking in hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes. Our study is the first to quantify the increase in acrolein exposure in hookah smokers and non-smokers exposed to exclusively hookah tobacco SHS at hookah social events in homes or hookah lounges. Our findings provide additional support for regulating hookah tobacco product content, protecting non-smokers' health by posting health warning signs for indoor smoking in hookah lounges, and encouraging home bans on hookah tobacco smoking to

Arab-American Hookah Smokers: Initiation, and Pros and Cons of Hookah Use.

PubMed

Kassem, Nada O F; Kassem, Noura O; Jackson, Sheila R; Daffa, Reem M; Liles, Sandy; Hovell, Melbourne F

2015-09-01

To examine initiation, pros and cons of hookah tobacco smoking among Arab Americans. In this descriptive cross-sectional study, we recruited a community-based convenience sample of 458 adult Arab-American hookah smokers, mean age 28.4 years, who completed self-administered questionnaires. Irrespective of sex, most participants initiated hookah tobacco use by young adulthood in private homes or hookah lounges influenced by friends and family. Women initiated hookah use later than men. Ever dual smokers (hookah smokers who ever smoked a cigarette) initiated hookah use later than cigarettes; however, early hookah initiators < 18 years initiated hookah and cigarettes concurrently. Participants enjoyed the flavors of hookah tobacco, and complained about coughing, dizziness, and headaches. Early and late initiation of hookah tobacco use warrant prevention programs targeting the youth and older adults in communities, colleges, and middle and high schools that include health education campaigns, and encouragement of voluntary smokefree home rules. Tobacco control policies aimed to prevent initiation of hookah use should include regulation of hookah tobacco flavors, and should target the physical environments in neighborhoods, especially around schools and colleges, to reduce the proliferation of hookah lounges. Dual hookah tobacco and cigarette use warrant continuous monitoring.

Pattern of shisha and cigarette smoking in the general population in Malaysia.

PubMed

Al-Naggar, Redhwan A; Bobryshev, Yuri V; Anil, Shirin

2014-01-01

Smoking is a primary risk factor for cancer development. While most research has focused on smoking cigarettes, the increasing popularity of shisha or water pipe smoking has received less attention. This study measured the prevalence and risk factors for shisha and cigarette smoking and related knowledge. This cross-sectional analytical study was conducted in Shah Alam, Malaysia. Participants aged ≥ 18 years were selected from restaurants. Data regarding demographic variables, smoking patterns, and knowledge about shisha smoking were collected in local languages. Logistic regression was performed to assess risk factors. Of 239 participants, 61.9 % were male and 99.2% revealed their smoking status. Some 57.4% were smokers: 50.7% only cigarettes, 5.9% only shisha and 42% both. Mean age of starting cigarette smoking was 17.5 ± 2.4 years and for shisha smoking 18.7 ± 2.0 years. In a univariate model, male gender, age 33-52 years and monthly income > MYR 4,000 increased the risk and unemployment and being a student decreased the risk. In a multivariate model, male gender increased the risk of smoking, while being a student decreased the risk, adjusting for age and income. The perception of shisha being less harmful than cigarettes was present in 14.6% and 7.5% had the opinion that shisha is not harmful at all, while 21.7% said that it is less addictive than cigarettes, 39.7% said that shisha did not contain tar and nicotine, 34.3% said that it did not contain carbon monoxide and 24.3% thought that shisha did not cause health problems. Prevalence of shisha and cigarette smoking is high in the general population in Malaysia and knowledge about shisha smoking is relatively low. The findings of our study might have implications for understanding similarities and differences in incidence of shisha and cigarette smoking in other cultural/geographic regions.

Water pipe (shisha) smoking and associated factors among Malaysian university students.

PubMed

Al-Naggar, Redhwan Ahmed; Saghir, Fatma S A

2011-01-01

The objective of this study was to determine the prevalence of waterpipe (shisha) smoking and associated factors among Malaysian university students. A total of 200 university students from Management and Science University participated in this study. The survey was conducted by simple random sampling by randomly distributing self-administered questionnaires to the library, cafeterias and classes. The protocol of this study was approved by the ethics committee of Management and Science University. Consent forms were obtained from the students before they answered the questionnaire. Statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 13. with the Student's t-test for comparison of the mean practice and backward multiple linear regression for multivariate analysis. The majority of the subjects were male, single, Malay and from urban areas (61.5%, 94.5%, 66%, 76.5%; respectively). In this study 30% of the study participants were shisha smokers. Regarding knowledge about shisha smoking, the majority (48.5%) mentioned that shisha is less harmful than cigarettes and 55% reported that shisha is less addictive. Univariate analysis showed that age, race, sex and income significantly influenced the practice of smoking shisha among university students (p=0.019, p=0.002, p=0.001, p=0.018; respectively). For multivariate analysis, income and gender demonstrated significant influence (both p=0.001). There was a high prevalence of shisha smoking among Malaysian university students and knowledge about the dangers is low. Income and gender significantly influenced the practice of smoking shisha in our population. Banning of smoking including shisha smoking in public places is strongly recommended.

Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, tar and nicotine yields

PubMed Central

Shihadeh, Alan; Salman, Rola; Jaroudi, Ezzat; Saliba, Najat; Sepetdjian, Elizabeth; Blank, Melissa D.; Cobb, Caroline O.; Eissenberg, Thomas

2012-01-01

Waterpipe (hookah, narghile, shisha) use has become a global phenomenon, with numerous product variations. One variation is a class of products marketed as “tobacco-free” alternatives for the “health conscious user”. In this study toxicant yields from waterpipes smoked using conventional tobacco-based and tobacco-free preparations were compared. A human-mimic waterpipe smoking machine was used to replicate the puffing sequences of 31 human participants who completed two double-blind ad libitum smoking sessions in a controlled clinical setting: once with a tobacco-based product of their choosing and once with a flavor-matched tobacco-free product. Outcome measures included yields of carbon monoxide, nitric oxide, volatile aldehydes, nicotine, tar, and polycyclic aromatic hydrocarbons. Smoke from both waterpipe preparations contained substantial quantities of toxicants. Nicotine yield was the only outcome that differed significantly between preparations. These findings contradict advertising messages that “herbal” waterpipe products are a healthy alternative to tobacco products. PMID:22406330

What Is a Hookah?

MedlinePlus

... hookah smoking could be even more dangerous than cigarettes because people often smoke at hookah bars for an hour or more. Hookah Pens Hookah pens are basically another kind of e-cigarette (vape pen). Some disposable hookah pens vaporize a ...

Hookahs

MedlinePlus

... Exposure is High in Multiunit Housing Smokeless Products Electronic Cigarettes Youth Tobacco Prevention Tobacco Products Tobacco Ingredient ... from 22% to 40%. 5 New forms of electronic hookah smoking, including steam stones and hookah pens, ...

Benzene uptake in Hookah smokers and non-smokers attending Hookah social events: regulatory implications.

PubMed

Kassem, Nada O F; Kassem, Noura O; Jackson, Sheila R; Liles, Sandy; Daffa, Reem M; Zarth, Adam T; Younis, Maram A; Carmella, Steven G; Hofstetter, C Richard; Chatfield, Dale A; Matt, Georg E; Hecht, Stephen S; Hovell, Melbourne F

2014-12-01

Benzene is a human hematotoxicant and a leukemogen that causes lymphohematopoietic cancers, especially acute myelogenous leukemia. We investigated uptake of benzene in hookah smokers and non-smokers attending hookah social events in naturalistic settings where hookah tobacco was smoked exclusively. We quantified S-phenylmercapturic acid (SPMA), a metabolite of benzene, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home. Urinary SPMA levels in hookah smokers increased significantly following a hookah social event (P < 0.001). This increase was 4.2 times higher after hookah lounge events (P < 0.001) and 1.9 times higher after home events (P = 0.003). In non-smokers, urinary SPMA levels increased 2.6 times after hookah lounge events (P = 0.055); however, similar urinary SPMA levels were detected before and after home events, possibly indicating chronic exposure to benzene (P = 0.933). Our data provide the first evidence for uptake of benzene in hookah smokers and non-smokers exposed to hookah tobacco secondhand smoke at social events in private homes compared with their counterparts in hookah lounges. Hookah tobacco smoke is a source of benzene exposure, a risk factor for leukemia. Because there is no safe level of exposure to benzene, our results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, initiate labeling of hookah-related products, and include hookah smoking in clean indoor air legislation.

Urinary NNAL in hookah smokers and non-smokers after attending a hookah social event in a hookah lounge or a private home.

PubMed

Kassem, Nada O F; Kassem, Noura O; Liles, Sandy; Jackson, Sheila R; Chatfield, Dale A; Jacob, Peyton; Benowitz, Neal L; Hovell, Melbourne F

2017-10-01

Tobacco smoking and exposure to tobacco secondhand smoke (SHS) can cause lung cancer. We determined uptake of NNK (4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone), a tobacco specific potent pulmonary carcinogen, in hookah smokers and non-smokers exposed to hookah tobacco SHS. We analyzed data from a community-based convenience sample of 201 of adult (aged ≥18 years) exclusive hookah smokers (n = 99) and non-smokers (n = 102) residing in San Diego County, California. Participants spent an average of three consecutive hours indoors, in hookah lounges or private homes, where hookah tobacco was smoked exclusively. Total NNAL [the sum of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides], the major metabolites of NNK, were quantified in spot urine samples provided the morning of and the morning after attending a hookah event. Among hookah smokers urinary NNAL increased significantly (p<0.001) following a hookah social event; the geometric mean doubled, from 1.97 to 4.16 pg/mg. Among non-smokers the increase was not significant (p = 0.059). Post hookah event urinary NNAL levels were highest in daily hookah smokers, and significantly higher than in non-daily smokers or non-smokers (GM: 14.96 pg/mg vs. 3.13 pg/mg and 0.67 pg/mg, respectively). For both hookah smokers and non-smokers, pre-to-post event change in urinary NNAL was not significantly different between hookah lounges and homes. We suggest posting health warning signs inside hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes. Copyright © 2017 Elsevier Inc. All rights reserved.

Associations between Hookah Tobacco Smoking Knowledge and Hookah Smoking Behavior among US College Students

ERIC Educational Resources Information Center

Nuzzo, Erin; Shensa, Ariel; Kim, Kevin H.; Fine, Michael J.; Barnett, Tracey E.; Cook, Robert; Primack, Brian A.

2013-01-01

Hookah tobacco smoking is increasing among US college students, including those who would not otherwise use tobacco. Part of hookah's appeal is attributed to the perception that hookah is less harmful than cigarettes. The aims of this study were to assess knowledge of harmful exposures associated with hookah smoking relative to cigarette smoking…

Portrayal of waterpipe (shisha, hookah, nargile) smoking on Twitter: a qualitative exploration.

PubMed

Grant, A; O'Mahoney, H

2016-11-01

To describe and characterize social media content in relation to waterpipe smoking using qualitative methods. Exploratory qualitative design. A representative sample of pre-existing social media content from Twitter relating to waterpipe smoking and written in the English language was collected during a 1 week period in July 2014. A total of 9671 tweets were collected; duplicates and retweets were removed leaving 4439 unique tweets. Data were analyzed semiotically (positive, negative, positive and negative, no sentiment, unclassifiable) and thematically. Photographs attached to tweets written by individual users indexed using #hookah (n = 299) were subjected to content analysis. Over half of all tweets were positive about waterpipe smoking (59%), with 3% negative, 21% lacking sentiment and 17% unclassifiable. However, there were variations by likely author of tweet, with 91% of tweets from individual users classified as positive. Twitter users focused on their emotional experience, location, other products they were consuming alongside waterpipe smoking, and who they were with. Analysis of photographs highlighted a high degree of synergy between text and visual representations of waterpipe smoking, and two thirds of photographs contained at least part of a waterpipe. Waterpipe smoking may be normalized as an enjoyable activity in this online environment, posing a challenge for public health. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

An Unusual Cause of Carbon Monoxide Poisoning: Narghile Smoking

PubMed Central

Ateş, Alpay; Arikan, Müge; Özgök, Ayşegül

2016-01-01

Patient: Male, 27 Final Diagnosis: Carbon monoxide poisoning Symptoms: Dizziness • nausea • Syncope Medication: — Clinical Procedure: O2 treatment Specialty: Anesthesiology Objective: Challenging differential diagnosis Background: Carbon monoxide (CO) poisoning is commonly seen during the winter season in Turkey due to use of charcoal stoves and water heaters, but narghile smoking is a rare cause of CO poisoning. Case Report: In this paper, we report a CO poisoning case caused by narghile smoking. The patient was admitted to the ED with nausea, dizziness, vertigo, and syncope. Conclusions: The diagnosis of CO poisoning depends on suspicious anamnesis. The major treatment of CO poisoning is oxygen supply. PMID:27618983

Hookah's new popularity among US college students: a pilot study of the characteristics of hookah smokers and their Facebook displays.

PubMed

Brockman, Libby N; Pumper, Megan A; Christakis, Dimitri A; Moreno, Megan A

2012-01-01

(1) To confirm the prevalence of hookah use among US college students. (2) To identify substances commonly smoked in hookahs and other substance use characteristics of hookah smokers. (3) Given the powerful influence of Facebook and its potential role in promoting behaviours, to assess the prevalence of hookah references on Facebook profiles. Cross-sectional study. Two large US universities; www.Facebook.com. 307 Facebook profiles were coded and 216 of these profile owners completed an online survey. On average, participants were 18.8 years old (SD=0.7), women (54%), Caucasian (70.4%) and approximately half were from each university. Lifetime and frequency of hookah use, substance smoked in hookah, cigarette and marijuana use, hookah references displayed on Facebook. 27.8% of participants endorsed hookah use; there were no significant differences between age, gender, race or university for hookah use. Hookah users reported smoking tobacco (78%), hash (12%) and both tobacco and marijuana/hash (10%) in their hookah. Compared with non-hookah smokers, hookah smokers were more likely to report using cigarettes (OR=3.41, 95%CI=1.2 to 9.64) and marijuana (OR=15.01, 95%CI=6.5 to 34.65). Hookah references were present on 5% of Facebook profiles. More than one quarter of college students smoke hookah. Most smoke tobacco in their hookah, and hookah smoking is associated with polysubstance use. Hookah may present new risks for nicotine addiction in this population.

Hookah's new popularity among US college students: a pilot study of the characteristics of hookah smokers and their Facebook displays

PubMed Central

Brockman, Libby N; Pumper, Megan A; Christakis, Dimitri A; Moreno, Megan A

2012-01-01

Objectives (1) To confirm the prevalence of hookah use among US college students. (2) To identify substances commonly smoked in hookahs and other substance use characteristics of hookah smokers. (3) Given the powerful influence of Facebook and its potential role in promoting behaviours, to assess the prevalence of hookah references on Facebook profiles. Design Cross-sectional study. Setting Two large US universities; www.Facebook.com. Participants 307 Facebook profiles were coded and 216 of these profile owners completed an online survey. On average, participants were 18.8 years old (SD=0.7), women (54%), Caucasian (70.4%) and approximately half were from each university. Outcome measures Lifetime and frequency of hookah use, substance smoked in hookah, cigarette and marijuana use, hookah references displayed on Facebook. Results 27.8% of participants endorsed hookah use; there were no significant differences between age, gender, race or university for hookah use. Hookah users reported smoking tobacco (78%), hash (12%) and both tobacco and marijuana/hash (10%) in their hookah. Compared with non-hookah smokers, hookah smokers were more likely to report using cigarettes (OR=3.41, 95%CI=1.2 to 9.64) and marijuana (OR=15.01, 95%CI=6.5 to 34.65). Hookah references were present on 5% of Facebook profiles. Conclusions More than one quarter of college students smoke hookah. Most smoke tobacco in their hookah, and hookah smoking is associated with polysubstance use. Hookah may present new risks for nicotine addiction in this population. PMID:23242241

Analytical Determination of Nicotine and Tar Levels in Various Dokha and Shisha Tobacco Products.

PubMed

Mahboub, Bassam; Mohammad, Ayesha Begum; Nahlé, Ayssar; Vats, Mayank; Al Assaf, Omar; Al-Zarooni, Hamdan

2018-05-10

In the Middle East, there is no precise data and literature on tobacco-based products, such as dokha and shisha. The proposed study aims to quantify the levels of nicotine and tar in different kinds of dokha and shisha products that are sold in the local marketplace. The amount of nicotine in dokha and shisha products can be quantitatively determined using a combination of the "kissling" and "silicotungstic acid" method proposed by Robert M. Chapin. The tar residue from the smoke sample was collected on a glass wool placed before the stopcock (tap) of a separatory funnel as the smoke passes through the inlet of an electronically controlled vacuum pump. The nicotine levels in dokha and shisha samples ranged from 23.83 to 52.80 mg/g and 0.80 to 20.52 mg/g, respectively. The nicotine level varies between different tobacco products. It varies from 0.5 to 19.5 mg/g in cigarettes, from 10.3 to 23.1 mg/g in snuff tobacco, from 11 to 18 mg/g in electronic cigarettes and from 2.9 to 16.6 mg/g in chewing tobacco. The tar levels in the dokha and shisha samples ranged from 21.6 to 45.02 mg/g and 1.68 to 11.87 mg/g, respectively. Smokers are at a high risk of getting lung cancer, chronic obstructive pulmonary disease, emphysema and coronary artery disease owing to the high levels of nicotine and tar present in dokha and shisha tobacco products. These findings contradict the widespread belief among teenagers that dokha and shisha tobacco products are safer alternatives to cigarettes.

Fallacies about water pipe use in Turkish university students - what might be the consequences?

PubMed

Alvur, Muge Tuncay; Cinar, Nursan; Akduran, Funda; Dede, Cemile

2014-01-01

The popularity of the narghile waterpipe, also referred to as hookah, shisha or hubble-bubble has increased tremendously during the past few decades. The aim of this study was to expose perception of narghile among a representative sample of university students in Sakarya University campus. Written approval was taken from the local education authority. An anonymous questionnaire which was prepared by the investigators and contained 17 questions was administered. Nine of the questions were related to socio-demographic characteristics and eight were related to the students harm perceptions about waterpipe. A total of 1,320 questionnaries were received and after preliminary evaluation 1,255 (95.7%) were found to be suitable for evaluation. The data was evaluated in SPSS program by using percentages and averages. The mean ± SD age of the students was 20.8 ± 2.29 years (min 18, max 32). There were 864 (68.8%) females and 391 (31.2%) males. A total of 6.3 % of the students (n=79) believed that waterpipe is not harmful because its smoke does not burn the lungs. Almost one-third (n=318) think that the carcinogenic chemicals are filtered while waterpipe smoke passes from the water; 12.1 % of the students (n=152) checked "true" for the statement of "waterpipe smoke contains no nicotine". It is seen that 14.0 % of the students (n=176) think waterpipe with fruit/ aroma is healthier than plain waterpipe. As a result of this study, it is found out that a substantial number of university students have false beliefs on harmful effects of waterpipe smoking.

College students' perceptions and knowledge of hookah use.

PubMed

Creamer, MeLisa R; Loukas, Alexandra; Li, Xiaoyin; Pasch, Keryn E; Case, Kathleen; Crook, Brittani; Perry, Cheryl L

2016-11-01

Hookah is an increasingly popular tobacco product among college students. The purpose of this study was to determine if college students are aware of tobacco and nicotine content in hookah, and examine associations between college students' knowledge and perceptions of hookah and their past 30-day hookah use. Participants were 5451 young adults attending one of 24 2- and 4-year colleges. Analyses examined if hookah knowledge was uniquely associated with current hookah use, over and above perceptions of harm and addictiveness, number of other tobacco products currently used, and socio-demographic factors. Analyses were first conducted for the entire sample and then only for current hookah users. 26.9% of all students believed hookah did not contain tobacco and 38% believed that hookah did not contain nicotine. Students who believed that hookah contained tobacco were at increased odds of hookah use, and those with increased perceptions of harm were at decreased odds of hookah use. However, hookah knowledge was not associated with hookah users' intensity of use. Moreover, although increased perceptions of harm were associated with lower intensity of use among current users, increased perceptions of addictiveness were associated with higher intensity of use. This study shows gaps in knowledge of hookah contents, and adds to the body of literature, which provides evidence for mandating warning labels as well as tobacco interventions for college students. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The waterpipe: time for action.

PubMed

Maziak, Wasim

2008-11-01

The waterpipe, known in many cultures under different shapes and names (e.g. hookah, shisha, narghile), is a centuries-old tobacco use method that is witnessing a world-wide surge in popularity. This popularity is most noticeable among youths, and is surpassing cigarette smoking among this group in some societies. Many factors may have contributed to the recent waterpipe spread, including the introduction of sweetened/flavored waterpipe tobacco (known as Maassel), its reduced-harm perception, the thriving café culture, mass media and the internet. The passage of smoke through water on its way to the smoker underlies much of the common misperception that waterpipe use is less harmful than cigarettes. The health/addictive profile of waterpipe compared to cigarettes is largely unresearched and is likely to be influenced by the properties of smoke, duration and frequency of use, type of tobacco used, volume of smoke inhaled and the contribution of charcoal. However, the accumulation of evidence about the harmful and addictive potential of waterpipe use is outpacing the public health response to this health risk. A timely public health and policy action is needed in order to curb the emerging waterpipe smoking epidemic.

Pleasure and practice: a qualitative study of the individual and social underpinnings of shisha use in cafes among youth in the UK

PubMed Central

Haberer, Jessica E; O’Neil, Ivy

2018-01-01

Objectives To explore (1) the social function of shisha cafes for young people living in the UK and (2) other alternative activities (existing or potential) that do not involve tobacco smoking. Methods We conducted qualitative interviews with young adults (age 18–30) in Leeds, UK. Snowballing sampling was used in selecting the participants. Interviews were audio-recorded and explored the perspectives and experiences of young people in as well as potential alternative activities. Data were transcribed and analysed thematically. Results Shisha use plays a central role in social interactions. Youth described using shisha because of emotional and sensory pleasure. Shisha use was implicitly endorsed by respected professionals, such as doctors and university lecturers, who were seen smoking it. Most, but not all, shisha smokers acknowledged that shisha use is harmful. Suggestions for reducing shisha use included use of non- tobacco alternatives, legislation to reduce access and alternative means for socialising, such as sports. Conclusion For young people in the UK, the known health dangers of shisha are outweighed by its social benefits and shisha is perceived as acceptable. Interventions to reverse the increase in shisha cafes should focus on both individual smoker as well as the community, without sacrificing the importance of social interactions. PMID:29654007

Perception of young adults toward hookah use in Mumbai.

PubMed

Dani, K K; Oswal, K; Maudgal, S; Saranath, D

2015-01-01

The use of tobacco has been on the rise globally including in India, posing a grave public health problem. Recently, tobacco use through hookah smoking has increased among young adults in India, Middle East, Southwest Asia, Africa, Europe and North America. Hookah prevalence of 0.4-15% has been reported in India. The aim of the study was to understand perception of hookah use among young adults in Mumbai. A total of 500 college students, with/without hookah habit, were given a self-administered questionnaire to indicate their perception of hookah use, using yes/no responses. The responses were analyzed in the users/non-users and considered significantly different at P < 0.05. Responses were received from 122 hookah users and 325 non-users. The perception of hookah use between users and non-users and males and females, showed significant differences (P < 0.05), with respect to hookah being injurious to health, causes cancer, is addictive, influence of a close friend, flavors, curiosity toward hookah use and willingness to prepare hookah at home. Whereas, differences in the groups perception of hookah as safer than cigarettes, harmful air quality, ambience, cool look and means of socializing, was not observed. The perception of young adults in Mumbai, toward hookah use, indicates an increased trend to use hookah. We recommend deterrents for hookah use by display of health warnings on hookah assembly and the tobacco products, implementation of government policies on hookah and tobacco use and punitive measures for offenders.

Pulmonary functions of narghile smokers compared to cigarette smokers: a case-control study.

PubMed

Ben Saad, Helmi; Khemiss, Mehdi; Nhari, Saida; Ben Essghaier, Mejda; Rouatbi, Sonia

2013-01-01

Studies of the lung function profiles of exclusive narghile smokers (ENS) are few, have some methodological limits, and present contradictory conclusions. The present study aimed to compare the plethysmographic profiles of ENS with age- and height-matched exclusive cigarette smokers (ECS). Males aged 35-60 living in Sousse, Tunisia, who have been smoking narghile exclusively for more than 10 narghile-years (n = 36) or cigarettes exclusively for more than 10 pack-years (n = 106) were recruited to participate in this case-control study. The anthropometric and plethysmographic data were measured according to international recommendations using a body plethysmograph (ZAN 500 Body II, Meβgreräte GmbH, Germany). Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as: first second forced expiratory volume/forced vital capacity (FEV1/FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total lung capacity < LLN. Lung hyperinflation was defined as residual volume > upper-limit-of-normal. Student t-test and χ(2) test were used to compare plethysmographic data and profiles of the two groups. The subjects in the ENS and ECS groups are well matched in age (45±7 vs. 47±5 years) and height (1.73±0.06 vs. 1.72±0.06 m) and used similar quantities of tobacco (36±22 narghile-years vs. 35±19 pack-years). Compared to the ENS group, the ECS group had significantly lower FEV1 (84±12 vs. 60±21%), FVC (90±12 vs. 76±18%), and FEV1/FVC (99±7 vs. 83±17%). The two groups had similar percentages of RVD (31 vs. 36%), while the ECS group had a significantly higher percentage of LAOVD (8 vs. 58%) and lung hyperinflation (36 vs.57%). Chronic exclusive narghile smoking has less adverse effects on pulmonary function tests than chronic exclusive cigarette smoking.

Pulmonary functions of narghile smokers compared to cigarette smokers: a case-control study.

PubMed

Saad, Helmi Ben; Khemiss, Mehdi; Nhari, Saida; Essghaier, Mejda Ben; Rouatbi, Sonia

2013-01-01

Background Studies of the lung function profiles of exclusive narghile smokers (ENS) are few, have some methodological limits, and present contradictory conclusions. The present study aimed to compare the plethysmographic profiles of ENS with age- and height-matched exclusive cigarette smokers (ECS). Methods Males aged 35-60 living in Sousse, Tunisia, who have been smoking narghile exclusively for more than 10 narghile-years (n = 36) or cigarettes exclusively for more than 10 pack-years (n = 106) were recruited to participate in this case-control study. The anthropometric and plethysmographic data were measured according to international recommendations using a body plethysmograph (ZAN 500 Body II, Meβgreräte GmbH, Germany). Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as: first second forced expiratory volume/forced vital capacity (FEV 1 /FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total lung capacity < LLN. Lung hyperinflation was defined as residual volume > upper-limit-of-normal. Student t-test and χ 2 test were used to compare plethysmographic data and profiles of the two groups. Results The subjects in the ENS and ECS groups are well matched in age (45±7 vs. 47±5 years) and height (1.73±0.06 vs. 1.72±0.06 m) and used similar quantities of tobacco (36±22 narghile-years vs. 35±19 pack-years). Compared to the ENS group, the ECS group had significantly lower FEV 1 (84±12 vs. 60±21%), FVC (90±12 vs. 76±18%), and FEV 1 /FVC (99±7 vs. 83±17%). The two groups had similar percentages of RVD (31 vs. 36%), while the ECS group had a significantly higher percentage of LAOVD (8 vs. 58%) and lung hyperinflation (36 vs.57%). Conclusion Chronic exclusive narghile smoking has less adverse effects on pulmonary function tests than chronic exclusive cigarette smoking.

Hookah Smoking Behavior Initiation in the Context of Millennials

PubMed Central

Castaneda, Gail; Barnett, Tracey E.; Soule, Eric K; Young, Mary Ellen

2016-01-01

Objectives This study aims to examine current hookah users’ perceptions, attitudes, and normative beliefs regarding hookah smoking to further elucidate the rise in hookah smoking prevalence among young adults (aged 18–24 years) and reveal why hookah smoking is perceived as less harmful than other forms of tobacco consumption. Study Design Qualitative. Methods Data analysis of six focus group interviews with hookah smokers between 18–24 years was analyzed using a grounded theory approach. Focus groups were evenly split between frequent and infrequent hookah users, and were predominantly composed of college students, with two groups of hookah users consisting of 18–24 year olds of non-student status. Results Hookah users shared a much larger set of positive hookah smoking behavioral beliefs as opposed to negative behavioral beliefs. Generational traits served as the overarching commonality among the behavior performance initiation determinants observed. The most notable generational trends observed were within the cultural category, which included the following millennial characteristics: autonomy, personalization, novelty appeal, convenience, globally oriented, entertainment, collaboration, health conscious, and valuing their social network. Conclusions Millennial hookah users revealed mindfulness regarding both potential negative and positive reasons stemming from continued hookah use; however, behavioral beliefs were primarily fixated on the perception that hookah smoking was a healthier alternative to cigarette smoking. Future implications for this study’s findings include generating more positive ways to express these traits for young adults; policy implications include raising hookah bar age limits, implementing indoor smoking restrictions, and limiting the ease of accessibility for purchasing hookah supplies. PMID:27003670

Hookah smoking behavior initiation in the context of Millennials.

PubMed

Castañeda, G; Barnett, T E; Soule, E K; Young, M E

2016-08-01

This study aims to examine current hookah users' perceptions, attitudes, and normative beliefs regarding hookah smoking to further elucidate the rise in hookah smoking prevalence among young adults (aged 18-24 years) and reveal why hookah smoking is perceived as less harmful than other forms of tobacco consumption. Qualitative. Data from six focus group interviews with hookah smokers aged between 18 and 24 years were analyzed using a grounded theory approach. Focus groups were evenly split between frequent and infrequent hookah users, and were predominantly composed of college students, with two groups of hookah users consisting of 18-24 year olds of non-student status. Hookah users shared a much larger set of positive hookah smoking behavioral beliefs as opposed to negative behavioral beliefs. Generational traits served as the overarching commonality among the behavior performance initiation determinants observed. The most notable generational trends observed were within the cultural category, which included the following millennial characteristics: autonomy, personalization, novelty appeal, convenience, globally oriented, entertainment, collaboration, health conscious, and valuing their social network. Millennial hookah users revealed mindfulness regarding both potential negative and positive reasons stemming from continued hookah use; however, behavioral beliefs were primarily fixated on the perception that hookah smoking was a healthier alternative to cigarette smoking. Future implications for this study's findings include generating more positive ways to express these traits for young adults; policy implications include raising hookah bar age limits, implementing indoor smoking restrictions, and limiting the ease of accessibility for purchasing hookah supplies. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Factors Associated with Hookah Use among Male High School Students: The Role of Demographic Characteristics and Hookah User and Non-User Prototypes.

PubMed

Bashirian, Saeed; Barati, Majid; Mohammadi, Younes; Mostafaei, Hossein

2016-01-01

As students' hookah use has become a widespread problem in the developing countries, it is time to understand the cognitive determinants of students' decisions to do so. This study aimed to investigate the roles of psychological and demographic factors associated with hookah use among male high school students. This descriptive-analytical study was performed among 601 high school male students, recruited through multistage sampling method in the Kermanshah City, west of Iran in 2016. The data-gathering tool consisted of a self-administered questionnaire with questions about hookah use behavior and demographic, behavioral and psychological variables. Data were analyzed using SPSS-18 software using chi-square and logistic regression. 36.1% of the participants reported ever hookah use and 17.1% mentioned using hookah in the past month. Pleasure (28.1%) and sensation seeking (22.5%) were common reasons of hookah use. In comparison to non-users, hookah users evaluated a typical hookah user as more clever, less immature, more popular, more attractive, more self-confident, more independent, and less selfish (P<0.001). The results revealed the importance of psychological factors when examining students' hookah use status. Thus, design and implementation of interventions might be effective in prevention of hookah use among students.

Calls to Poison Centers for hookah smoking exposures.

PubMed

Retzky, Sandra S; Spiller, Henry A; Callahan-Lyon, Priscilla

2018-06-01

Over the past decade, smoking behaviors have changed in the US. Hookah or waterpipe smoking is increasing, especially among youth and young adults. Social media sites describe the "hookah high" or "buzz", which may be related to nicotine, carbon monoxide, or other inhalants in hookah smoke. Most important is the risk of carbon monoxide poisoning. Case reports include a high number of victims presenting with loss of consciousness from either syncope or seizures. Anaphylaxis and a very rare respiratory hypersensitivity reaction, acute eosinophilic pneumonia, have also been reported from hookah smoking in previously healthy young adults. This article provides background information on hookah smoking, describes hookah-induced acute injuries that could precipitate poison center calls, and offers suggestions for exposure characterization.

Risk factors for hookah smoking among arabs and chaldeans.

PubMed

Jamil, Hikmet; Geeso, Sanabil G; Arnetz, Bengt B; Arnetz, Judith E

2014-06-01

Hookah smoking is more prevalent among individuals of Middle Eastern descent. This study examined general and ethnic-specific risk factors for hookah smoking among Arabs and Chaldeans. A self-administered anonymous questionnaire was conducted among 801 adults residing in Southeast Michigan. Binary logistic regression modeling was used to predict risk factors for hookah smoking. Hookah smoking was significantly more prevalent among Arabs (32%) than Chaldeans (26%, p < 0.01) and being Arab was a risk factor for lifetime hookah use. Younger age (<25 years), being male, higher annual income, and having health insurance were significant risk factors for hookah use. Chaldeans believed to a greater extent than Arabs that smoking hookah is less harmful than cigarette smoking (75 vs. 52%, p < 0.001). Hookah smoking is prevalent in both ethnic groups, but significantly higher among Arabs. Results indicate that prevention efforts should target younger males with higher incomes.

The rise in narghile (shisha, hookah) waterpipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers

PubMed Central

2011-01-01

Background The prevalence of waterpipe tobacco smoking (WTS) in the Middle East region and worldwide is increasing. There is evidence to indicate both short term and long term health effects of WTS, resulting in the issuance of an advisory note by the World Health Organization. Methods This research aimed at gaining an in-depth understanding of the factors contributing to the rise in WTS in Lebanon. Qualitative focus groups (25) and in-depth interviews (9) were conducted with adults in Lebanon in 2007. Participants were recruited to represent diversity in smoking status, gender, age groups and urban/rural residence. The interviews and focus groups were thematically analyzed, and recurrent themes noted and summarized. Results The main themes identified were availability, affordability, innovation, influence of media, lack of a policy framework, and the sensory characteristics evoked from WTS. Men and women, smokers and non-smokers, and younger and older participants differed in their emphases on the above themes. These themes, though specific to waterpipe, are similar to themes manipulated by the cigarette industry, and eventually controlled through tobacco control policies. Conclusions Understanding reasons behind the rise in waterpipe tobacco use is important if appropriate prevention, cessation, and policy interventions are to be formulated. Strict adherence to the FCTC is warranted, with careful and vigilant attention that all tobacco products are covered by laws in both high as well as middle to lower income countries. PMID:21569577

Knowledge and attitudes toward hookah usage among university students.

PubMed

Holtzman, Adam L; Babinski, Dara; Merlo, Lisa J

2013-01-01

Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. The sample included 943 university students recruited between February 2009 and January 2010. Respondents (M age = 20.02) included 376 males, 533 females, and 34 who did not report sex. An anonymous online questionnaire was completed by respondents. In this sample, 42.9% of college students had tried hookah, and 40% of those individuals had used it in the past 30 days. Students perceived fewer negative consequences of hookah smoking compared with cigarette smoking. Age, sex, racial background, marijuana/cigarette use, and perceptions of side effects were significantly associated with hookah use. University students are misinformed regarding the health consequences of hookah smoking. Programs aimed at education, prevention, and intervention for hookah use are needed to address this growing public health concern.

Hookah use among college students: prevalence, drug use, and mental health.

PubMed

Goodwin, Renee D; Grinberg, Alice; Shapiro, Jack; Keith, Diana; McNeil, Michael P; Taha, Farah; Jiang, Bianca; Hart, Carl L

2014-08-01

There is consistent evidence that hookah use is as, if not more, harmful than cigarette use. Yet, hookah users underestimate the potential deleterious effects of hookah use. This study examined the rates of hookah use and associated demographic characteristics in a sample of undergraduates at a small Northeastern university. This study also examined the relationships between hookah use and other substance use, mental health problems, and perceived levels of stress. Data were drawn from the Spring 2009 American Health Association-National College Health Assessment (ACHA-NCHA) at one small, Northeastern university (N=1799). The relationships between hookah use and other substance use, mental health problems, and perceived stress levels were examined using logistic regression analyses. Hookah use (in the past month) was reported among 14.1% (253/1799) of this sample of undergraduates. Hookah users were more likely to use other substances, including cigarettes, cannabis, alcohol, cocaine, and amphetamines. The strongest associations emerged between hookah use and alcohol and cigarette use. There were no significant associations found between hookah use and any mental health problems or perceived stress levels. Hookah users are significantly more likely to use other substances, including alcohol, cigarettes, cannabis, cocaine, and amphetamines compared with non-hookah users. In contrast to cigarette smoking, hookah use does not appear to be associated with mental health problems or perceived stress levels in this sample of undergraduates. Further investigation into the prevalence and correlates of hookah use is needed in representative population samples. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

What Factors are Associated with Electronic Cigarette, Shisha-Tobacco and Conventional Cigarette Use? Findings from a Cross-Sectional Survey of Australian Adolescents?

PubMed

Williams, Tahlia; White, Victoria

2018-01-16

Adolescents' use of electronic cigarettes and shisha-tobacco increased in several countries during the 2000s, including in the United States, United Kingdom and Canada. Few studies have examined the factors associated with exclusive e-cigarette or shisha-tobacco use and whether adolescents using these substances exclusively differ from those using traditional cigarettes. To examine the socio-demographic and behavioural correlates of exclusive e-cigarette and exclusive shisha-tobacco use to those found for users of tobacco cigarettes and multiple nicotine products in Australian adolescents. Cross-sectional survey of smoking behaviours of a random sample of 4,576 students in the Australian state of Victoria aged 12-17 conducted between June 2014 and December 2014. Overall, 14% of students had used an e-cigarette with 3% using e-cigarettes exclusively. 13% had used shisha-tobacco, with 2% using shisha-tobacco exclusively. Most students (65%) using e-cigarette and shisha-tobacco (67%) had also used tobacco cigarettes. After adjusting for demographic factors, students using e-cigarettes only were more likely to have never used cannabis or drink alcohol in the past year compared to tobacco cigarette users. Compared to tobacco cigarette users, students using only shisha-tobacco were younger, less likely to use cannabis or alcohol or have friends or parents who smoke. Most Australian adolescents who use alternative nicotine and tobacco-related products do so in conjunction with tobacco cigarettes. Students using e-cigarettes or shisha-tobacco exclusively were less likely to use other substances. Australian longitudinal studies are needed to determine whether this group of students are on a pathway to traditional tobacco use.

Hookah Smoking and Facilitators/Barriers to Lounge Use among Students at a US University.

PubMed

Kassem, Nada O F; Jackson, Sheila R; Boman-Davis, Marie; Kassem, Noura O; Liles, Sandy; Daffa, Reem M; Yasmin, Roxana; Madanat, Hala; Hovell, Melbourne F

2015-11-01

To examine hookah tobacco use, hookah lounge attendance, and facilitators and barriers to hookah lounge attendance. A cross-sectional Web-based survey of a random sample of 1332 undergraduate students (Mean Age = 21.2 years) attending a United States university. The majority of respondents (72.8%) had ever smoked hookah tobacco, and 28% of those had ever smoked during adolescence. The majority of ever hookah smokers (81.5%) and a portion of never hookah smokers (20%) had ever been to a hookah lounge. The adjusted odds of ever visiting a hookah lounge were 2.1 times higher among participants who reported that the closest hookah lounge to the university was < 5 miles away than those who reported that the closest hookah lounge was ≥ 5 miles away. Facilitators of visiting hookah lounges included friends and close proximity of hookah lounges to campus; barriers included cost of smoking hookah, crowded lounges, and having to be 18 years old. Youth are vulnerable to experimenting with hookah tobacco smoking. Hookah lounges provide patrons the opportunity to smoke hookah tobacco with smoker and non-smoker friends in entertaining settings. Our findings suggest that zoning laws and anti-hookah smoking legislation may help curb hookah uptake by prohibiting hookah lounges from opening in close proximity to universities, reducing the density of hookah lounges in cities, and raising the admission age for hookah lounges to 21 years.

Potential harmful health effects of inhaling nicotine-free shisha-pen vapor: a chemical risk assessment of the main components propylene glycol and glycerol.

PubMed

Kienhuis, Anne S; Soeteman-Hernandez, Lya G; Bos, Peter Mj; Cremers, Hans Wjm; Klerx, Walther N; Talhout, Reinskje

2015-01-01

A shisha-pen is an electronic cigarette variant that is advertised to mimic the taste of a water pipe, or shisha. The aim of this study was to assess the potential harmful health effects caused by inhaling the vapor of a nicotine-free shisha-pen. Gas chromatography analysis was performed to determine the major components in shisha-pen vapor. Risk assessment was performed using puff volumes of e-cigarettes and "normal" cigarettes and a 1-puff scenario (one-time exposure). The concentrations that reached the airways and lungs after using a shisha-pen were calculated and compared to data from published toxicity studies. The main components in shisha-pen vapor are propylene glycol and glycerol (54%/46%). One puff (50 to 70 mL) results in exposure of propylene glycol and glycerol of 430 to 603 mg/m(3) and 348 to 495 mg/m(3), respectively. These exposure concentrations were higher than the points of departure for airway irritation based on a human study (propylene glycol, mean concentration of 309 mg/m(3)) and a rat study (glycerol, no-observed adverse effect level of 165 mg/m(3)). Already after one puff of the shisha-pen, the concentrations of propylene glycol and glycerol are sufficiently high to potentially cause irritation of the airways. New products such as the shisha-pen should be detected and risks should be assessed to inform regulatory actions aimed at limiting potential harm that may be caused to consumers and protecting young people to take up smoking.

Hookah Smoking and Facilitators/Barriers to Lounge Use among Students at a US University

PubMed Central

Kassem, Nada O. F.; Jackson, Sheila R.; Boman-Davis, Marie; Kassem, Noura O.; Liles, Sandy; Daffa, Reem M.; Yasmin, Roxana; Madanat, Hala; Hovell, Melbourne F.

2015-01-01

Objective To examine hookah tobacco use, hookah lounge attendance, and facilitators and barriers to hookah lounge attendance. Methods A cross-sectional Web-based survey of a random sample of 1332 undergraduate students (Mean Age = 21.2 years) attending a United States university. Results The majority of respondents (72.8%) had ever smoked hookah tobacco, and 28% of those had ever smoked during adolescence. The majority of ever hookah smokers (81.5%) and a portion of never hookah smokers (20%) had ever been to a hookah lounge. The adjusted odds of ever visiting a hookah lounge were 2.1 times higher among participants who reported that the closest hookah lounge to the university was < 5 miles away than those who reported that the closest hookah lounge was ≥ 5 miles away. Facilitators of visiting hookah lounges included friends and close proximity of hookah lounges to campus; barriers included cost of smoking hookah, crowded lounges, and having to be 18 years old. Conclusion Youth are vulnerable to experimenting with hookah tobacco smoking. Hookah lounges provide patrons the opportunity to smoke hookah tobacco with smoker and non-smoker friends in entertaining settings. Our findings suggest that zoning laws and anti-hookah smoking legislation may help curb hookah uptake by prohibiting hookah lounges from opening in close proximity to universities, reducing the density of hookah lounges in cities, and raising the admission age for hookah lounges to 21 years. PMID:26450551

Urban college student self-report of hookah use with health care providers.

PubMed

Jani, Samir Ranjit; Brown, Darryl; Berhane, Zekarias; Peter, Nadja; Solecki, Susan; Turchi, Renee

2018-07-01

This study's purpose was to describe urban college students' communication about hookah with health care providers. Participants included a random sample of undergraduate urban college students and health care providers. Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.

Measuring Indoor Air Quality of Hookah Lounges

PubMed Central

Fiala, Steven C.; Pawlak, Rebecca L.

2012-01-01

Many states have implemented smoke-free workplace laws to protect employees and customers from exposure to secondhand smoke. However, exemptions in these laws have allowed indoor tobacco smoking in hookah lounges to proliferate in recent years. To describe the amount of secondhand smoke in hookah lounges, we measured the indoor air quality of 10 hookah lounges in Oregon. Air quality measurements ranged from “unhealthy” to “hazardous” according to Environmental Protection Agency standards, indicating a potential health risk for patrons and employees. PMID:22994168

Hookah Use Predicts Cigarette Smoking Progression Among College Smokers.

PubMed

Doran, Neal; Godfrey, Kathryn M; Myers, Mark G

2015-11-01

Hookah use is increasingly common among U.S. college students, but little is known regarding the relationship between hookah and cigarette use. The purpose of this study was to test the hypothesis that the added nicotine exposure from hookah use may accelerate the uptake of cigarettes. An ethnically diverse sample of college students (n = 256; 43% female) who had smoked cigarettes in the past month completed 2 in-person interviews over 6 months. This study was a secondary analysis of data collected for a longitudinal study of young adult cigarette smoking patterns. Analyses examined 6-month changes in past 30 day cigarettes smoked and number of days smoking, controlling for age, nicotine dependence, marijuana use, and the respective baseline variable for each outcome. Current hookah use (any use in past 30 days) was endorsed by 34% of participants at baseline, while 94% reported lifetime use. Change in past 30 day number of cigarettes (p = .043) and number of smoking days (p = .040) differed significantly between those who did or did not report recent hookah use at baseline. Hookah users reported a greater number of cigarettes smoked at the 6-month follow-up, while nonusers decreased their smoking quantity. For number of smoking days in the past 30, hookah users reported a smaller decrease than nonusers. Recent hookah use predicted increased cigarette smoking over 6 months in a college sample. These are the first prospective data demonstrating this relationship, indicating the value of developing strategies to prevent hookah use among college students. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Banning shisha smoking in public places in Iran: an advocacy coalition framework perspective on policy process and change.

PubMed

Khayatzadeh-Mahani, Akram; Breton, Eric; Ruckert, Arne; Labonté, Ronald

2017-07-01

Shisha smoking is a widespread custom in Iran with a rapidly growing prevalence especially among the youth. In this article, we analyze the policy process of enforcing a federal/state ban on shisha smoking in all public places in Kerman Province, Iran. Guided by the Advocacy Coalition Framework (ACF), we investigate how a shisha smoking ban reached the political agenda in 2011, how it was framed by different policy actors, and why no significant breakthrough took place despite its inclusion on the agenda. We conducted a qualitative study using a case study approach. Two main sources of data were employed: face-to-face in-depth interviews and document analysis of key policy texts. We interviewed 24 policy actors from diverse sectors. A qualitative thematic framework, incorporating both inductive and deductive analyses, was employed to analyze our data. We found that the health sector was the main actor pushing the issue of shisha smoking onto the political agenda by framing it as a public health risk. The health sector and its allies advocated enforcement of a federal law to ban shisha smoking in all public places including teahouses and traditional restaurants whereas another group of actors opposed the ban. The pro-ban group was unable to neutralize the strategies of the anti-ban group and to steer the debate towards the health harms of shisha smoking. Our analysis uncovers three main reasons behind the policy stasis: lack of policy learning due to lack of agreement over evidence and related analytical conflicts between the two groups linked to differences in core and policy beliefs; the inability of the pro-ban group to exploit opportunities in the external policy subsystem through generating stronger public support for enforcement of the shisha smoking ban; and the nature of the institutional setting, in particular the autocratic governance of CHFS which contributed to a lack of policy learning within the policy subsystem. Our research demonstrated the utility

Factors associated with hookah use initiation among adolescents.

PubMed

Reveles, Caroline C; Segri, Neuber J; Botelho, Clovis

2013-01-01

to determine the prevalence and to analyze factors associated with hookah use initiation among adolescents. This was a cross-sectional study, in which questionnaires were collected from 495 students attending public and private schools of the urban area of the city of Várzea Grande, in the state of Mato Grosso, Brazil. Data were analyzed through descriptive, bivariate, and multiple Poisson regression analyses. A total of 19.7% students had tried a hookah. The use of hookah was associated with the final period of adolescence [PR=6.54 (2.79, 15.32)]; enrollment in private schools [PR=2.23 (1.73, 2.88)]; and presence of work activities [PR=1.80 (1.17, 2.78)]. The proportion of adolescents that had tried a hookah was high. The influence of age, work activities, and class period on smoking initiation using the hookah was observed. Preventive measures encompassing all forms of tobacco smoking should be targeted at adolescents in the school environment, aiming at tobacco use control. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Preferences and Perceptions of Flavored Hookah Tobacco among US Women.

PubMed

Scott-Sheldon, Lori A J; Stroud, Laura R

2018-05-01

We assessed preferences, perceptions, and intentions to use flavored waterpipe (hookah) tobacco (HT) among women of reproductive age in the United States. A convenience sample of women 18-44 years of age (N = 238; mean age = 28; 74% white) were recruited via Amazon Mechanical Turk to complete a survey assessing preferences, perceptions, and intentions to use flavored HT. Of the women who had ever used hookah (62%), most (82%) used hookah sweetened with fruit flavors. Preferences for hookah flavors were statistically different between flavors such that women overall preferred sweet flavors (fruits, candy or other sweets, chocolate) versus other flavors (menthol/mint, clove/spice, alcohol, other beverages, tobacco/unflavored). Perceptions of general or pregnancy-related harmfulness did not differ between flavors. Sweet flavors (fruits, candy or other sweets, chocolate) were perceived to be less harsh than tobacco/unflavored hookah among women who had ever used hookah. Flavor preferences (but not perceptions of harmfulness or harshness) predicted intentions to use flavored HT in the future. Sweet flavored tobacco is preferred and used by reproductive-age women. Prohibiting flavorings in HT will likely lessen the appeal of smoking hookah to protect the health of women and children.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study.

PubMed

Baheiraei, Azam; Shahbazi Sighaldeh, Shirin; Ebadi, Abbas; Kelishadi, Roya; Majdzadeh, Reza

2015-02-24

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members' smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls' participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study

PubMed Central

Baheiraei, Azam; Sighaldeh, Shirin Shahbazi; Ebadi, Abbas; Kelishadi, Roya; Majdzadeh, Reza

2015-01-01

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members’ smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls’ participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well. PMID:26156895

Waterpipe Promotion and Use on Instagram: #Hookah.

PubMed

Allem, Jon-Patrick; Chu, Kar-Hai; Cruz, Tess Boley; Unger, Jennifer B

2017-10-01

Waterpipe (hookah) use is becoming more prevalent in the United States and abroad with potential implications for public health. As waterpipe use rapidly grows in popularity, novel data streams are needed that can help capture and document the social and environmental context in which individuals use, and are marketed, this emerging tobacco product. This study characterized waterpipe-related posts on Instagram in order to inform regulatory and policy activities in the United States. Data were collected from Instagram, an image-based social media site. Inclusion criteria for this study comprised an Instagram post with the hashtag "#hookah" that was accompanied by geo-location metadata demonstrating that the post was inside the contiguous United States. Rules were established for coding themes of images (n = 1705). Seven percent of images depicted a single person using a waterpipe and/or blowing smoke, 25% depicted two or more persons lounging and/or using a waterpipe, 6% depicted waterpipes, coals or flavored tobacco without people, 18% of images were promotional material for hookah lounges and restaurant/bars/nightclubs referencing hookah in the text or depicting a waterpipe, 25% were non-waterpipe-related promotional material, 1% were sexually explicit material, and 18% other. 31% of all images depicted or referenced alcohol. 30% of posts provided geo-location from a hookah lounge, 56% from a restaurant/bar/nightclub, and 14% from other types of locations. The cross promotion of waterpipe and alcohol use by hookah lounges, and restaurants/bars/nightclubs suggests that poly-substance use is regularly depicted, and promoted, in nightlife entertainment as well as normalized on Instagram in the United States. In the US Instagram posts with the hashtag #hookah regularly depicted waterpipe use in conjunction with alcohol use. Instagram's focus on images facilitates picture-based advertising where hookah lounges promote drink specials at the same time nightclubs promote

Acute Effect of Hookah Smoking on the Human Coronary Microcirculation

PubMed Central

Nelson, Michael D.; Rezk-Hanna, Mary; Rader, Florian; Mason, O’Neil R.; Tang, Xiu; Shidban, Sarah; Rosenberry, Ryan; Benowitz, Neal L.; Tashkin, Donald P.; Elashoff, Robert M.; Lindner, Jonathan R.; Victor, Ronald G.

2017-01-01

Hookah (water pipe) smoking is a major new understudied epidemic affecting youth. Because burning charcoal is used to heat the tobacco product, hookah smoke delivers not only nicotine but also large amounts of charcoal combustion products, including carbon-rich nanoparticles that constitute putative coronary vasoconstrictor stimuli and carbon monoxide, a known coronary vasodilator. We used myocardial contrast echocardiography perfusion imaging with intravenous lipid shelled microbubbles in young adult hookah smokers to determine the net effect of smoking hookah on myocardial blood flow. In 9 hookah smokers (age 27 – 5 years, mean – SD), we measured myocardial blood flow velocity (β), myocardial blood volume (A), myocardial blood flow (A × β) as well as myocardial oxygen consumption (MVO2) before and immediately after 30 minutes of ad lib hookah smoking. Myocardial blood flow did not decrease with hookah smoking but rather increased acutely (88 – 10 to 120 – 19 a.u./s, mean – SE, p = 0.02), matching a mild increase in MVO2 (6.5 – 0.3 to 7.6 – 0.4 ml·minute−1, p <0.001). This was manifested primarily by increased myocardial blood flow velocity (0.7 – 0.1 to 0.9 – 0.1 second−1, p = 0.01) with unchanged myocardial blood volume (133 – 7 to 137 – 7 a.u., p = ns), the same pattern of coronary microvascular response seen with a low-dose β-adrenergic agonist. Indeed, with hookah, the increased MVO2 was accompanied by decreased heart rate variability, an indirect index of adrenergic overactivity, and eliminated by β-adrenergic blockade (i.v. propranolol). In conclusion, nanoparticle-enriched hookah smoke either is not an acute coronary vasoconstrictor stimulus or its vasoconstrictor effect is too weak to overcome the physiologic dilation of coronary microvessels matching mild cardiac β-adrenergic stimulation. PMID:27067622

Scientific-Chemical Viewpoints regarding Smoking: A Science Laboratory for All

ERIC Educational Resources Information Center

Blonder, Ron

2008-01-01

This article describes laboratory activity that examines the chemical process of smoking and the components of smoke, of both cigarettes and water pipes (narghiles also known as "hookah"). The aim of this activity is to expose adolescents to the scientific aspects of smoking; and to present the relevance of chemistry in everyday life. (Contains 3…

Identifying Sentiment of Hookah-Related Posts on Twitter

PubMed Central

Ramanujam, Jagannathan; Lerman, Kristina; Chu, Kar-Hai; Boley Cruz, Tess; Unger, Jennifer B

2017-01-01

Background The increasing popularity of hookah (or waterpipe) use in the United States and elsewhere has consequences for public health because it has similar health risks to that of combustible cigarettes. While hookah use rapidly increases in popularity, social media data (Twitter, Instagram) can be used to capture and describe the social and environmental contexts in which individuals use, perceive, discuss, and are marketed this tobacco product. These data may allow people to organically report on their sentiment toward tobacco products like hookah unprimed by a researcher, without instrument bias, and at low costs. Objective This study describes the sentiment of hookah-related posts on Twitter and describes the importance of debiasing Twitter data when attempting to understand attitudes. Methods Hookah-related posts on Twitter (N=986,320) were collected from March 24, 2015, to December 2, 2016. Machine learning models were used to describe sentiment on 20 different emotions and to debias the data so that Twitter posts reflected sentiment of legitimate human users and not of social bots or marketing-oriented accounts that would possibly provide overly positive or overly negative sentiment of hookah. Results From the analytical sample, 352,116 tweets (59.50%) were classified as positive while 177,537 (30.00%) were classified as negative, and 62,139 (10.50%) neutral. Among all positive tweets, 218,312 (62.00%) were classified as highly positive emotions (eg, active, alert, excited, elated, happy, and pleasant), while 133,804 (38.00%) positive tweets were classified as passive positive emotions (eg, contented, serene, calm, relaxed, and subdued). Among all negative tweets, 95,870 (54.00%) were classified as subdued negative emotions (eg, sad, unhappy, depressed, and bored) while the remaining 81,667 (46.00%) negative tweets were classified as highly negative emotions (eg, tense, nervous, stressed, upset, and unpleasant). Sentiment changed drastically when

Predictors of non- hookah smoking among high-school students based on prototype/willingness model.

PubMed

Abedini, Sedigheh; MorowatiSharifabad, MohammadAli; Chaleshgar Kordasiabi, Mosharafeh; Ghanbarnejad, Amin

2014-01-01

The aim of the study was to determine predictors of refraining from hookah smoking among high-school students in Bandar Abbas, southern Iran based on Prototype/Willingness model. This cross- sectional with analytic approach was performed on 240 high-school students selected by a cluster random sampling. The data of demographic and Prototype-Willingness Model constructs were acquired via a self-administrated questionnaire. Data were analyzed by mean, frequency, correlation, liner and logistic regression statistical tests. Statistically significant determinants of the intention to refrain from hookah smoking were subjective norms, willingness, and attitude. Regression model indicated that the three items together explained 46.9% of the non-smoking hookah intention variance. Attitude and subjective norms predicted 36.0% of the non-smoking hookah intention variance. There was a significant relationship between the participants' negative prototype about the hookah smokers and the willingness to avoid from hookah smoking (P=0.002). Also willingness predicted non-smoking hookah better than the intention (P<0.001). Deigning intervention to increase negative prototype about the hookah smokers and reducing situations and conditions which facilitate hookah smoking, such as easy access to tobacco products in the cafés, beaches can be useful results among adolescents to hookah smoking prevention.

Identifying Sentiment of Hookah-Related Posts on Twitter.

PubMed

Allem, Jon-Patrick; Ramanujam, Jagannathan; Lerman, Kristina; Chu, Kar-Hai; Boley Cruz, Tess; Unger, Jennifer B

2017-10-18

The increasing popularity of hookah (or waterpipe) use in the United States and elsewhere has consequences for public health because it has similar health risks to that of combustible cigarettes. While hookah use rapidly increases in popularity, social media data (Twitter, Instagram) can be used to capture and describe the social and environmental contexts in which individuals use, perceive, discuss, and are marketed this tobacco product. These data may allow people to organically report on their sentiment toward tobacco products like hookah unprimed by a researcher, without instrument bias, and at low costs. This study describes the sentiment of hookah-related posts on Twitter and describes the importance of debiasing Twitter data when attempting to understand attitudes. Hookah-related posts on Twitter (N=986,320) were collected from March 24, 2015, to December 2, 2016. Machine learning models were used to describe sentiment on 20 different emotions and to debias the data so that Twitter posts reflected sentiment of legitimate human users and not of social bots or marketing-oriented accounts that would possibly provide overly positive or overly negative sentiment of hookah. From the analytical sample, 352,116 tweets (59.50%) were classified as positive while 177,537 (30.00%) were classified as negative, and 62,139 (10.50%) neutral. Among all positive tweets, 218,312 (62.00%) were classified as highly positive emotions (eg, active, alert, excited, elated, happy, and pleasant), while 133,804 (38.00%) positive tweets were classified as passive positive emotions (eg, contented, serene, calm, relaxed, and subdued). Among all negative tweets, 95,870 (54.00%) were classified as subdued negative emotions (eg, sad, unhappy, depressed, and bored) while the remaining 81,667 (46.00%) negative tweets were classified as highly negative emotions (eg, tense, nervous, stressed, upset, and unpleasant). Sentiment changed drastically when comparing a corpus of tweets with social bots

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

PubMed

Fevrier, Bradley; Nabors, Laura; Vidourek, Rebecca A; King, Keith A

2018-04-25

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

Sex Differences in Hookah-Related Images Posted on Tumblr: A Content Analysis.

PubMed

Primack, Brian A; Carroll, Mary V; Shensa, Ariel; Davis, Wesley; Levine, Michele D

2016-01-01

Hookah tobacco smoking is prevalent, widespread, and associated with large amounts of toxicants. Hookah tobacco smoking may be viewed differently by males and females. For example, females have been drawn to types of tobacco that are flavored, milder, and marketed as more social and exotic. Individuals often use the growing segment of anonymous social networking sites, such as Tumblr, to learn about potentially dangerous or harmful behaviors. We used a systematic process involving stratification by time of day, day of week, and search term to gather a sample of 140 Tumblr posts related to hookah tobacco smoking. After a structured codebook development process, 2 coders independently assessed all posts in their entirety, and all disagreements were easily adjudicated. When data on poster sex and age were available, we found that 77% of posts were posted by females and 35% were posted by individuals younger than 18. The most prominent features displayed in all posts were references to or images of hookahs themselves, sexuality, socializing, alcohol, hookah smoke, and tricks performed with hookah smoke. Compared with females, males more frequently posted images of hookahs and alcohol-related images or references. This information may help guide future research in this area and the development of targeted interventions to curb this behavior.

Social Context of Smoking Hookah among College Students: Scale Development and Validation

ERIC Educational Resources Information Center

Sharma, Eva; Beck, Kenneth H.; Clark, Pamela I.

2013-01-01

Objective: To develop an instrument that measures the social context of hookah use among college students. Participants: A pool of 50 potential items, based on 44 in-depth interviews with regular college hookah smokers, was administered to a sample of 274 hookah users between October and December 2011. Methods: Participants were approached in…

A pilot study to assess the bacterial contaminants in hookah pipes in a community setting.

PubMed

Martinasek, M; Rivera, Z; Ferrer, A; Freundt, E

2018-05-01

Hookah smoking among young adults remains a public health threat. Increasing research has uncovered the deleterious effects of hookah smoking, including both acute and chronic health conditions. Due to the current lack of regulation, hookah bars/lounges lack protocols for equipment sanitation. To examine evidence of bacterial contamination in hookah pipes due to a lack of sanitation regulations. For this field/laboratory study, 10 hookah bars/lounges were studied. Isolated bacteria were characterized and identified by species using 16S ribosomal RNA gene sequencing. At the 10 hookah bars sampled, the mouthpiece had the highest bacterial prevalence and diversity. Some of the bacterial isolates were found to be antibiotic-resistant. Ten of the isolated bacteria were Gram-positive and two were identified as Gram-negative. Levels of bacterial contamination vary widely from one hookah bar to the next, and reflect a lack of industry standards for cleaning these devices. Bacterial contamination of hookah pipes may represent a fomite for transmission of infectious diseases. Our results warrant future surveillance of hookahs to monitor for potential human pathogens.

E-cigarettes and E-hookahs

MedlinePlus

Electronic cigarettes; Electronic hookahs; Vaping; Electronic nicotine delivery systems; Smoking - electronic cigarettes ... Elsevier Saunders; 2016:chap 46. Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control . 2014;23( ...

Knowledge and Attitudes toward Hookah Usage among University Students

ERIC Educational Resources Information Center

Holtzman, Adam L.; Babinski, Dara; Merlo, Lisa J.

2013-01-01

Objective: Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. Participants: The sample included 943 university students recruited between February 2009 and January 2010. Respondents ("M" age = 20.02) included 376 males, 533…

Review of hookah tobacco smoking among college students: policy implications and research recommendations.

PubMed

Gathuru, Irene M; Tarter, Ralph E; Klein-Fedyshin, Michele

2015-01-01

About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy". Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking. Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.

Examining Hookah as an Introduction to Nicotine Products among College Students.

PubMed

Kulak, Jessica A; Saddleson, Megan L; Travers, Mark J; Bansal-Travers, Maansi; Homish, Gregory G; Mahoney, Martin C; Giovino, Gary A

2018-03-13

Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.

Electronic Cigarette and Electronic Hookah: A Pilot Study Comparing Two Vaping Products.

PubMed

Dube, Shanta R; Pathak, Sarita; Nyman, Amy L; Eriksen, Michael P

Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products has proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) Model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. In June-August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Statistical analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. Among 54 products, 70.4% were e-cigarettes and 29.6% were e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products.

Electronic Cigarette and Electronic Hookah: A Pilot Study Comparing Two Vaping Products☆

PubMed Central

Dube, Shanta R.; Pathak, Sarita; Nyman, Amy L.; Eriksen, Michael P.

2015-01-01

Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products have proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. In June–August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Descriptive analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. Among 54 products, 70.4% was e-cigarettes and 29.6% was e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products. PMID:26740911

A Comparison of Cigarette- and Hookah-Related Videos on YouTube

PubMed Central

Carroll, Mary V.; Shensa, Ariel; Primack, Brian A.

2013-01-01

Objective YouTube is now the second most visited site on the Internet. We aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube. Methods Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After 3 trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, 2 of them independently coded each video for content including positive and negative associations with smoking and major content type. Results Median view counts were 606,884 for cigarettes and 102,307 for hookahs (P<.001). However, the number of comments per 1,000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, P=.003). There was no significant difference in the number of “like” designations per 100 reactions (91 vs. 87, P=.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs. 92%, P<.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs. 5%, P<.001), to mention short-term consequences (50% vs. 18%, P<.001) and long-term consequences (44% vs. 2%, P<.001) of tobacco use, to contain explicit antismoking messages (39% vs. 0%, P<.001), and to provide specific information on how to quit tobacco use (21% vs. 0%, P<.001). Conclusions Although Internet user–generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programs to correct common misconceptions regarding hookah use. PMID:22363069

Exemptions for hookah bars in clean indoor air legislation: a public health concern.

PubMed

Noonan, Devon

2010-01-01

Popularity of waterpipe smoking or hookah smoking in the United States has been growing for some time now among youth and young adults. Currently, many cities and states have exemptions that allow hookah bars to remain in operation despite the passage of clean indoor air legislation. From a public health perspective this is concerning for many reasons. One public health concern with the increase in popularity of this type of tobacco use is the associated health effects. Another concern is that hookah smoke produces a sweet smelling aroma making it less obvious that patrons and employees of hookah bars are inhaling noxious fumes from mainstream smoke, as well as the toxins from the charcoal that is used to heat the tobacco. The purpose of this paper is to discuss smoke-free air legislation in relation to hookah use, the public health implications of exempting hookah bars from current smoke-free legislation, and implications for the public health nurse in protecting the public from the dangers of second-hand smoke, and limiting this new form of tobacco use.

Tracking Hookah Bars in New York: Utilizing Yelp as a Powerful Public Health Tool.

PubMed

Cawkwell, Philip B; Lee, Lily; Weitzman, Michael; Sherman, Scott E

2015-01-01

While cigarette use has seen a steady decline in recent years, hookah (water pipe) use has rapidly increased in popularity. While anecdotal reports have noted a rise in hookah bars, methodological difficulties have prevented researchers from drawing definitive conclusions about the number of hookah bars in any given location. There is no publicly available database that has been shown to reliably provide this information. It is now possible to analyze Internet trends as a measure of population behavior and health-related phenomena. The objective of the study was to investigate whether Yelp can be used to accurately identify the number of hookah bars in New York State, assess the distribution and characteristics of hookah bars, and monitor temporal trends in their presence. Data were obtained from Yelp that captures a variety of parameters for every business listed in their database as of October 28, 2014, that was tagged as a "hookah bar" and operating in New York State. Two algebraic models were created: one estimated the date of opening of a hookah bar based on the first Yelp review received and the other estimated whether the bar was open or closed based on the date of the most recent Yelp review. These findings were then compared with empirical data obtained by Internet searches. From 2014 onward, the date of the first Yelp review predicts the opening date of new hookah bars to within 1 month. Yelp data allow the estimate of such venues and demonstrate that new bars are not randomly distributed, but instead are clustered near colleges and in specific racial/ethnic neighborhoods. New York has seen substantially more new hookah bars in 2012-2014 compared with the number that existed prior to 2009. Yelp is a powerful public health tool that allows for the investigation of various trends and characteristics of hookah bars. New York is experiencing tremendous growth in hookah bars, a worrying phenomenon that necessitates further investigation.

U.S. hookah tobacco smoking establishments advertised on the internet.

PubMed

Primack, Brian A; Rice, Kristen R; Shensa, Ariel; Carroll, Mary V; DePenna, Erica J; Nakkash, Rima; Barnett, Tracey E

2012-02-01

Establishments dedicated to hookah tobacco smoking recently have proliferated and helped introduce hookah use to U.S. communities. To conduct a comprehensive, qualitative assessment of websites promoting these establishments. In June 2009, a systematic search process was initiated to access the universe of websites representing major hookah tobacco smoking establishments. In 2009-2010, codebook development followed an iterative paradigm involving three researchers and resulted in a final codebook consisting of 36 codes within eight categories. After two independent coders had nearly perfect agreement (Cohen's κ = 0.93) on double-coding the data in the first 20% of sites, the coders divided the remaining sites and coded them independently. A thematic approach to the synthesis of findings and selection of exemplary quotations was used. The search yielded a sample of 144 websites originating from states in all U.S. regions. Among the hookah establishments promoted on the websites, 79% served food and 41% served alcohol. Of the websites, none required age verification, <1% included a tobacco-related warning on the first page, and 4% included a warning on any page. Although mention of the word tobacco was relatively uncommon (appearing on the first page of only 26% sites and on any page of 58% of sites), the promotion of flavorings, pleasure, relaxation, product quality, and cultural and social aspects of hookah smoking was common. Websites may play a role in enhancing or propagating misinformation related to hookah tobacco smoking. Health education and policy measures may be valuable in countering this misinformation. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A comparison of cigarette- and hookah-related videos on YouTube.

PubMed

Carroll, Mary V; Shensa, Ariel; Primack, Brian A

2013-09-01

YouTube is now the second most visited site on the internet. The authors aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube. Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After three trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, two of them independently coded each video for content including positive and negative associations with smoking and major content type. Median view counts were 606,884 for cigarettes-related videos and 102,307 for hookah-related videos (p<0.001). However, the number of comments per 1000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, p=0.003). There was no significant difference in the number of 'like' designations per 100 reactions (91 vs 87, p=0.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs 92%, p<0.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs 5%, p<0.001), to mention short-term consequences (50% vs 18%, p<0.001) and long-term consequences (44% vs 2%, p<0.001) of tobacco use, to contain explicit antismoking messages (39% vs 0%, p<0.001) and to provide specific information on how to quit tobacco use (21% vs 0%, p<0.001). Although internet user-generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programmes to correct common misconceptions regarding hookah use.

#Hookahlife: The Rise of Waterpipe Promotion on Instagram.

PubMed

Ben Taleb, Ziyad; Laestadius, Linnea I; Asfar, Taghrid; Primack, Brian A; Maziak, Wasim

2018-06-01

Hookah smoking is becoming increasingly popular worldwide, especially among young adults. The growth of social media has also enabled sharing of opinions, experiences, and marketing related to hookah via user-generated content. To evaluate the portrayal and promotion of hookah on Instagram and to highlight public health challenges created by this content. A qualitative content analysis was performed on a sample of 301 Instagram posts made with the hashtags #hookah or #shisha in October 2016. Of the 301 coded posts, 279 were relevant to hookah. These posts were most commonly made by hookah lounges/bars (29.2%) and individual users (27.6%). Posters were most commonly from Russia (38.5%), the United States (18.6%), and Germany (10.7%). A total of 63.8% of the posts were promotional in nature; 19.7% of posts contained hashtags that expressed hookah identity or community (e.g., #hookahlife); 35.5% of posts associated nightlife activities with hookah smoking and 33.0% portrayed hookah smoking as a social activity. Only one post (0.4%) mentioned that hookah might have negative health effects. Likes were more common on posts depicting novel rather than traditional hookah designs ( p = .027). Images from Instagram may help in understanding health behaviors such as hookah smoking. Our results suggest that domestic and international hookah promotion is common on Instagram. Instagram posts cast hookah in an overwhelmingly positive light and may normalize hookah use through associations with nightlife, community, and hookah identity. Policy makers and researchers should explore approaches for reducing the volume of promotional posts and tailoring counter-marketing to the specific themes presented on social media.

Hookah tobacco use and stressful life events in a sample of young non-daily cigarette smokers.

PubMed

Brikmanis, Kristin; Doran, Neal

2017-01-01

Understanding factors that influence hookah use among young adults is important given its increasing popularity and health risks. The purpose of this study was to examine whether young adult non-daily cigarette smokers use hookah for stress regulation. We hypothesized that greater perceived stress and greater stressful life events would predict probability and frequency of recent hookah use. Participants (n=598, 50.7% male) were non-daily smokers aged 18-24years (M=20.5, SD=1.8), who completed a baseline assessment online or via mobile phone as part of a longitudinal study. Participants had been non-daily smokers for at least six months but had never been daily smokers. Thirty-one percent of participants reported using hookah over the past 14days. Full-time students were more likely to have used hookah recently. More stressful life events and more frequent alcohol use predicted likelihood and frequency of hookah use (ps<0.05). Perceived stress was not associated with hookah use. Findings suggest that hookah tobacco use is related to frequency of stressful life events but not perceived stress among non-daily cigarette smokers. Tobacco prevention and intervention programs should address hookah use and should include adaptive strategies for coping with stressful events. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adolescent and Young Adult Perceptions of Hookah and Little Cigars/Cigarillos: Implications for Risk Messages

PubMed Central

Cornacchione, Jennifer; Wagoner, Kimberly G.; Wiseman, Kimberly D.; Kelley, Dannielle; Noar, Seth M.; Smith, Margaret H.; Sutfin, Erin L.

2016-01-01

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n=47) and susceptible nonusers (n=30). Transcripts were coded for emergent themes on participants’ perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects. PMID:27337629

Children's exposure to secondhand and thirdhand smoke carcinogens and toxicants in homes of hookah smokers.

PubMed

Kassem, Nada O F; Daffa, Reem M; Liles, Sandy; Jackson, Sheila R; Kassem, Noura O; Younis, Maram A; Mehta, Setoo; Chen, Menglan; Jacob, Peyton; Carmella, Steve G; Chatfield, Dale A; Benowitz, Neal L; Matt, Georg E; Hecht, Stephen S; Hovell, Melbourne F

2014-07-01

We examined homes of hookah-only smokers and nonsmokers for levels of indoor air nicotine (a marker of secondhand smoke) and indoor surface nicotine (a marker of thirdhand smoke), child uptake of nicotine, the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and the toxicant acrolein by analyzing their corresponding metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and NNAL-glucuronides (total NNAL) and 3-hydroxypropylmercapturic acid. Data were collected at 3 home visits during a 7-day study period from a convenience sample of 24 households with a child 5 years or younger. Three child urine samples and 2 air and surface samples from the living room and the child bedroom were taken in homes of nonsmokers (n = 5) and hookah-only smokers (n = 19) comprised of daily hookah smokers (n = 8) and weekly/monthly hookah smokers (n = 11). Nicotine levels in indoor air and on surfaces in the child bedrooms in homes of daily hookah smokers were significantly higher than in homes of nonsmokers. Uptake of nicotine, NNK, and acrolein in children living in daily hookah smoker homes was significantly higher than in children living in nonsmoker homes. Uptake of nicotine and NNK in children living in weekly/monthly hookah smoker homes was significantly higher than in children living in nonsmoker homes. Our data provide the first evidence for uptake of nicotine, the tobacco-specific lung carcinogen NNK, and the ciliatoxic and cardiotoxic agent acrolein in children living in homes of hookah smokers. Our findings suggest that daily and occasional hookah use in homes present a serious, emerging threat to children's long-term health. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Lifestyle-related determinants of hookah and cigarette smoking in Iranian adults.

PubMed

Sarrafzadegan, Nizal; Toghianifar, Nafiseh; Roohafza, Hamidreza; Siadat, Zahradana; Mohammadifard, Noushin; O'Loughlin, Jennifer

2010-02-01

To identify lifestyle-related determinants of hookah and cigarette smoking in Iranian adults, a total of 12,514 men and women aged >/=19 years in three counties in central Iran (Isfahan, Najafabad, Arak) were selected in multistage random sampling. Data on socio-demographic characteristics and lifestyle were collected in interviewer-administered questionnaires, as part of the baseline survey of the Isfahan Healthy Heart Program. Unhealthy lifestyle-related factors independently associated with cigarette and hookah smoking, were identified in sex-specific multivariate logistic regression analyses. High stress levels (OR: 1.55; 95% CI: 1.35-1.78 for men; OR: 1.63; 95% CI: 1.17-2.27 for women), family member smoking (OR: 1.61; 95% CI: 1.27-4.92 for men; OR: 2.49; 95% CI: 2.20-2.95 for women), and short/long sleep duration (OR: 1.18; 95% CI: 1.01-1.39 for men; OR: 1.52; 95% CI: 1.10-2.35 for women) were associated with cigarette smoking in both men and women. Poor diet was also related to cigarette smoking in men (OR: 1.55; 95% CI: 1.62-1.89). Family member smoking was associated with hookah smoking in both men (OR: 1.16; 95% CI: 1.05-3.12) and women (OR: 1.56; 95% CI: 1.02-4.92), and in addition high stress levels (OR: 2.87; 95% CI: 1.14-5.83) and short/long sleep duration (OR: 1.07; 95% CI: 1.02-2.41) were associated with hookah smoking in women. Unhealthy lifestyle-related factors co-occur with cigarette and hookah smoking in Iranian adults, likely increasing the risk for chronic health problems. Sex differences in the determinants of hookah and cigarette smoking may need to be taken into account in planning tobacco control strategies.

Hookah Smoking and Harm Perception among Asthmatic Adolescents: Findings from the Florida Youth Tobacco Survey

ERIC Educational Resources Information Center

Martinasek, Mary P.; Gibson-Young, Linda; Forrest, Jamie

2014-01-01

Background: Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by…

Urban College Student Self-Report of Hookah Use with Health Care Providers

ERIC Educational Resources Information Center

Jani, Samir Ranjit; Brown, Darryl; Berhane, Zekarias; Peter, Nadja; Solecki, Susan; Turchi, Renee

2018-01-01

Objective: This study's purpose was to describe urban college students' communication about hookah with health care providers. Participants: Participants included a random sample of undergraduate urban college students and health care providers. Methods: Students surveyed determined the epidemiology of hookah use in this population, how many…

Adolescent and Young Adult Perceptions of Hookah and Little Cigars/Cigarillos: Implications for Risk Messages.

PubMed

Cornacchione, Jennifer; Wagoner, Kimberly G; Wiseman, Kimberly D; Kelley, Dannielle; Noar, Seth M; Smith, Margaret H; Sutfin, Erin L

2016-07-01

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n = 47) and susceptible nonusers (n = 30). Transcripts were coded for emergent themes on participants' perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.

Children’s Exposure to Secondhand and Thirdhand Smoke Carcinogens and Toxicants in Homes of Hookah Smokers

PubMed Central

Daffa, Reem M.; Liles, Sandy; Jackson, Sheila R.; Kassem, Noura O.; Younis, Maram A.; Mehta, Setoo; Chen, Menglan; Jacob, Peyton; Carmella, Steve G.; Chatfield, Dale A.; Benowitz, Neal L.; Matt, Georg E.; Hecht, Stephen S.; Hovell, Melbourne F.

2014-01-01

Introduction: We examined homes of hookah-only smokers and nonsmokers for levels of indoor air nicotine (a marker of secondhand smoke) and indoor surface nicotine (a marker of thirdhand smoke), child uptake of nicotine, the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and the toxicant acrolein by analyzing their corresponding metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and NNAL-glucuronides (total NNAL) and 3-hydroxypropylmercapturic acid. Methods: Data were collected at 3 home visits during a 7-day study period from a convenience sample of 24 households with a child 5 years or younger. Three child urine samples and 2 air and surface samples from the living room and the child bedroom were taken in homes of nonsmokers (n = 5) and hookah-only smokers (n = 19) comprised of daily hookah smokers (n = 8) and weekly/monthly hookah smokers (n = 11). Results: Nicotine levels in indoor air and on surfaces in the child bedrooms in homes of daily hookah smokers were significantly higher than in homes of nonsmokers. Uptake of nicotine, NNK, and acrolein in children living in daily hookah smoker homes was significantly higher than in children living in nonsmoker homes. Uptake of nicotine and NNK in children living in weekly/monthly hookah smoker homes was significantly higher than in children living in nonsmoker homes. Conclusions: Our data provide the first evidence for uptake of nicotine, the tobacco-specific lung carcinogen NNK, and the ciliatoxic and cardiotoxic agent acrolein in children living in homes of hookah smokers. Our findings suggest that daily and occasional hookah use in homes present a serious, emerging threat to children’s long-term health. PMID:24590387

Waterpipes and Electronic Cigarettes: Increasing Prevalence and Expanding Science

PubMed Central

2015-01-01

The prevalence of noncigarette tobacco product use is on the rise across the globe, especially for waterpipes (also known as hookah, narghile, and shisha) and electronic cigarettes (e-cigarettes). The scientific literature reveals that waterpipe tobacco smoking is associated with exposure to a variety of toxicants that can cause short- and long-term adverse health events. In contrast, there is far less evidence of health harms related to e-cigarette use, although the variety of products in this category makes it difficult to generalize. We searched the PubMed database for all publications on waterpipes and e-cigarettes from January 2000 to March 2014. The number of publications on waterpipes rose in a slow, linear pattern during this time, while the number of publications on e-cigarettes showed exponential growth. The different trends suggest there may be more interest in studying a novel nicotine product (the e-cigarette) over a traditional tobacco product (the waterpipe). We posit that, although the specific research needs for these products are different, public health would be served best by a more equitable research approach. Scientists should continue to devote attention to understanding the unknown long-term health effects of e-cigarettes and their potential to serve as harm reduction or smoking cessation tools while simultaneously investigating how to reduce waterpipe smoking given that it exposes users to toxicants known to cause harm to health. Recent regulatory action in the United States, which proposes to include waterpipes and e-cigarettes under some of the same regulations as tobacco cigarettes, makes such research particularly timely. PMID:25338174

Comparison of tobacco-containing and tobacco-free waterpipe products: effects on human alveolar cells.

PubMed

Shihadeh, Alan; Eissenberg, Thomas; Rammah, Mayassa; Salman, Rola; Jaroudi, Ezzat; El-Sabban, Marwan

2014-04-01

In recent years, a class of products marketed as "tobacco-free" alternatives for the "health conscious user" has become widely available for waterpipe (hookah, narghile, or shisha) smoking. Their adoption may be in part driven by regulations banning tobacco smoking in public places and by an increasing awareness of the hazards of waterpipe tobacco smoking. Although these products are presented in advertising as a "healthier" choice, very little is known about their health effects. In this study, we compared the effects of smoke generated with tobacco-free and conventional tobacco-derived products on human alveolar cells. Smoke was generated with a smoking machine that precisely mimicked the puffing behavior of 15 experienced waterpipe smokers when they used conventional waterpipe tobacco products of their choice and flavor-matched tobacco-free products. Human alveolar epithelial cells (A549) were treated with particulate matter sampled from the smoke, and the effects on cell cycle, proliferation, and doubling time were measured during the subsequent 72hr. We found that smoke from both types of waterpipe products markedly reduced cell proliferation, caused cell cycle arrest at G0/G1, and increased cell doubling time. There were no significant differences across product in any measure. Tobacco-free and tobacco-based waterpipe products exert substantial and similar deleterious effects on human lung cells. This study adds to the nascent evidence base indicating that except for exposure to nicotine and its derivatives, use of tobacco-free waterpipe products does not present a reduced health risk relative to the use of conventional tobacco-based products.

Toxicant content, physical properties and biological activity of waterpipe tobacco smoke and its tobacco-free alternatives

PubMed Central

Shihadeh, Alan; Schubert, Jens; Klaiany, Joanne; El Sabban, Marwan; Luch, Andreas; Saliba, Najat A

2015-01-01

Objectives Waterpipe smoking using sweetened, flavoured tobacco products has become a widespread global phenomenon. In this paper, we review chemical, physical and biological properties of waterpipe smoke. Data sources Peer-reviewed publications indexed in major databases between 1991 and 2014. Search keywords included a combination of: waterpipe, narghile, hookah, shisha along with names of chemical compounds and classes of compounds, in addition to terms commonly used in cellular biology and aerosol sizing. Study selection The search was limited to articles published in English which reported novel data on waterpipe tobacco smoke (WTS) toxicant content, biological activity or particle size and which met various criteria for analytical rigour including: method specificity and selectivity, precision, accuracy and recovery, linearity, range, and stability. Data extraction Multiple researchers reviewed the reports and collectively agreed on which data were pertinent for inclusion. Data synthesis Waterpipe smoke contains significant concentrations of toxicants thought to cause dependence, heart disease, lung disease and cancer in cigarette smokers, and includes 27 known or suspected carcinogens. Waterpipe smoke is a respirable aerosol that induces cellular responses associated with pulmonary and arterial diseases. Except nicotine, smoke generated using tobacco-free preparations marketed for ‘health conscious’ users contains the same or greater doses of toxicants, with the same cellular effects as conventional products. Toxicant yield data from the analytical laboratory are consistent with studies of exposure biomarkers in waterpipe users. Conclusions A sufficient evidence base exists to support public health interventions that highlight the fact that WTS presents a serious inhalation hazard. PMID:25666550

A critique of the WHO TobReg's "Advisory Note" report entitled: "Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators".

PubMed

Chaouachi, Kamal

2006-11-17

The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved. We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field. The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report.

A critique of the WHO TobReg's "Advisory Note" report entitled: "Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators"

PubMed Central

Chaouachi, Kamal

2006-01-01

Background and aim The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved. Results We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field. Conclusion The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report. PMID:17112380

Waterpipes and electronic cigarettes: increasing prevalence and expanding science.

PubMed

Pepper, Jessica K; Eissenberg, Thomas

2014-08-18

The prevalence of non-cigarette tobacco product use is on the rise across the globe, especially for waterpipes (also known as hookah, narghile, and shisha) and electronic cigarettes (e-cigarettes). The scientific literature reveals that waterpipe tobacco smoking is associated with exposure to a variety of toxicants that can cause short- and long-term adverse health events. In contrast, there is far less evidence of health harms related to e-cigarette use, although the variety of products in this category makes it difficult to generalize. We searched the PubMed database for all publications on waterpipes and e-cigarettes from January 2000 to March 2014. The number of publications on waterpipes rose in a slow, linear pattern during this time, while the number of publications on e-cigarettes showed exponential growth. The different trends suggest there may be more interest in studying a novel nicotine product (the e-cigarette) over a traditional tobacco product (the waterpipe). We posit that, although the specific research needs for these products are different, public health would be served best by a more equitable research approach. Scientists should continue to devote attention to understanding the unknown long-term health effects of e-cigarettes and their potential to serve as harm reduction or smoking cessation tools while simultaneously investigating how to reduce waterpipe smoking given that it exposes users to toxicants known to cause harm to health. Recent regulatory action in the United States, which proposes to include waterpipes and e-cigarettes under some of the same regulations as tobacco cigarettes, makes such research particularly timely.

An Observational Study of Group Waterpipe Use in a Natural Environment

PubMed Central

2014-01-01

Introduction: To date research on tobacco smoking with a waterpipe (hookah, narghile, and shisha) has focused primarily on the individual user in a laboratory setting. Yet, waterpipe tobacco smoking is often a social practice that occurs in cafés, homes, and other natural settings. This observational study examined the behavior of waterpipe tobacco smokers and the social and contextual features of waterpipe use among groups in their natural environment. Methods: Trained observers visited urban waterpipe cafés on multiple occasions during an 8-month period. Observations of 241 individual users in naturally formed groups were made on smoking topography (puff frequency, duration, and interpuff interval [IPI]) and engagement in other activities (e.g., food and drink consumption, other tobacco use, and media viewing). Results: Most users were male in group sizes of 3–4 persons, on average, and each table had 1 waterpipe, on average. The predominant social features during observational periods were conversation and nonalcoholic drinking. Greater puff number was associated with smaller group sizes and more waterpipes per group, while longer IPIs were associated with larger group sizes and fewer waterpipes per group. Additionally, greater puff frequency was observed during media viewing and in the absence of other tobacco use. Conclusions: Overall, the results suggest that waterpipe smoking behavior is affected by group size and by certain social activities. Discussion focuses on how these findings enhance our understanding of factors that may influence exposure to waterpipe tobacco smoke toxicants in naturalistic environments. PMID:23943842

The Effect of Motivational Interviewing on Craving and Dependence on Hookah in Suburban Pregnant Women in South East of Iran.

PubMed

Mojahed, Kheirolnesa; Navidian, Ali

2018-05-30

Hookah smoking during pregnancy is a health concern which requires effective interventions. Thus, the authors have aimed to evaluate the effect of motivational interviewing on craving and dependence on hookah in pregnant women (n = 140) addicted to hookah who reside in the outskirts of Zahedan, a city in southeast of Iran. The subjects were selected using the convenience sampling and randomly divided into either the control or intervention group. The intervention group received five motivational interviewing group sessions about hookah smoking withdrawal, whereas the control group was given the conventional recommendations for quitting hookah. Data were collected after eight weeks during the post intervention period using Hookah Craving Test and Hookah Addiction Severity Index. Next, they were analyzed using independent t-test, paired t-test, and analysis of covariance (ANCOVA). After the motivational interviewing intervention, the independent t-test indicated a significant difference between the intervention and control groups in terms of the mean score of hookah craving (P = 0.0001). Moreover, ANCOVA, with control of the effect of pretest and duration of hookah addiction, demonstrated a significant difference between the two groups regarding the mean score of hookah dependence after the intervention (P = 0.0001). Motivational interviewing had a significant positive impact on decreased hookah craving and dependence (two indices of withdrawal). Therefore, healthcare providers are recommended to incorporate motivational interviewing-based education into prenatal care programs to promote the chance of hookah smoking withdrawal.

Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional.

PubMed

Hammal, Fadi; Wild, T Cameron; Nykiforuk, Candace; Abdullahi, Khadija; Mussie, Dawit; Finegan, Barry A

2016-05-01

When asserting the right of individuals to be free to smoke a hookah (waterpipe [WP]) in public places, the "cultural" importance of the practice is often cited. The purpose of this study was to explore the cultural significance of WP smoking. Qualitative methods were used to elicit the views of groups of WP smokers from different cultural backgrounds. Sixteen group discussion sessions with a total of 75 WP smokers aged between 18 and 30 were conducted. A few participants saw culture as a factor supporting WP smoking initiation and maintenance. The vast majority indicated that WPs being perceived as "healthier" than cigarettes, and the availability of flavored shisha as important factors in their initiation and ongoing use. Most started smoking before the age of 18 calling it a "high school thing" and admitted that they had easy access to WP cafés. Many indicated that they did not know if they were smoking tobacco or a "herbal" substance. Peer influence, availability of flavored products and facile access to WP cafés are major factors in WP initiation. Ethno-cultural traditions play only a minor role. The assertion that cultural traditions and practice are inherent in WP smoking as implied by media and marketing was not supported by our findings. Contemporary use of WP is spreading among new non-traditional users. Lack of knowledge about the harms of WP smoking indicates a need for education and regulation to require packaging and health warning labels and restrictions on access, especially to minors. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

You Tube: An International Medium for Sharing Videos about Hookah Smoking

ERIC Educational Resources Information Center

Seitz, Christopher M.; Milroy, Jeffrey J.; Orsini, Muhsin Michael; Wyrick, David L.; Herring, Jeremy; Koech, Mike

2011-01-01

The hookah pipe is an ancient tool for smoking tobacco and is a growing public health concern at the global level. YouTube is a website that allows its members to post videos for people to watch and to share comments about the videos in an online forum. The purpose of the study was to investigate the types of videos about hookah on YouTube, their…

Factors Associated with Perceptions of Hookah Addictiveness and Harmfulness among Young Adults

ERIC Educational Resources Information Center

Noonan, Devon; Patrick, Megan E.

2013-01-01

Hookah smoking is a form of tobacco use that is growing in popularity in the United States. College-aged students, who are known to experiment with multiple forms of tobacco, are particularly vulnerable to this tobacco trend. There is a common misconception that hookah smoking is not as dangerous as other forms of tobacco, which may help explain…

Beliefs and Attitudes Associated With Hookah Smoking Among a United States College Population.

PubMed

Martinasek, Mary P; Haddad, Linda G; Wheldon, Christopher W; Barnett, Tracey E

2017-03-01

This study explores the differences among smokers of waterpipe tobacco in a college population to better inform campaigns to curb waterpipe use. Participants included undergraduate and graduate students attending a liberal arts university in Florida. E-mail-based, cross-sectional surveys were collected in 2 sequential years. The majority of respondents (64%) reported having ever smoked a hookah, even if just 1-2 puffs. Of those who had ever smoked a hookah, 34% reported smoking a hookah within the previous 30 d. Constructs from the theory of reasoned action were all correlated with smoking behavior. The range of beliefs endorsed by smokers were more strongly associated with hookah-related attitudes compared with subjective norms. Concerns about health were stronger among never-smokers. Young adult college students continue to engage in waterpipe tobacco smoking at high rates. Campaigns need to focus on subsets of smokers and nonsmokers, independently. Copyright © 2017 by Daedalus Enterprises.

Research report: Charcoal type used for hookah smoking influences CO production.

PubMed

Medford, Marlon A; Gasier, Heath G; Hexdall, Eric; Moffat, Andrew D; Freiberger, John J; Moon, Richard E

2015-01-01

A hookah smoker who was treated for severe carbon monoxide poisoning with hyperbaric oxygen reported using a different type of charcoal prior to hospital admission, i.e., quick-light charcoal. This finding led to a study aimed at determining whether CO production differs between charcoals commonly used for hookah smoking, natural and quick-light. Our hypothesis was that quick-light charcoal produces significantly more CO than natural charcoal. A medium-sized hookah, activated charcoal filter, calibrated syringe, CO gas analyzer and infrared thermometer were assembled in series. A single 9-10 g briquette of either natural or quick-light charcoal was placed atop the hookah bowl and ignited. CO output (ppm) and temperature (degrees C) were measured in three-minute intervals over 90 minutes. The mean CO levels produced by quick-light charcoal over 90 minutes was significantly higher (3728 ± 2028) compared to natural charcoal (1730 ± 501 ppm, p = 0.016). However, the temperature was significantly greater when burning natural charcoal (292 ± 87) compared to quick-light charcoal (247 ± 92 degrees C, p = 0.013). The high levels of CO produced when using quick-light charcoals may be contributing to the increase in reported hospital admissions for severe CO poisoning.

Hookah and Cigarette Smoking Among African American College Students: Implications for Campus Risk Reduction and Health Promotion Efforts

PubMed Central

Jones, Brittni D.; Cunningham-Williams, Renee M.

2016-01-01

Objective To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. Participants AA college students (n=1,402; mean age=20, range=18–24 years; 75% female) who completed the Fall 2012 American College Health Association–National College Health Assessment II. Methods Respondents were stratified into four mutually exclusive groups by last 30-day smoking status: cigarette-only use (5.1%), hookah-only use (5.9%), dual use (2.4%), and non-use (86.6%). Multinomial logistic regression models identified the relative odds of exclusive and dual hookah and cigarette smoking. Results Current hookah and cigarette smoking rates were comparably low. Age, gender identity, current substance use, interest in tobacco use information, and student population prevailed as risks and protections for hookah and cigarette smoking. Conclusions Campus health promotion campaigns may need to tailor messages to AA students, particularly those who use substances, to underscore the health risks of hookah and cigarette smoking. PMID:26829515

Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking.

PubMed

Barnett, Tracey E; Soule, Eric K; Forrest, Jamie R; Porter, Lauren; Tomar, Scott L

2015-08-01

The emerging trends and rapid growth of electronic cigarettes (e-cigarettes) among adolescents are being monitored closely. The trends are critical as policy to prevent uptake among adolescents is considered. The purpose of this study is to describe the prevalence of e-cigarette use and potential correlates for use. Associations between e-cigarettes, cigarettes, and hookah are assessed. This study used data from the 2013 Florida Youth Tobacco Survey. Prevalence estimates were calculated in 2014 and differences were determined based on CIs. Adjusted logistic regression models were used to identify correlates of e-cigarette use among participants based on demographic and other tobacco products used. There were no sex differences in middle school, whereas male high school students reported higher use than their female counterparts. Cigarette smoking and hookah use were significantly associated with ever and current e-cigarette use among both middle and high school students. Although e-cigarettes are being assessed as a potential replacement product for traditional tobacco, evidence from this study indicates the possibility of multiple product use among adolescents. E-cigarettes are not only associated with traditional cigarettes, but also with hookahs, a similar emerging product that offer tobacco flavors that may appeal to adolescents. Notably, many e-cigarette users also reported no cigarette or hookah use. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Expectancies for and use of e-cigarettes and hookah among young adult non-daily smokers.

PubMed

Doran, Neal; Brikmanis, Kristin

2016-09-01

Understanding predictors of e-cigarette and hookah use among young adults is important in light of their increasing prevalence, particularly in younger populations. The purpose of this study was to test the hypothesis that young adult non-daily cigarette smokers' use of e-cigarettes and hookah would be positively associated with their expectancies about these products. Young adults (n=377, 58.0% male) aged 18-24years (M=20.5, SD=1.8) who had been non-daily smokers for at least six months but had never been daily smokers completed a baseline assessment online or via mobile phone as part of a larger, longitudinal study. Approximately one in three participants reported any e-cigarette (34.0%) and/or hookah (33.4%) use in the past 14days; 37% of those who used either product reported using both. More positive e-cigarette expectancies were associated with higher odds of any e-cigarette use and with heavier use in the past two weeks. Similarly, more positive expectancies for hookah use predicted greater odds of any use as well as more frequent use of hookah (all ps<0.001). Cigarette expectancies were correlated with ANTP expectancies, but did not account for the latter's association with ANTP use. Findings suggest that expectancies play a role in determining whether young adult cigarette smokers also use these nicotine products. These data also suggest use of e-cigarettes and/or hookah may be as common as not among young adult nondaily smokers. Published by Elsevier Ltd.

Characteristics of Hookah Tobacco Smoking Sessions and Correlates of Use Frequency Among US Adults: Findings From Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study.

PubMed

Robinson, Joelle N; Wang, Baoguang; Jackson, Kia J; Donaldson, Elisabeth A; Ryant, Chase A

2018-05-03

Hookah tobacco smoking has increased in the United States. However, information on hookah use frequency and other characteristics of hookah use is limited. Investigators analyzed data from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US youth and adults. Our analysis draws on baseline data from adult (ages ≥18 years) ever (N = 10 624) and past year (n = 3947) hookah users. Bivariate and regression analyses were conducted to identify associations between demographics, use characteristics, and hookah use frequency. Overall, 16.4% of adults reported ever smoking tobacco from a hookah. Of those, 31.9% reported smoking hookah within the past year. Among 3947 past-year hookah tobacco smokers, 10.7% were daily/weekly users, 13.7% were monthly users, 42.1% smoked every couple of months, and 33.5% smoked about once a year. Among daily/weekly hookah users, 66% were young adults (ages 18-24 years). When comparing daily/weekly hookah users to those who smoked every couple of months, more frequent hookah use was associated with younger age, male gender, a greater number of times the hookah is refilled during a session, fewer people sharing, and hookah ownership. Although there were few demographic differences between daily/weekly users and less frequent hookah tobacco smokers, some notable differences in use behaviors exist among use frequency groups. Unlike other tobacco products, hookah is often smoked communally, over an extended time period. A detailed understanding of hookah user characteristics and experiences could inform hookah-specific measures, messaging, and regulations. To our knowledge, this is one of the first studies to characterize hookah use frequency, session length, and other hookah use experiences using a nationally representative sample of US adult hookah smokers. Understanding characteristics of hookah tobacco smokers, their use experiences, and patterns of hookah use

Tobacco in the Arab world: old and new epidemics amidst policy paralysis

PubMed Central

Maziak, Wasim; Nakkash, Rima; Bahelah, Raed; Husseini, Abdullatif; Fanous, Nadia; Eissenberg, Thomas

2014-01-01

The Arab world is comprised of 22 countries with a combined population of ∼360 million. The region is still at the initial stages of the tobacco epidemic, where it is expected to witness an increase in smoking levels and mounting tobacco-related morbidity and mortality in the future. Still, the bleak outlook of the tobacco epidemic in the Arab world continues to be faced with complacency in the form of underutilization of surveillance systems to monitor the tobacco epidemic and prioritize action, and failure to implement and enforce effective policies to curb the tobacco epidemic. Understandably, the focus on the Arab world carries the risk of trying to generalize to such a diverse group of countries at different level of economic and political development. Yet, tobacco control in the Arab world faces some shared patterns and common challenges that need to be addressed to advance its cause in this region. In addition, forces that promote tobacco use, such as the tobacco industry, and trends in tobacco use, such as the emerging waterpipe epidemic tend to coalesce around some shared cultural and socio-political features of this region. Generally, available data from Arab countries point at three major trends in the tobacco epidemic: (1) high prevalence of cigarette smoking among Arab men compared with women; (2) the re-emergence of waterpipe (also known as hookah, narghile, shisha, arghile) smoking as a major tobacco use method, especially among youth and (3) the failure of policy to provide an adequate response to the tobacco epidemic. In this review, we will discuss these trends, factors contributing to them, and the way forward for tobacco control in this unstable region. PMID:23958628

Substance and hookah use and living arrangement among fraternity and sorority members at US colleges and universities.

PubMed

Sidani, Jaime E; Shensa, Ariel; Primack, Brian A

2013-04-01

Hookah tobacco smoking is associated with substantial toxicant exposures and is increasing among college students in the United States. Greek (fraternity/sorority) students, especially those living in Greek housing, have high rates of risky alcohol use. The extent to which this is true for other substances, including hookah tobacco smoking, is not well known. The objective of this study is to examine associations between Greek involvement and living arrangement (non-member, non-resident member, resident member) and rates of hookah tobacco smoking, in relation to other substances, among US college students. We used national data from 82,251 student responses from the 2008 to 2009 administration of the National College Health Assessment. Generalized estimating equations were utilized to determine adjusted odds ratios for substance use outcomes based on involvement and living arrangements, while adjusting for covariates and clustering of students within institutions. Among resident members, ever use was highest for marijuana (52.4 %), hookah (48.5 %) and cigarettes (46.6 %). In multivariable models, adjusted odds were lowest for non-Greeks and highest for Greek resident members. Compared to non-Greeks, Greek resident members had nearly double the odds for current use of hookah, cigars, and marijuana, as well as two and a half times the odds for current use of smokeless tobacco and three times the odds for alcohol bingeing. Similar to other substances, hookah tobacco smoking is highest among Greek resident members, compared with both Greeks living outside Greek housing and non-Greeks. It is valuable for substance use surveillance and intervention to focus on Greek resident members.

Tobacco in the Arab world: old and new epidemics amidst policy paralysis.

PubMed

Maziak, Wasim; Nakkash, Rima; Bahelah, Raed; Husseini, Abdullatif; Fanous, Nadia; Eissenberg, Thomas

2014-09-01

The Arab world is comprised of 22 countries with a combined population of ∼360 million. The region is still at the initial stages of the tobacco epidemic, where it is expected to witness an increase in smoking levels and mounting tobacco-related morbidity and mortality in the future. Still, the bleak outlook of the tobacco epidemic in the Arab world continues to be faced with complacency in the form of underutilization of surveillance systems to monitor the tobacco epidemic and prioritize action, and failure to implement and enforce effective policies to curb the tobacco epidemic. Understandably, the focus on the Arab world carries the risk of trying to generalize to such a diverse group of countries at different level of economic and political development. Yet, tobacco control in the Arab world faces some shared patterns and common challenges that need to be addressed to advance its cause in this region. In addition, forces that promote tobacco use, such as the tobacco industry, and trends in tobacco use, such as the emerging waterpipe epidemic tend to coalesce around some shared cultural and socio-political features of this region. Generally, available data from Arab countries point at three major trends in the tobacco epidemic: (1) high prevalence of cigarette smoking among Arab men compared with women; (2) the re-emergence of waterpipe (also known as hookah, narghile, shisha, arghile) smoking as a major tobacco use method, especially among youth and (3) the failure of policy to provide an adequate response to the tobacco epidemic. In this review, we will discuss these trends, factors contributing to them, and the way forward for tobacco control in this unstable region. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Prime and boost aerosol exposure via fog machine or shisha smoke followed by cinnamon hypersensitivity and anaphylaxis to spiced food.

PubMed

Jensen-Jarolim, Erika; Roth-Walter, Franziska; Leitner, Erich; Buchleitner, Stefan; Vogelsang, Harald; Kinaciyan, Tamar

2016-01-01

Cinnamon aldehyde (alias cinnamaldehyde) is widely used in food, textile or cosmetic industry. It is mostly associated with contact allergy, but immediate type allergies have been reported. The present study was triggered by a case of anaphylactic events to cinnamon in food and upon skin prick test. We investigated a possible correlation of exposure to a disco fog machine and/or shisha consumption with immediate type hypersensitivity to cinnamon aldehyde in the patient and healthy volunteers. In both fog machines and shisha pipes heating of glycerol-based fluids before evaporation renders chemical transversion to malodorous acrolein. Therefore, both methods are frequently operated with aroma additives. Cinnamon aldehyde and derivatives could be detected by gas chromatography in sampled fog flavored with cola fragrance. The patient as well as healthy (mostly female) volunteers were skin prick tested using cinnamon aldehyde diluted in 0.9 % NaCl, Vaseline® or fog fluid. Persons with a history of exposure to disco fog or shisha (n = 10, mean 32.8 years) reacted with a significantly larger wheal and flare reaction in the skin test (p = 0.0115, p = 0.0146, or p = 0.098) than the non-exposed (n = 8, mean 37.3 years). Both groups were gender matched, but differed in the mean age by 4.5 years. This reaction was specific as compared to skin reactivity to cinnamon alcohol, with only a trend to higher reactivity in exposed persons (ns). From our data we conclude that hapten fragrances such as cinnamon aldehyde may during heating in glycerol fluids associate to complete antigens and via inspiration lead to specific immediate type hypersensitivity. In some cases the hypersensitivity may be unmasked by spiced food containing cinnamon aldehyde or related chemicals, and lead to severe adverse reactions.

Tobacco Marketing and Subsequent Use of Cigarettes, E-cigarettes and Hookah in Adolescents.

PubMed

Cruz, Tess Boley; McConnell, Rob; Low, Brittany Wagman; Unger, Jennifer B; Pentz, Mary Ann; Urman, Robert; Berhane, Kiros; Chou, Chih Ping; Liu, Fei; Barrington-Trimis, Jessica

2018-05-28

Tobacco marketing has expanded from cigarettes to other tobacco products through many promotional channels. Marketing exposure is associated with use of that tobacco product. However, it's unclear if marketing for one product leads to subsequent use of other tobacco products. This prospective cohort study assessed self-reported marketing exposure for six tobacco products across five marketing channels in 11th/12th grade students in 2014. Approximately 16 months later a follow-up survey was conducted online (N=1553) to assess initiation of cigarettes, e-cigarettes and hookah. Adolescent never smokers with frequent exposure to cigarette marketing on the Internet and in stores are more than two times as likely to begin smoking as young adults (Internet OR 2.98 [95% CI, 1.56-5.66); Stores OR, 2.83 [95% CI, 1.23-6.50]). Never users of e-cigarettes were significantly more likely to initiate use, if exposed to Internet, store and outdoor e-cigarette marketing. Never users of hookah were more likely to use hookah after seeing it marketed in stores. Youth exposed to marketing of e-cigarettes, hookah, cigars, smokeless and pipe tobacco in stores were two to three times more likely to begin smoking cigarettes even though the marketed products were not cigarettes. Adolescent exposure to marketing of tobacco products is associated with initiation of those products as young adults. Exposure to marketing for non-cigarette tobacco products is associated with subsequent cigarette smoking, even when the promoted products are not cigarettes. Future research and interventions should consider the influence of marketing from multiple tobacco products on adolescent tobacco use. Adolescents grow up in a rich media environment with exposure to tobacco marketing in both their homes (e.g., through the Internet and television) and their communities (e.g., stores and billboards). This prospective study provides evidence that adolescents exposed to tobacco marketing for multiple tobacco

Epidemiology, attitudes and perceptions toward cigarettes and hookah smoking amongst adults in Jordan.

PubMed

Abu-Helalah, Munir Ahmad; Alshraideh, Hussam Ahmad; Al-Serhan, Ala-Aldeen Ahmad; Nesheiwat, Adel Issa; Da'na, Moh'd; Al-Nawafleh, Ahmad

2015-11-01

The aims of this study are to assess cigarette and hookah smoking rates amongst adult population in Jordan and to determine predictors of smoking status. Selected beliefs, perceptions and attitudes toward cigarettes and hookah smoking were also assessed. This cross-sectional study was conducted in five regional governorates of Jordan through face-to-face interviews on a random sample of adult population aged 18-79 years. Data was collected using a piloted questionnaire based on the Global Adult Tobacco Questionnaire. The overall prevalence of cigarette smoking in our sample (869) was 59.1 % amongst males and 23.3 % amongst females, while the overall prevalence of hookah smoking was 18.9 % amongst males and 23.1 % amongst females. Leisure and imitation were the most commonly reported reasons for smoking. Regardless of smoking status, people were aware of health risks associated smoking and also had negative perceptions toward smoking. Smoking rates for both genders have reached alarmingly high rates in Jordan. There is an urgent need for a comprehensive national programme to target the country's growing burden of smoking. Suggestions on leisure time activities should be included in such programmes.

Small Area Estimate Maps: Is a Hookah Less Harmful? - Small Area Estimates

Cancer.gov

This metric is defined as a person 18 years of age or older who must have reported that he/she thinks that smoking tobacco using a hookah is less harmful or much less harmful compared to smoking cigarettes.

Racial and ethnic differences in current use of cigarettes, cigars, and hookahs among lesbian, gay, and bisexual young adults.

PubMed

Blosnich, John R; Jarrett, Traci; Horn, Kimberly

2011-06-01

Research demonstrates that lesbians, gays, and bisexuals (i.e., LGBs or sexual minorities) smoke more than their heterosexual peers, but relatively less is known about the heterogeneity within LGB populations, namely racial/ethnic differences. Moreover, smoking research on sexual minorities has focused mainly on cigarette smoking, with little attention to other forms of smoking, such as hookahs/water pipes. Using a large national sample of college students, we examined differences by race and sexual orientation in prevalence of smoking cigarettes, cigars/cigarillos/clove cigarettes, and hookahs. All LGB racial groups had higher cigarette smoking prevalence than their heterosexual racial group counterparts. Significantly more White and Hispanic LGBs smoked hookahs when compared, respectively, with White and Hispanic heterosexuals. Given the higher prevalence of multiple forms of smoking among sexual minorities, the heterogeneity within sexual minority populations and the nuances of multiple identities (i.e., racial, ethnic, and sexual minority), targeted-if not tailored-prevention and cessation efforts are needed to address smoking disparities in these diverse communities. Prevention, intervention, and epidemiological research on smoking behaviors among college attending young adults should take into account other forms of smoking, such as hookah use.

Abstinence Rates among College Cigarette Smokers Enrolled in A Randomized Clinical Trial Evaluating Quit and Win Contests: The Impact of Concurrent Hookah Use

PubMed Central

Bengtson, J.E.; Wang, Q.; Luo, X.; Marigi, Erick; Winta, Ghidei; Ahluwalia, J.S.

2015-01-01

Objective To examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use. Methods Analyses were conducted on data from 1,217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010–2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates. Results Participants smoked 11.5(±8.1) cigarettes per day on 28.5(±3.8) days/month, and 22% smoked hookah in the past 30 days. Hookah smokers (n=270) were more likely to be male (p<0.0001), younger (p<0.0001), report more binge drinking (p<0.0001) and score higher on impulsivity (p<0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR= 0.64, 95% CI=0.45–0.93, p=0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR = 0.37, CI=0.14–0.99, p=0.05). Conclusion College cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates. PMID:25773472

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training.

PubMed

Koubaa, Abdessalem; Triki, Moez; Trabelsi, Hajer; Masmoudi, Liwa; Zeghal, Khaled N; Sahnoun, Zouhair; Hakim, Ahmed

2015-01-01

Introduction Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers. Aim To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers. Methods Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity ([Formula: see text]). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program. Results As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved [Formula: see text] (4.4 and 4.7%, respectively), v [Formula: see text] (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively). Conclusions After 12 weeks of interval training program, the increase of [Formula: see text] and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training.

PubMed

Koubaa, Abdessalem; Triki, Moez; Trabelsi, Hajer; Masmoudi, Liwa; Zeghal, Khaled N; Sahnoun, Zouhair; Hakim, Ahmed

2015-01-01

Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers. To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers. Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (VO2max). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program. As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved VO2max (4.4 and 4.7%, respectively), v VO2max (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively). After 12 weeks of interval training program, the increase of VO2max and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved

Subjective experiences at first use of cigarette, e-cigarettes, hookah, and cigar products among Texas adolescents

PubMed Central

Mantey, Dale S.; Harrell, Melissa B.; Case, Kathleen; Crook, Brittani; Kelder, Steven H.; Perry, Cheryl L.

2017-01-01

Introduction Subjective experiences (“SEs”) at first cigarette use have been thoroughly examined; however, limited research has examined SEs at first use of non-cigarette products. This study addresses this gap in the literature. Methods Cross-sectional data from 6th, 8th and 10th grade students in four metropolitan areas of Texas (n = 3907/N = 461,069). Nausea, coughing, relaxation, rush/buzz, and dizziness at first use were assessed for cigarettes, e-cigarettes, hookah, and cigar products. Chi-square analyses examined differences in the prevalence of first use SEs by product. Weighted multiple logistic regression analyses examined the association of SEs and current product use. Covariates were grade, gender, race/ethnicity, and current other tobacco product use. Results Exploratory factor analysis of SEs determined differing factor structures across tobacco products. For example, the following items loaded onto the positive SE factor: 1) relaxation, rush, and dizziness for cigarettes, and 2) relaxation and rush for e-cigarettes, hookah, and cigar products. Prevalence of negative SEs (coughing and nausea) were higher for cigarette and cigar products compared to e-cigarettes and hookah. Positive SEs for cigarettes were associated with increased odds of current cigarette use (AOR = 1.51); similarly positive SEs for cigars were associated with increased odds of current cigar use (AOR = 2.11). Feeling nauseous at first use of cigars was associated with decreased odds of current cigar use (AOR = 0.18). No SEs were associated with current e-cigarette or hookah use. Conclusions Subjective experiences at first use differ by tobacco product. Longitudinal studies are needed to examine temporal relationships between SEs at first use and sustained tobacco use. PMID:28182981

Social Influences on Use of Cigarettes, E-Cigarettes, and Hookah by College Students

ERIC Educational Resources Information Center

Noland, Melody; Ickes, Melinda J.; Rayens, Mary Kay; Butler, Karen; Wiggins, Amanda T.; Hahn, Ellen J.

2016-01-01

Objectives: (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences. Participants: Undergraduate students attending a large university in the Southeast United States (N = 511). Methods: An April 2013 online survey…

Patterns of Alternative Tobacco Product Use: Emergence of Hookah and E-cigarettes as Preferred Products Amongst Youth.

PubMed

Gilreath, Tamika D; Leventhal, Adam; Barrington-Trimis, Jessica L; Unger, Jennifer B; Cruz, Tess Boley; Berhane, Kiros; Huh, Jimi; Urman, Robert; Wang, Kejia; Howland, Steve; Pentz, Mary Ann; Chou, Chih Ping; McConnell, Rob

2016-02-01

There is a growing public health concern related to the rapid increase in the use of multiple tobacco products among adolescents. This study examined patterns of adolescent use of cigarettes, e-cigarettes, cigars/cigarillo, hookah/waterpipe, and smokeless/dip/chewing tobacco in a population of southern California adolescents. Data from 2,097 11th- and 12th-grade participants in the Southern California Children's Health Study were collected via self-report in 2014. Study participants were asked about lifetime and current (past 30 days) use of cigarettes, cigars/cigarillos/little cigars, e-cigarettes, hookah/waterpipe, and smokeless/dip/chewing tobacco. Latent class analysis (LCA) was used to identify patterns of tobacco use. Hookah/waterpipe tobacco use had the highest current prevalence (10.7%) followed by e-cigarettes (9.6%). The prevalence of use of smokeless/dip/chewing tobacco was lowest, with 2.2% of adolescents reporting current use. The LCA suggested four distinct classes, comprising nonusers (72.3% of the sample), polytobacco experimenters (13.9%), e-cigarette/hookah users (8.2%), and polytobacco users (5.6%). Multinomial logistic regression based on these four classes found that males had double the odds to be polytobacco users relative to nonusers compared to females (odds ratio, 2.3; 95% confidence interval, 1.26-4.25). By identifying naturally occurring configurations of tobacco product use in teens, these findings may be useful to practitioners and policymakers to identify the need for tobacco control interventions that address specific tobacco products and particular combinations of polytobacco use. LCA can be used to identify segments of the population overrepresented among certain tobacco use classes (e.g., boys) that may benefit most from targeted polyproduct intervention approaches. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Assessment of Prevalence, Beliefs, and Habits of Hookah Smoking Among People with a Medical Background Compared to People with a Non-medical Background: A Cross-sectional Self-administered Questionnaire-based Study

PubMed Central

Jain, Ashna

2016-01-01

Introduction: Hookah smoking has seen a reemergence in popularity in the last 30 years, particularly in the young urban population. This study aimed to compare the prevalence of and the attitude and beliefs about hookah smoking of people with a medical background and compare it with people from a non-medical background. Materials and methods: An anonymous questionnaire with ten questions about various aspects of hookah smoking was formulated using Google forms®, which was then circulated via Facebook®, Whatsapp® and emails to the intended participants and all responses were recorded and analyzed. Results: The total number of respondents were 470. The number of respondents with a medical background was 45.31%. The percentage of the respondents with a medical background who smoked a hookah was 28.63%, while the same percentage of the respondents with a non-medical background was 63.42. The perception of hookah being less harmful than a cigarette was not found to be statistically different between the two groups. Respondents with a medical background were more ignorant of the presence or absence of tobacco in the hookah they smoked. The average duration of the hookah smoking habit, the frequency of its use per month, and the average lengths of the hookah smoking session were 3.52 years (95% CI of 3.21 to 3.82), 1.946 (95% CI 1.799 to 2.093), and 58.90 minutes (95% CI of 54.42 to 63.37), respectively. Conclusion: The knowledge about the ill effects of smokeless tobacco should be integrated into the structured teaching curriculum of undergraduate medical and dental courses as they prepare future physicians and dental surgeons for an anti-tobacco campaign. PMID:27660734

E-cigarettes, Hookah Pens and Vapes: Adolescent and Young Adult Perceptions of Electronic Nicotine Delivery Systems.

PubMed

Wagoner, Kimberly G; Cornacchione, Jennifer; Wiseman, Kimberly D; Teal, Randall; Moracco, Kathryn E; Sutfin, Erin L

2016-10-01

Most studies have assessed use of "e-cigarettes" or "electronic cigarettes," potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations. Ten focus groups with 77 adolescents and young adults, ages 13-25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes. Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including "e-cigarette," "e-hookah," "hookah pens," "tanks," and "vapes." Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine. Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers. Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our

E-cigarettes, Hookah Pens and Vapes: Adolescent and Young Adult Perceptions of Electronic Nicotine Delivery Systems

PubMed Central

Cornacchione, Jennifer; Wiseman, Kimberly D.; Teal, Randall; Moracco, Kathryn E.; Sutfin, Erin L.

2016-01-01

Introduction: Most studies have assessed use of “e-cigarettes” or “electronic cigarettes,” potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations. Methods: Ten focus groups with 77 adolescents and young adults, ages 13–25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes. Results: Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including “e-cigarette,” “e-hookah,” “hookah pens,” “tanks,” and “vapes.” Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine. Conclusions: Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers. Implications: Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on

Understanding Tobacco-Related Attitudes among College and Noncollege Young Adult Hookah and Cigarette Users

ERIC Educational Resources Information Center

Lee, Youn Ok; Bahreinifar, Sareh; Ling, Pamela M.

2014-01-01

Objective: To examine differences in tobacco-related attitudes and hookah and cigarette use among college and noncollege young adults. Participants: Time-location samples of young adult bar patrons in San Diego, California ("N" = 2,243), Tulsa ("N" = 2,095) and Oklahoma City ("N" = 2,200), Oklahoma, Albuquerque…

A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy.

PubMed

Kahr, Maike K; Padgett, Shannon; Shope, Cindy D; Griffin, Emily N; Xie, Susan S; Gonzalez, Pablo J; Levison, Judy; Mastrobattista, Joan; Abramovici, Adi R; Northrup, Thomas F; Stotts, Angela L; Aagaard, Kjersti M; Suter, Melissa A

2015-12-21

Studies reveal that electronic cigarette (e-cigarette) and hookah use are increasing among adolescents and young adults. However, the long-term health effects are unknown, especially with regards to pregnancy. Because of the increased use in women of reproductive age, and the unknown long-term health risks, our primary objectives were to determine the perceived risks of e-cigarette and hookah use in pregnancy, and learn common colloquial terms associated with e-cigarettes. Furthermore, we sought to determine if there is a stigma associated with e-cigarette use in pregnancy. Eleven focus groups including 87 participants were conducted immediately following regularly scheduled CenteringPregnancy® prenatal care with women at three different clinics in the greater Houston area. A minimum of two facilitators led the groups, using ten lead-in prompts, with Spanish translation as necessary. Facilitators took notes which were compared immediately following each group discussion and each group was audio recorded and transcribed. Three facilitators utilized NVivo 9.0 software to organize the transcribed data into nodes to identify major themes. To increase rigor, transcripts were further analyzed by two obstetricians who were instructed to find the major themes. Analyses revealed contradicting themes concerning e-cigarette use. In general, e-cigarettes were perceived as safer alternatives to regular tobacco cigarettes, especially if used as smoking cessation devices. A major theme is that use in pregnancy is harmful to the fetus. However, it was perceived that use for smoking cessation in pregnancy may have fewer side effects. We found that a common term for e-cigarettes is "Blu." In our discussion of hookah use, participants perceived use as popular among teenagers and that use in pregnancy is dangerous for the fetus. Although a strong theme emerged against hookah use, we found contradicting themes in our discussions on e-cigarette use in pregnancy. It is possible that e

Perceived Harm, Addictiveness, and Social Acceptability of Tobacco Products and Marijuana Among Young Adults: Marijuana, Hookah, and Electronic Cigarettes Win

PubMed Central

Berg, Carla J.; Stratton, Erin; Schauer, Gillian L.; Lewis, Michael; Wang, Yanwen; Windle, Michael; Kegler, Michelle

2015-01-01

Background There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. Objectives This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. Methods In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products. Results Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth. PMID:25268294

Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win.

PubMed

Berg, Carla J; Stratton, Erin; Schauer, Gillian L; Lewis, Michael; Wang, Yanwen; Windle, Michael; Kegler, Michelle

2015-01-01

There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products. Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.

Hookah and Cigarette Smoking among African American College Students: Implications for Campus Risk Reduction and Health Promotion Efforts

ERIC Educational Resources Information Center

Jones, Brittni D.; Cunningham-Williams, Renee M.

2016-01-01

Objective: To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. Participants: AA college students (N = 1,402; mean age = 20, range = 18-24 years; 75% female) who completed the Fall 2012 American College Health Association--National College Health Assessment…

What Online Communities Can Tell Us About Electronic Cigarettes and Hookah Use: A Study Using Text Mining and Visualization Techniques.

PubMed

Chen, Annie T; Zhu, Shu-Hong; Conway, Mike

2015-09-29

The rise in popularity of electronic cigarettes (e-cigarettes) and hookah over recent years has been accompanied by some confusion and uncertainty regarding the development of an appropriate regulatory response towards these emerging products. Mining online discussion content can lead to insights into people's experiences, which can in turn further our knowledge of how to address potential health implications. In this work, we take a novel approach to understanding the use and appeal of these emerging products by applying text mining techniques to compare consumer experiences across discussion forums. This study examined content from the websites Vapor Talk, Hookah Forum, and Reddit to understand people's experiences with different tobacco products. Our investigation involves three parts. First, we identified contextual factors that inform our understanding of tobacco use behaviors, such as setting, time, social relationships, and sensory experience, and compared the forums to identify the ones where content on these factors is most common. Second, we compared how the tobacco use experience differs with combustible cigarettes and e-cigarettes. Third, we investigated differences between e-cigarette and hookah use. In the first part of our study, we employed a lexicon-based extraction approach to estimate prevalence of contextual factors, and then we generated a heat map based on these estimates to compare the forums. In the second and third parts of the study, we employed a text mining technique called topic modeling to identify important topics and then developed a visualization, Topic Bars, to compare topic coverage across forums. In the first part of the study, we identified two forums, Vapor Talk Health & Safety and the Stopsmoking subreddit, where discussion concerning contextual factors was particularly common. The second part showed that the discussion in Vapor Talk Health & Safety focused on symptoms and comparisons of combustible cigarettes and e

What Online Communities Can Tell Us About Electronic Cigarettes and Hookah Use: A Study Using Text Mining and Visualization Techniques

PubMed Central

Zhu, Shu-Hong; Conway, Mike

2015-01-01

Background The rise in popularity of electronic cigarettes (e-cigarettes) and hookah over recent years has been accompanied by some confusion and uncertainty regarding the development of an appropriate regulatory response towards these emerging products. Mining online discussion content can lead to insights into people’s experiences, which can in turn further our knowledge of how to address potential health implications. In this work, we take a novel approach to understanding the use and appeal of these emerging products by applying text mining techniques to compare consumer experiences across discussion forums. Objective This study examined content from the websites Vapor Talk, Hookah Forum, and Reddit to understand people’s experiences with different tobacco products. Our investigation involves three parts. First, we identified contextual factors that inform our understanding of tobacco use behaviors, such as setting, time, social relationships, and sensory experience, and compared the forums to identify the ones where content on these factors is most common. Second, we compared how the tobacco use experience differs with combustible cigarettes and e-cigarettes. Third, we investigated differences between e-cigarette and hookah use. Methods In the first part of our study, we employed a lexicon-based extraction approach to estimate prevalence of contextual factors, and then we generated a heat map based on these estimates to compare the forums. In the second and third parts of the study, we employed a text mining technique called topic modeling to identify important topics and then developed a visualization, Topic Bars, to compare topic coverage across forums. Results In the first part of the study, we identified two forums, Vapor Talk Health & Safety and the Stopsmoking subreddit, where discussion concerning contextual factors was particularly common. The second part showed that the discussion in Vapor Talk Health & Safety focused on symptoms and comparisons

Inhibitory control and the onset of combustible cigarette, e-cigarette, and hookah use in early adolescence: The moderating role of socioeconomic status.

PubMed

Riggs, Nathaniel R; Pentz, Mary Ann

2016-01-01

The purpose of the study was to test the moderating influence of socioeconomic status (SES) on the associations between inhibitory control and the onset of combustible cigarette, electronic (e-) cigarette, and hookah use in early adolescence. A total of 407 adolescents self-reported nicotine use, inhibitory control, and SES. The hypothesis that inhibitory control would be significantly associated with nicotine use onset (i.e., combustible cigarettes, e-cigarettes, and hookah) only under the condition of low SES was tested. Direct associations were found for inhibitory control on "ever use" of all three nicotine use variables. A moderating effect was also found whereby low inhibitory control was significantly associated with nicotine use onset when participants were from low, but not high, SES families. Findings illustrate one contextual condition under which inhibitory control is associated with early onset of nicotine use.

Determinants of Gastroesophageal Reflux Disease, Including Hookah Smoking and Opium Use– A Cross-Sectional Analysis of 50,000 Individuals

PubMed Central

Islami, Farhad; Nasseri-Moghaddam, Siavosh; Pourshams, Akram; Poustchi, Hossein; Semnani, Shahryar; Kamangar, Farin; Etemadi, Arash; Merat, Shahin; Khoshnia, Masoud; Dawsey, Sanford M.; Pharoah, Paul D.; Brennan, Paul; Abnet, Christian C.; Boffetta, Paolo; Malekzadeh, Reza

2014-01-01

Background Gastroesophageal reflux disease (GERD) is a common cause of discomfort and morbidity worldwide. However, information on determinants of GERD from large-scale studies in low- to medium-income countries is limited. We investigated the factors associated with different measures of GERD symptoms, including frequency, patient-perceived severity, and onset time. Methods We performed a cross-sectional analysis of the baseline data from a population-based cohort study of ∼50,000 individuals in in Golestan Province, Iran. GERD symptoms in this study included regurgitation and/or heartburn. Results Approximately 20% of participants reported at least weekly symptoms. Daily symptoms were less commonly reported by men, those of Turkmen ethnicity, and nass chewers. On the other hand, age, body mass index, alcohol drinking, cigarette smoking, opium use, lower socioeconomic status, and lower physical activity were associated with daily symptoms. Most of these factors showed similar associations with severe symptoms. Women with higher BMI and waist to hip ratio were more likely to report frequent and severe GERD symptoms. Hookah smoking (OR 1.34, 95% CI 1.02–1.75) and opium use (OR 1.70, 95% CI 1.55–1.87) were associated with severe symptoms, whereas nass chewing had an inverse association (OR 0.87, 95% CI 0.76–0.99). After exclusion of cigarette smokers, hookah smoking was still positively associated and nass chewing was inversely associated with GERD symptoms (all frequencies combined). Conclusion GERD is common in this population. The associations of hookah and opium use and inverse association of nass use with GERD symptoms are reported for the first time. Further studies are required to investigate the nature of these associations. Other determinants of GERD were mostly comparable to those reported elsewhere. PMID:24586635

Multiple tobacco product use among adults in the United States: cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus.

PubMed

Lee, Youn O; Hebert, Christine J; Nonnemaker, James M; Kim, Annice E

2014-05-01

Noncigarette tobacco products are increasingly popular. Researchers need to understand multiple tobacco product use to assess the effects of these products on population health. We estimate national prevalence and examine risk factors for multiple product use. We calculated prevalence estimates of current use patterns involving cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus using data from the 2012 RTI National Adult Tobacco Survey (N=3627), a random-digit-dial telephone survey of adults aged 18 and over. Associations between use patterns (exclusive single product and multiple products) and demographic characteristics were examined using Pearson chi-square tests and logistic regression. 32.1% of adults currently use 1 or more tobacco products; 14.9% use cigarettes exclusively, and 6.6% use one noncigarette product exclusively, 6.9% use cigarettes with another product (dual use), 1.3% use two noncigarette products, and 2.4% use three or more products (polytobacco use). Smokers who are young adult, male, never married, reside in the West, and made prior quit attempts were at risk for multiple product use. Over 10% of U.S. adults use multiple tobacco products. A better understanding of multiple product use involving combustible products, like cigars and hookah, is needed. Multiple product use may be associated with past quit attempts. Copyright © 2014 Elsevier Inc. All rights reserved.

Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015).

PubMed

Singh, S K; Enzhong, L; Reidpath, D D; Allotey, P

2017-03-01

To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth. The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?' Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review. This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth. This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Social influences on use of cigarettes, e-cigarettes, and hookah by college students.

PubMed

Noland, Melody; Ickes, Melinda J; Rayens, Mary Kay; Butler, Karen; Wiggins, Amanda T; Hahn, Ellen J

2016-01-01

(1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences. Undergraduate students attending a large university in the Southeast United States (N = 511). An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics. Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco. To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies.

Social Influences on Use of Cigarettes, E-Cigarettes, and Hookah by College Students

PubMed Central

Noland, Melody; Ickes, Melinda. J.; Rayens, Mary Kay; Butler, Karen; Wiggins, Amanda T.; Hahn, Ellen J.

2016-01-01

Objectives (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette and/or hookah users and nonusers; and (2) Determine variables associated with social influences. Participants Undergraduate students attending a large university in the Southeast U.S. (N=511). Methods An April 2013 online survey assessed use of three types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics. Results Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all three forms of tobacco. Conclusion To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies. PMID:26822236

Changes in Antioxidant Defense Capability and Lipid Profile after 12-Week Low- Intensity Continuous Training in Both Cigarette and Hookah Smokers: A Follow-Up Study

PubMed Central

Koubaa, Abdessalem; Triki, Moez; Trabelsi, Hajer; Masmoudi, Liwa; Sahnoun, Zouhair; Hakim, Ahmed

2015-01-01

To examine the impact of low-intensity continuous training program on antioxidant defense capability and lipid profile in male cigarette or hookah smokers. Forty-three male adults participated in a 12-week continuous training program at an intensity of 40% of VO2max. All subjects were subjected to anthropometric, physical and biochemical tests before and after the training program. The increase of Glutathione reductase (GR) and Superoxide dismutase (SOD) is significant only for cigarette smokers (CS) and hookah smokers (HS) groups. The Malondialdehyde (MDA) decrease and α-tocopherol increase are significant only for HS group. GPx was increased in NS, CS and HS by 2.6% (p< 0.01), 2% (p< 0.05) and 1.7% (p< 0.05) respectively. Likewise, significant improvements of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and TC / HDL-C ratio were observed in three groups. En contrast no significant changes were recorded in triglycerides (TG). Also, significant reduction of total cholesterol (TC) for CS group (p< 0.01) and HS groups (p< 0.05). This continuous training program appears to have an important role in lipid levels improving and oxidative stress attenuation. PMID:26121249

'Herbal' but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served.

PubMed

Hammal, Fadi; Chappell, Alyssa; Wild, T Cameron; Kindzierski, Warren; Shihadeh, Alan; Vanderhoek, Amanda; Huynh, Cong Khanh; Plateel, Gregory; Finegan, Barry A

2015-05-01

There are limited data on the composition and smoke emissions of 'herbal' shisha products and the air quality of establishments where they are smoked. Three studies of 'herbal' shisha were conducted: (1) samples of 'herbal' shisha products were chemically analysed; (2) 'herbal' and tobacco shisha were burned in a waterpipe smoking machine and main and sidestream smoke analysed by standard methods and (3) the air quality of six waterpipe cafés was assessed by measurement of CO, particulate and nicotine vapour content. We found considerable variation in heavy metal content between the three products sampled, one being particularly high in lead, chromium, nickel and arsenic. A similar pattern emerged for polycyclic aromatic hydrocarbons. Smoke emission analyses indicated that toxic byproducts produced by the combustion of 'herbal' shisha were equivalent or greater than those produced by tobacco shisha. The results of our air quality assessment demonstrated that mean PM2.5 levels and CO content were significantly higher in waterpipe establishments compared to a casino where cigarette smoking was permitted. Nicotine vapour was detected in one of the waterpipe cafés. 'Herbal' shisha products tested contained toxic trace metals and PAHs levels equivalent to, or in excess of, that found in cigarettes. Their mainstream and sidestream smoke emissions contained carcinogens equivalent to, or in excess of, those of tobacco products. The content of the air in the waterpipe cafés tested was potentially hazardous. These data, in aggregate, suggest that smoking 'herbal' shisha may well be dangerous to health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Disposable Electronic Cigarettes and Electronic Hookahs: Evaluation of Performance

PubMed Central

Williams, Monique; Ghai, Sanjay

2015-01-01

Introduction: The purpose of this study was to characterize the performance of disposable button-activated and disposable airflow-activated electronic cigarettes (EC) and electronic hookahs (EH). Methods: The airflow rate required to produce aerosol, pressure drop, and the aerosol absorbance at 420nm were measured during smoke-outs of 9 disposable products. Three units of each product were tested in these experiments. Results: The airflow rates required to produce aerosol and the aerosol absorbances were lower for button-activated models (3mL/s; 0.41–0.55 absorbance) than for airflow-activated models (7–17mL/s; 0.48–0.84 absorbance). Pressure drop was also lower across button-activated products (range = 6–12mm H2O) than airflow-activated products (range = 15–67mm H20). For 25 of 27 units tested, airflow did not have to be increased during smoke-out to maintain aerosol production, unlike earlier generation models. Two brands had uniform performance characteristics for all parameters, while 3 had at least 1 product that did not function normally. While button-activated models lasted 200 puffs or less and EH airflow-activated models often lasted 400 puffs, none of the models produced as many puffs as advertised. Puff number was limited by battery life, which was shorter in button-activated models. Conclusion: The performance of disposable products was differentiated mainly by the way the aerosol was produced (button vs airflow-activated) rather than by product type (EC vs EH). Users needed to take harder drags on airflow-activated models. Performance varied within models, and battery life limited the number of puffs. Data suggest quality control in manufacturing varies among brands. PMID:25104117

Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey

PubMed Central

Jaam, M.; Al-Marridi, W.; Fares, H.; Izham, M.; Kheir, N.

2016-01-01

Objective: To evaluate the perceptions and attitudes of waterpipe (shisha) smokers in Qatar regarding the health risks associated with addiction and to determine their intentions to quit. Methods: A cross-sectional survey was conducted among 181 self-reported waterpipe smokers. Participants were approached in public places as well as in shisha cafes in Qatar. The questionnaire included items related to perception, attitude and intention to quit. Both descriptive and inferential statistics were performed for data analyses, with P ≤ 0.05 considered statistically significant. Results: About 44% of the respondents believed that waterpipe smoking was safer than cigarette smoking, and more than 70% would not mind if their children became involved in waterpipe smoking. More than half of the current smokers wanted to quit smoking shisha at some point, and 17% identified health concerns as the main motivating factor for their intention to quit. Conclusion: A large proportion of shisha smokers viewed shisha as a safer alternative to cigarettes, yet they admitted to intending to quit. These findings underscore the need to design educational interventions and awareness campaigns as well as impose stringent laws on waterpipe smoking in public places in Qatar. PMID:27051611

Knowledge About the Waterpipe (Hookah), a Qualitative Assessment Among Community Workers in a Major Urban Center in Canada.

PubMed

Hammal, Fadi; Wild, T Cameron; Finegan, Barry A

2016-08-01

Waterpipe (WP) use has surged in popularity since the introduction of flavoured shisha. It is now an increasingly popular form of smoking among youth in North America. Health professionals/educators knowledge about the WP may well be inadequate. This study, using qualitative methods, sought to explore the knowledge and attitude of leaders in the community toward the WP. Family physicians, pharmacists, tobacco counsellors, social workers and educators were invited to participate in a one-one interview using open-ended questions. A total of 27 interviews were conducted. Individuals from Eastern Mediterranean backgrounds raised doubt about the overemphasised cultural significance of the WP and perceived this as a marketing strategy by industry. Most felt that WP smokers believed the WP to be less harmful than cigarettes and that the use of flavoured tobacco was motivating people to smoke. Participants believed that education should be directed at the general public and healthcare professionals, suggesting school programs and the use of social media to inform young smokers. Most thought that the current practices regarding packaging and second hand smoke exposure are confusing. They identified the lack of knowledge, poor enforcement procedures, "so called cultural aspects" and the economic impact of banning the WP on small businesses as barriers to change. Despite the awareness of an increase in WP use, our participants recognized that little has been done to curb this problem. Our findings emphasize the need for further education and better legislation to regulate WP use and availability.

Impact of active and passive smoking as risk factors for asthma and COPD in women presenting to primary care in Syria: first report by the WHO-GARD survey group

PubMed Central

Mohammad, Yousser; Shaaban, Rafea; Al-Zahab, Bassam Abou; Khaltaev, Nikolai; Bousquet, Jean; Dubaybo, Basim

2013-01-01

Background The burden of chronic respiratory disease (CRD) is alarming. International studies suggest that women with CRD are undersurveyed and underdiagnosed by physicians worldwide. It is unclear what the prevalence of CRD is in the general population of Syria, particularly among women, since there has never been a survey on CRD in this nation. The purpose of this study was to investigate the impact of different patterns of smoking on CRD in women. Materials and methods We extracted data on smoking patterns and outcome in women from the Global Alliance Against Chronic Respiratory Diseases survey. Using spirometric measurements before and after the use of inhaled bronchodilators, we tracked the frequency of CRD in females active and passive narghile or cigarette smokers presenting to primary care. We administered the questionnaire to 788 randomly selected females seen during 1 week in the fiscal year 2009–2010 in 22 primary care centers in six different regions of Syria. Inclusion criteria were age >6 years, presenting for any medical complaint. In this cross-sectional study, three groups of female subjects were evaluated: active smokers of cigarettes, active smokers of narghiles, and passive smokers of either cigarettes or narghiles. These three groups were compared to a control group of female subjects not exposed to active or passive smoking. Results Exposure to active cigarette smoke but not narghile smoke was associated with doctor-diagnosed chronic obstructive pulmonary disease (COPD). However, neither cigarette nor narghile active smoking was associated with increased incidence of spirometrically diagnosed COPD. Paradoxically, exposure to passive smoking of either cigarettes or narghiles resulted in association with airway obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 70% according to the Global initiative for chronic Obstructive Lung Disease criteria; association with FEV1 < 80% predicted, evidencing

Knowledge, Attitudes, and Normative Beliefs as Predictors of Hookah Smoking Initiation: A Longitudinal Study of University Students

PubMed Central

2014-01-01

Introduction: While cross-sectional studies have shown that hookah tobacco smoking (HTS) is an increasingly popular behavior among university students, little is known about factors associated with initiation. This study sought to determine associations between knowledge, attitudes, and normative beliefs and initiation of HTS among university students. Methods: Data were from a prospective longitudinal cohort study of 569 randomly selected first- and second-year university students. Online questionnaires that were developed in accordance with our composite theoretical model were completed in September 2010 and April 2011. Results: About one-seventh (13%) of participants initiated HTS by follow-up. Positive attitudes and favorable normative beliefs were associated with increased adjusted odds of initiation (AOR = 4.12, 95% CI = 2.56, 6.59; and AOR = 2.01, 95% CI = 1.35, 2.99, respectively), while negative attitudes were associated with decreased adjusted odds (AOR = 0.62, 95% CI = 0.48, 0.80). Correct knowledge regarding toxicants associated with HTS was not significantly associated with initiation. Conclusions: While positive attitudes and favorable normative beliefs are associated with initiation of HTS in a cohort of never-users, increased knowledge about toxins is not associated with lower initiation. It may be particularly valuable for educational interventions to attempt to alter positive attitudes and normative beliefs related to HTS. PMID:24323574

Knowledge, attitudes, and normative beliefs as predictors of hookah smoking initiation: a longitudinal study of university students.

PubMed

Sidani, Jaime E; Shensa, Ariel; Barnett, Tracey E; Cook, Robert L; Primack, Brian A

2014-06-01

While cross-sectional studies have shown that hookah tobacco smoking (HTS) is an increasingly popular behavior among university students, little is known about factors associated with initiation. This study sought to determine associations between knowledge, attitudes, and normative beliefs and initiation of HTS among university students. Data were from a prospective longitudinal cohort study of 569 randomly selected first- and second-year university students. Online questionnaires that were developed in accordance with our composite theoretical model were completed in September 2010 and April 2011. About one-seventh (13%) of participants initiated HTS by follow-up. Positive attitudes and favorable normative beliefs were associated with increased adjusted odds of initiation (AOR = 4.12, 95% CI = 2.56, 6.59; and AOR = 2.01, 95% CI = 1.35, 2.99, respectively), while negative attitudes were associated with decreased adjusted odds (AOR = 0.62, 95% CI = 0.48, 0.80). Correct knowledge regarding toxicants associated with HTS was not significantly associated with initiation. While positive attitudes and favorable normative beliefs are associated with initiation of HTS in a cohort of never-users, increased knowledge about toxins is not associated with lower initiation. It may be particularly valuable for educational interventions to attempt to alter positive attitudes and normative beliefs related to HTS.

Health issues in the Arab American community. Tobacco use patterns among high school students: do Arab American youth differ?

PubMed

Weglicki, Linda S; Templin, Thomas; Hammad, Adnan; Jamil, Hikmet; Abou-Mediene, Sharifa; Farroukh, Mona; Rice, Virginia Hill

2007-01-01

To determine tobacco use rates (cigarette, water pipe smoking [WPS] or narghile) in Arab American compared to non-Arab youth. A convenience sample of 2,782 14- to 18-year-old high school students from a midwest community completed a 21-item tobacco use history survey. Seventy-one percent of the participants were ArA. Grades 9 through 12 were equally represented. Results included 'ever tried cigarettes [narghile]' (20%, 39%); 'smoked cigarettes [narghile] in the past 30 days' (7%, 22%); and 'regular smoking [narghile]' (3%, 15%) for ArA and non-Arab youths, respectively. Each was significantly related to grade and ethnicity. WPS for ArA and non-Arab youths was (38%, 21%); (17%, 11%); and (7%, 5%) for 'ever used,' 'used in the past 30 days,' and 'regular use,' respectively. Grade, ethnicity, and sex were significantly related to WPS. Cigarette smoking rates for non-Arab youth were lower than current national youth smoking rates but significantly higher than ArA youth. Rates for ArA youth were much lower than current national reported data. Rates of WPS for US youth, regardless of race or ethnicity, are not known. Findings from this study indicate that both ArA and non-Arab youth are experimenting and using WPS regularly. These results underscore the importance of assessing novel forms of tobacco use, particularly WPS, a growing phenomenon among US youth.

Waterpipe tobacco smoking: A new smoking epidemic among the young?

PubMed Central

Soule, Eric K.; Lipato, Thokozeni

2015-01-01

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. PMID:26756025

Patterns and predictors of tobacco smoking cessation: a hospital-based study of pregnant women in Lebanon.

PubMed

Yunis, Kalid; Beydoun, Hind; Nakad, Pascale; Khogali, Mustafa; Shatila, Faysal; Tamim, Hala

2007-01-01

To describe patterns of cigarette and narghile (hubble-bubble or water-pipe) smoking before and during pregnancy and identify predictors of successful smoking cessation. A survey was conducted on 4660 pregnant women who delivered single live births between September 1st, 2001 and December 31st, 2002 at five hospitals in Beirut, Lebanon. Women were classified into four groups according to patterns of tobacco use before and during pregnancy: 1) consistent non-users, 2) successful quitters, 3) unsuccessful quitters and 4) consistent users. High education (OR = 2.03, 95% CI: 0.99-4.15), adequate prenatal care (OR = 1.72, 95% CI: 1.02-2.91) and mild smoking at baseline (OR = 2.35, 95% CI: 1.36-4.09) were main determinants of successful cigarette smoking cessation, whereas successful quitters of narghile use were more likely to be nulliparous (OR = 1.80, 95% CI: 1.08-2.99) or to have a nonsmoking partner (OR = 7.57, 95 % CI: 2.31-24.78). Different populations should be targeted when designing smoking cessation interventions for cigarette and narghile users.

Elements including metals in the atomizer and aerosol of disposable electronic cigarettes and electronic hookahs.

PubMed

Williams, Monique; Bozhilov, Krassimir; Ghai, Sanjay; Talbot, Prue

2017-01-01

Our purpose was to quantify 36 inorganic chemical elements in aerosols from disposable electronic cigarettes (ECs) and electronic hookahs (EHs), examine the effect of puffing topography on elements in aerosols, and identify the source of the elements. Thirty-six inorganic chemical elements and their concentrations in EC/EH aerosols were determined using inductively coupled plasma optical emission spectroscopy, and their source was identified by analyzing disassembled atomizers using scanning electron microscopy and energy dispersive X-ray spectroscopy. Of 36 elements screened, 35 were detected in EC/EH aerosols, while only 15 were detected in conventional tobacco smoke. Some elements/metals were present in significantly higher concentrations in EC/EH aerosol than in cigarette smoke. Concentrations of particular elements/metals within EC/EH brands were sometimes variable. Aerosols generated at low and high air-flow rates produced the same pattern of elements, although the total element concentration decreased at the higher air flow rate. The relative amount of elements in the first and last 60 puffs was generally different. Silicon was the dominant element in aerosols from all EC/EH brands and in cigarette smoke. The elements appeared to come from the filament (nickel, chromium), thick wire (copper coated with silver), brass clamp (copper, zinc), solder joints (tin, lead), and wick and sheath (silicon, oxygen, calcium, magnesium, aluminum). Lead was identified in the solder and aerosol of two brands of EHs (up to 0.165 μg/10 puffs). These data show that EC/EH aerosols contain a mixture of elements, including heavy metals, with concentrations often significantly higher than in conventional cigarette smoke. While the health effects of inhaling mixtures of heated metals is currently not known, these data will be valuable in future risk assessments involving EC/EH elements/metals.

Elements including metals in the atomizer and aerosol of disposable electronic cigarettes and electronic hookahs

PubMed Central

Williams, Monique; Bozhilov, Krassimir; Ghai, Sanjay; Talbot, Prue

2017-01-01

Objective Our purpose was to quantify 36 inorganic chemical elements in aerosols from disposable electronic cigarettes (ECs) and electronic hookahs (EHs), examine the effect of puffing topography on elements in aerosols, and identify the source of the elements. Methods Thirty-six inorganic chemical elements and their concentrations in EC/EH aerosols were determined using inductively coupled plasma optical emission spectroscopy, and their source was identified by analyzing disassembled atomizers using scanning electron microscopy and energy dispersive X-ray spectroscopy. Results Of 36 elements screened, 35 were detected in EC/EH aerosols, while only 15 were detected in conventional tobacco smoke. Some elements/metals were present in significantly higher concentrations in EC/EH aerosol than in cigarette smoke. Concentrations of particular elements/metals within EC/EH brands were sometimes variable. Aerosols generated at low and high air-flow rates produced the same pattern of elements, although the total element concentration decreased at the higher air flow rate. The relative amount of elements in the first and last 60 puffs was generally different. Silicon was the dominant element in aerosols from all EC/EH brands and in cigarette smoke. The elements appeared to come from the filament (nickel, chromium), thick wire (copper coated with silver), brass clamp (copper, zinc), solder joints (tin, lead), and wick and sheath (silicon, oxygen, calcium, magnesium, aluminum). Lead was identified in the solder and aerosol of two brands of EHs (up to 0.165 μg/10 puffs). Conclusion These data show that EC/EH aerosols contain a mixture of elements, including heavy metals, with concentrations often significantly higher than in conventional cigarette smoke. While the health effects of inhaling mixtures of heated metals is currently not known, these data will be valuable in future risk assessments involving EC/EH elements/metals. PMID:28414730

Characteristics of cigarette smoking and quitting among university students in Syria.

PubMed

Maziak, W; Hammal, F; Rastam, S; Asfar, T; Eissenberg, T; Bachir, M E; Fouad, M F; Ward, K D

2004-08-01

No study to date in Syria has documented the smoking and quitting characteristics in a representative sample of university students, and this study aims to fill this void. In 2003, a cross-sectional survey was carried out among students at Aleppo University using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 +/- 2.1 years; response rate, 98.8%). Experiences and attitudes related to smoking and quitting were assessed for two popular forms of tobacco use in Syria-cigarettes and narghile (waterpipe). Current cigarette smoking was reported by 30.9% of male and 7.4% of female students and daily smoking by 24.8% of male and 5.2% of female students. Narghile smoking was seen among 25.5% of men and 4.9% of women, mostly on an occasional basis. More than half of current smokers (56%) believed they could quit cigarettes, 75.2% were interested in quitting, and 78% of those had made a quit attempt in the past year. Important correlates of cigarette smoking among students were being older, male, and smoking narghile, while being older and from a poorer family were associated with increased interest in quitting. Interestingly, peers' smoking was associated with current smoking among students, but inversely with their willingness to quit. Cigarette smoking is mainly a problem of male students, whose narghile smoking is likely to be dramatically increasing as well, sometimes practiced as a substitute for cigarettes. The findings that most smokers in this sample are interested in quitting smoking and have tried unsuccessfully to do so indicate that cessation support for youths in this country is urgently needed.

Health effects associated with waterpipe smoking

PubMed Central

El-Zaatari, Ziad M; Chami, Hassan A; Zaatari, Ghazi S

2015-01-01

Objective It is widely held that waterpipe smoking (WPS) is not associated with health hazards. However, several studies have documented the uptake of several toxicants and carcinogens during WPS that is strongly associated with harmful health effects. This paper reviews the literature on the health effects of WPS. Data sources Three databases-PubMed, MEDLINE and EMBASE-were searched until August 2014 for the acute and long-term health effects of WPS using the terms ‘waterpipe’ and its synonyms (hookah, shisha, goza, narghileh, arghileh and hubble-bubble) in various spellings. Study selection We included original clinical studies, case reports and systematic reviews and focused on clinical human studies. ∼10% of the identified studies met the selection criteria. Data extraction Data were abstracted by all three authors and summarised into tables. Abstracted data included study type, results and methodological limitations and were analysed jointly by all three authors. Data synthesis WPS acutely leads to increased heart rate, blood pressure, impaired pulmonary function and carbon monoxide intoxication. Chronic bronchitis, emphysema and coronary artery disease are serious complications of long-term use. Lung, gastric and oesophageal cancer are associated with WPS as well as periodontal disease, obstetrical complications, osteoporosis and mental health problems. Conclusions Contrary to the widely held misconception, WPS is associated with a variety of adverse short-term and long-term health effects that should reinforce the need for stronger regulation. In addition, this review highlights the limitations of the published work, which is mostly cross-sectional or retrospective. Prospective studies should be undertaken to assess the full spectrum of health effects of WPS, particularly in view of its growing popularity and attractiveness to youth. PMID:25661414

Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine.

PubMed

Abu Shomar, Reem T; Lubbad, Ihab K; El Ansari, Walid; Al-Khatib, Issam A; Alharazin, Hatem J

2014-06-01

To assess university students' extent of smoking, knowledge of smoking health risks, and awareness of existing national anti-smoking laws. Self-administered questionnaire was employed across 7 universities (1,104 students, equal proportions of males and females) located in Gaza Strip, Palestine. About 55% of participants reported ever smoking, 31% were current cigarette smokers, and 36% were 'strictly' (only) narghile (water pipe) smokers. Mean age of smoking initiation was 17 +/- 3.15 years. Smokers had less knowledge of smoking associated health risks than nonsmokers. Students' knowledge of existing anti-smoking laws was generally low (11.3-25.5%), and significantly more smokers had knowledge about existing laws (ban of advertisement of smoking, ban of smoking in public places, and ban of selling cigarettes to minors) than non-smokers. About 81% of current smokers tried to quit smoking at least once during their life, 53% felt ready to quit smoking if cessation assistance was provided, 17% were not ready to quit, and 30% were reluctant/felt unsure if they were ready to quit. Most students (94.3%) reported that there were no smoking cessation centres in Palestine, or did not know if such centres existed. Males were associated with almost all categories of smoking (e.g. smoking both cigarettes and narghile, or smoking narghile only). There is a lack of knowledge about the existing national anti-smoking legislation among university students in Gaza, Palestine. Smoking cessation centres also seem non-existent in Gaza. Multi-level interventions and actions are required by policy makers, educators and non-governmental agencies to prevent smoking among university students in Gaza, and to educate them on tobacco cessation counselling, on the dangers of tobacco use, and about effective stress management strategies to help them to cope with stressors. Smoking cessation interventions are required to address both cigarette and narghile use. Efforts need to be invested in

Second-hand smoke in indoor hospitality venues in Pakistan.

PubMed

Zaidi, S M A; Moin, O; Khan, J A

2011-07-01

Second-hand smoke (SHS) constitutes a significant public health threat in countries with a high smoking prevalence. However, data assessing the quality of indoor air at public venues in Pakistan are limited. To measure mean concentrations of PM(2.5) (particulate matter ≤2.5 microns in diameter), a sensitive indicator of SHS, in hospitality venues in Pakistan. Data were collected discreetly from 39 indoor venues such as cafes, restaurants and shisha (water-pipe) bars from three major cities in Pakistan. Data were recorded using a portable air quality monitoring device. The overall mean PM(2.5) value for the visited venues was 846 μg/m(3) (95%CI 484-1205). The mean PM(2.5) value was 101 μg/m(3) (95%CI 69-135 μg/m(3)) for non-smoking venues, 689 μg/m(3) (95%CI 241-1138) for cigarette smoking venues and 1745 μg/m(3) (95%CI 925-2565) for shisha smoking venues. The significant levels of SHS recorded in this study, in particular from shisha smoking venues, could represent a major public health burden in Pakistan. Appropriate legislation needs to be enforced to protect the health of those exposed to the hazards of second-hand tobacco smoke.

Prevalence of tobacco use among adults in Egypt, 2009.

PubMed

Fouad, Heba; Awa, Fatimah El; Naga, Randa Abou El; Emam, Awatef Hussien; Labib, Sahar; Palipudi, Krishna Mohan; Andes, Linda J; Asma, Samira; Talley, Brandon

2016-06-01

We assessed the differences in overall use of tobacco and in the use of various tobacco products, by sex and by frequency of use across various demographic groups. We used data from the Global Adult Tobacco Survey (GATS), conducted in 2009 in Egypt. The data consist of answers to GATS by 20,924 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older from all regions of Egypt. Current tobacco use was defined as current smoking or use of smokeless tobacco products, either daily or occasionally. We analyzed the differences in current cigarette, shisha, and smokeless tobacco use by sex and frequency of use (daily or occasional); and by demographic characteristics that included age, region, education level and employment status. Overall, 19.7% of the Egyptian population currently use some form of tobacco. Men (38.1% [95% confidence interval (CI) 36.8-39.4]) are much more likely than women (0.6% [95% CI 0.4-0.9]) to use tobacco. Almost 96% of men who use tobacco, do so daily. Men are more likely to use manufactured cigarettes (31.8% [95% CI 30.6-33.1]) than shisha (6.2% [95% CI 5.6-6.9]) or smokeless tobacco (4.1% [95% CI 3.4-4.8]). Few women use tobacco (cigarettes (0.2%), shisha (0.3%) and smokeless tobacco (0.3%)); however, all women who currently smoke shisha, do so daily. Lower educational status, being between ages 25-64 and being employed predicted a higher use of tobacco. Egypt has implemented several initiatives to reduce tobacco use. The World Health Organization (WHO) MPOWER technical package, which aims to reverse the tobacco epidemic, is implemented at various levels throughout the country. Our findings show that there is significant variation in the prevalence of tobacco use and types of tobacco used by adult men and women in Egypt. GATS data can be used to better understand comparative patterns of tobacco use by adults, which in turn can be used to develop interventions. © The Author(s) 2013.

IMPACT OF SMOKING HABITS ON THE STATE OF CHROMATIN AND MORPHOLOGY OF BUCCAL EPITHELIAL CELLS AMONG MEDICAL STUDENTS.

PubMed

Volkova, O; Ryabokon, E; Magda, I; Shckorbatov, Y

2017-01-01

The cells of buccal epithelium were investigated in groups of smoking and non-smoking students. Cell samples were collected by scraping with blunt sterile spatula, stained with orcein and photographed. The smoking of cigarettes and hookah induces significant decrease in nuclear and cell perimeter and cell area in cells of buccal epithelium. Smoking of hookah induces, besides, the heterochromatization in cell nuclei and the decrease of nuclear area. The data obtained indicate stress reaction in cells (heterochromatinization) and apoptosis-related changes in cells (decrease of nuclear and cell perimeter and cell area). These data show unfavorable effects of smoking cigarettes and even more harmful effect of hookah smoking.

Relationship between happiness and tobacco smoking among high school students.

PubMed

Ataeiasl, Maryam; Sarbakhsh, Parvin; Dadashzadeh, Hossein; Augner, Christoph; Anbarlouei, Masoumeh; Mohammadpoorasl, Asghar

2018-01-01

Recent research has described negative relationship between happiness and habitual smoking among adolescents. No study of this relationship has been conducted among Iranian adolescents. The aim of the present study was to characterize the relationship between happiness and cigarette or hookah smoking among a sample of high school students. A sample of 1,161 10th-grade students in Tabriz (northwest Iran) was selected by multi-stage proportional cluster sampling. Participants completed a self-administered multiple-choice questionnaire including information on cigarette smoking, hookah smoking, happiness score, substance abuse, self-injury, general risk-taking behavior, attitudes towards smoking, socioeconomic information, and demographic characteristics. An ordinal logistic regression model was used for data analysis. It was found that 5.9 and 5.0% of students were regular cigarette smokers and regular hookah smokers, respectively. After controlling for potential confounders, higher happiness scores were found to protect students against more advanced stages of cigarette smoking (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p=0.013). However, no significant relationship was found between happiness scores and hookah smoking status (OR, 1.01; 95% CI, 0.97 to 1.02; p=0.523). Happiness scores were associated with less advanced stages of habitual cigarette smoking among high school students. Our findings underscore the necessity of conducting longitudinal or interventional studies aiming to determine the effects of enhancing happiness on preventing the transition through the stages of cigarette and hookah smoking.

Prevalence of tobacco use among students aged 13-15 years in Health Ministers' Council/Gulf Cooperation Council Member States, 2001-2004.

PubMed

Moh'd Al-Mulla, Ahmad; Abdou Helmy, Sahar; Al-Lawati, Jawad; Al Nasser, Sami; Ali Abdel Rahman, Salah; Almutawa, Ayesha; Abi Saab, Bassam; Al-Bedah, Abdullah Mohammed; Al-Rabeah, Abdullah Mohamed; Ali Bahaj, Ahmed; El-Awa, Fatimah; Warren, Charles W; Jones, Nathan R; Asma, Samira

2008-06-01

This article examines differences and similarities in adolescent tobacco use among Member States of the Health Ministers' Council for the Gulf Cooperation Council (HMC/GCC) using Global Youth Tobacco Survey (GYTS) data. Nationally representative samples of students in grades associated with ages 13-15 in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen. Schools were selected proportional to enrollment size, classes were randomly selected within participating schools, and all students in selected classes were eligible to participate. GYTS results confirmed that boys are significantly more likely than girls to smoke cigarettes or use shisha (water pipe). Students had higher rates of tobacco use than adults in Bahrain, Oman, and United Arab Emirates. For boys and girls, shisha use was higher than cigarette smoking in almost all countries. Susceptibility to initiate smoking among never smokers was higher than current cigarette smoking in all countries. Exposure to secondhand smoke in public places was greater than 30%, direct protobacco advertising exposure was greater than 70% on billboards and in newspapers, and more than 10% of students were influenced by indirect advertising. Finally, less than half of the students were taught in school about the dangers of tobacco use in the past year. For boys and girls, high prevalence of cigarette smoking, high prevalence of shisha use, and high susceptibility of never smokers to initiate smoking in the next year are troubling indicators for the future of chronic disease and tobacco-related mortality in the Member States of the HMC/GCC.

Adolescents’ Perceptions of Health Risks, Social Risks, and Benefits Differ Across Tobacco Products

PubMed Central

Roditis, Maria; Delucchi, Kevin; Cash, David; Halpern-Felsher, Bonnie

2016-01-01

Objective This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco. Methods A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure. Results Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender. Conclusion Given the significant differences in adolescents’ perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes. PMID:27107909

Adolescents' Perceptions of Health Risks, Social Risks, and Benefits Differ Across Tobacco Products.

PubMed

Roditis, Maria; Delucchi, Kevin; Cash, David; Halpern-Felsher, Bonnie

2016-05-01

This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco. A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure. Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender. Given the significant differences in adolescents' perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Tobacco Use Among Arab Immigrants Living in Colorado: Prevalence and Cultural Predictors.

PubMed

El Hajj, Dana G; Cook, Paul F; Magilvy, Kathy; Galbraith, Michael E; Gilbert, Lynn; Corwin, Marla

2017-03-01

The authors determined the prevalence of smoking among Arab immigrants living in Colorado. The authors also evaluated the relationship between acculturation and tobacco use, including both cigarettes and hookah among Arab immigrants. A cross-sectional survey of 100 adult Arab immigrants living in Colorado was carried out. The results revealed that 19% of the study participants were current cigarette smokers and 21% were current hookah smokers. Participants who were more integrated into Arab culture were more likely to use tobacco products ( p = .03) and to have family members ( p = .02) and friends who use tobacco products ( p = .007). Acculturation plays a major role in affecting the health habits of Arab immigrants living in Colorado, especially in the area of hookah smoking. Understanding some culturally relevant predictors of tobacco use might assist health care providers in designing successful smoking cessation programs.

Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products.

PubMed

Harrell, Paul T; Naqvi, Syeda Mahrukh H; Plunk, Andrew D; Ji, Ming; Martins, Silvia S

2017-11-01

Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]). Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.

Awareness and use of non-conventional tobacco products among U.S. students, 2012.

PubMed

Wang, Baoguang; King, Brian A; Corey, Catherine G; Arrazola, René A; Johnson, Sarah E

2014-08-01

Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth. This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics. Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip). Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products. Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth. Published by Elsevier Inc.

Awareness and Use of Non-conventional Tobacco Products Among U.S. Students, 2012

PubMed Central

Wang, Baoguang; King, Brian A.; Corey, Catherine G.; Arrazola, René A.; Johnson, Sarah E.

2015-01-01

Background Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth. Purpose This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics. Methods Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip). Results Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products. Conclusions Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth. PMID:25044194

E-cigarette marketing exposure and combustible tobacco use among adolescents in the United States.

PubMed

Auf, Rehab; Trepka, Mary Jo; Selim, Moaz; Ben Taleb, Ziyad; De La Rosa, Mario; Cano, Miguel Ángel

2018-03-01

E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6-12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.5), hookah (AOR: 1.4, 95% CI: 1.2-1.7), cigars (AOR: 1.5, 95% CI: 1.4-1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5-1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5-2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tobacco use among 10th grade students in Istanbul and related variables.

PubMed

Evren, Cuneyt; Evren, Bilge; Bozkurt, Muge

2014-04-01

Aim of this study was to determine prevalence of cigarette smoking and hookah use among 10th grade students in Istanbul, Turkey, and to compare sociodemographic, psychological and behavioral variables according to frequency of tobacco use. Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul/Turkey. The questionnaire included sections about demographic data, family characteristics, school life, psychological symptoms and use of substances including tobacco, hookah, alcohol, marijuana, volatiles, heroin, cocaine, non-prescribed legal tranquillizers (benzodiazepines, alprazolam etc.) and illegal tranquillizers (flunitrazepam). The analyses were conducted based on the 4957 subjects. Trial at least once in life is observed as 45.4% for hookah use and as 24.4% for cigarette use. Risk of hookah and cigarette use was significantly higher in male students than in female students. Frequency of tobacco use is related with various sociodemographic, psychological and behavioral variables. Our data also shows that using tobacco and alcohol increases the risk of all the other substances use and these effects are interrelated. The data suggest that there is a link between tobacco use and substance use, psychological, behavioral and social factors. There is also a strong association between tobacco use and suicidal behavior as well as self-mutilative, impulsive, hyperactive, delinquent, aggressive and behavioral problems. The illumination of these relationships may be relevant in prevention and management of tobacco use as well as important problems, such as substance use, impulsivity, hyperactivity, delinquent, aggressive self-mutilative and suicidal behavior among 10th grade students in Istanbul. Copyright © 2013 Elsevier B.V. All rights reserved.

Tobacco and nicotine delivery product use in a national sample of pregnant women.

PubMed

Kurti, Allison N; Redner, Ryan; Lopez, Alexa A; Keith, Diana R; Villanti, Andrea C; Stanton, Cassandra A; Gaalema, Diann E; Bunn, Janice Y; Doogan, Nathan J; Cepeda-Benito, Antonio; Roberts, Megan E; Phillips, Julie; Higgins, Stephen T

2017-11-01

Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women. Copyright © 2017 Elsevier Inc. All rights reserved.

Very light smoking and alternative tobacco use among college students.

PubMed

Li, Xiaoyin; Loukas, Alexandra; Perry, Cheryl L

2018-06-01

Concurrent use of cigarettes with alternative tobacco products (ATPs), even among very light smokers, may be harmful. This study examined current use of e-cigarettes, cigars, and hookah, and susceptibility to future use of these products in a sample of college student cigarette smokers. Participants were 1161 18-29 year old (M age = 21.15; SD = 2.72; 52.7% female; 41.2% non-Hispanic white) current, or past 30-day cigarette smokers, drawn from a larger study. Current smokers were categorized as very light smokers [≤5 cigarettes per day (cpd)] and heavier smokers (>5 cpd). 88.6% of all participating college student smokers were very light smokers and 67.7% used at least one ATP concurrently. The prevalence of current use in this sample was 42.9% for e-cigarettes, 36.4% for hookah, and 25.9% for cigars. Compared to heavier smokers, very light smokers were more likely to be younger, racial/ethnic minorities, and four-year versus two-year college students. Multilevel logistic regression models showed that after controlling for socio-demographic characteristics and substance use, being a very light smoker, compared with a heavier smoker, was negatively associated with concurrent e-cigarette use, but positively associated with concurrent cigar use, and not associated with concurrent hookah use. Moreover, compared to heavier smokers, very light smokers reported being more susceptible to future cigar and hookah use, but not e-cigarette use. Concurrent use of cigarettes with ATPs is popular among all college student smokers, but very light smokers are more likely than heavier smokers to use combustible ATPs. Smoking intervention programs and campus policies should caution smokers, especially very light smokers, against ATP use. Copyright © 2018 Elsevier Ltd. All rights reserved.

Indicators of dependence for different types of tobacco product users: Descriptive findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study.

PubMed

Strong, David R; Pearson, Jennifer; Ehlke, Sarah; Kirchner, Thomas; Abrams, David; Taylor, Kristie; Compton, Wilson M; Conway, Kevin P; Lambert, Elizabeth; Green, Victoria R; Hull, Lynn C; Evans, Sarah E; Cummings, K Michael; Goniewicz, Maciej; Hyland, Andrew; Niaura, Raymond

2017-09-01

With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products. A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products. This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n=8689), e-cigarette only (n=437), cigar only (traditional, cigarillo, or filtered) (n=706), hookah only (n=461), smokeless tobacco only (n=971), cigarette plus e-cigarette (n=709), and multiple tobacco product users (n=2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean=0.0, SD=1.0), we observed a range of TD with hookah (mean=-1.71) and cigar (mean=-1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean=0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p<0.001), e-cigarette only (p<0.002), cigar (p<0.001), hookah only (p<0.001), and smokeless tobacco users (p<0.001). The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products. Copyright © 2017 Elsevier B.V. All rights reserved.

Flavoured non-cigarette tobacco product use among US adults: 2013–2014

PubMed Central

Bonhomme, Michèle G; Holder-Hayes, Enver; Ambrose, Bridget K; Tworek, Cindy; Feirman, Shari P; King, Brian A; Apelberg, Benjamin J

2017-01-01

Introduction Limited data exist on flavoured non-cigarette tobacco product (NCTP) use among US adults. Methods Data from the 2013 to 2014 National Adult Tobacco Survey (N=75 233), a landline and cellular telephone survey of US adults aged ≥18, were assessed to estimate past 30-day NCTP use, flavoured NCTP use and flavour types using bivariate analyses. Results During 2013–2014, 14.4% of US adults were past 30-day NCTP users. Nationally, an estimated 10.2 million e-cigarette users (68.2%), 6.1 million hookah users (82.3%), 4.1 million cigar smokers (36.2%) and 4.0 million smokeless tobacco users (50.6%) used flavoured products in the past 30 days. The most prevalent flavours reported were menthol/mint (76.9%) for smokeless tobacco; fruit (74.0%) for hookah; fruit (52.4%), candy/chocolate/other sweet flavours (22.0%) and alcohol (14.5%) for cigars/cigarillos/filtered little cigars; fruit (44.9%), menthol/mint (43.9%) and candy/chocolate/other sweet flavours (25.7%) for e-cigarettes and fruit (56.6%), candy/chocolate/other sweet flavours (26.5%) and menthol/mint (24.8%) for pipes. Except for hookah and pipes, past 30-day flavoured product use was highest among 18–24-year olds. By cigarette smoking, never smoking e-cigarette users (84.8%) were more likely to report flavoured e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current smokers (63.2%). Conclusions Flavoured NCTP use is prominent among US adult tobacco users, particularly among e-cigarette, hookah and cigar users. Flavoured product use, especially fruit and sweet-flavoured products, was higher among younger adults. It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products. PMID:27794065

Real Time Assessment of Young Adults' Attitudes toward Tobacco Messages.

PubMed

Hébert, Emily T; Vandewater, Elizabeth A; Businelle, Michael S; Harrell, Melissa B; Kelder, Steven H; Perry, Cheryl L

2018-01-01

We used ecological momentary assessment (EMA) to examine young adults' attitudes towards pro-tobacco messages encountered in real time and their association with intentions to use tobacco. Young adults (N = 92, ages 18-29) recorded sightings of marketing or social media related to tobacco in real time via mobile app for 28 days. Participants reported message characteristics, their attitudes towards the message, and intentions to use the depicted product for each submission. We used generalized linear mixed models to examine factors related to attitude towards message and intentions to use tobacco. Messages depicting e-cigarettes (p < .001) or hookah (p < .05) were associated with significantly more favorable attitudes compared with traditional cigarettes. Positive attitude towards the message was significantly associated with intention to use the depicted product (p < .001). Messages depicting e-cigarettes and hookah were significantly associated with higher intention to use. Message source was not significantly related to attitudes towards the message or product use intentions. Marketing featuring e-cigarettes and hookah is an important target for future regulation. Given that pro-tobacco and e-cigarette messages are prevalent online, future research should consider the Internet and social media as important venues for counter-marketing and intervention efforts.

Perceptions and Experiences with Flavored Non-Menthol Tobacco Products: A Systematic Review of Qualitative Studies.

PubMed

Kowitt, Sarah D; Meernik, Clare; Baker, Hannah M; Osman, Amira; Huang, Li-Ling; Goldstein, Adam O

2017-03-23

Although a few countries have banned flavored cigarettes (except menthol), flavors in most tobacco products remain unregulated across the globe. We conducted a systematic review of qualitative studies examining perceptions of and experiences with flavored non-menthol tobacco products. Of 20 studies on flavored tobacco products included in our qualitative systematic review, 10 examined hookah, six examined e-cigarettes, two examined little cigars and cigarillos (LCCs), and three examined other tobacco products, including cigarettes. The majority of studies, regardless of product type, reported positive perceptions of flavored tobacco products, particularly among young adults and adolescents. In six studies that assessed perceptions of harm (including hookah, LCCs, and other flavored tobacco products), participants believed flavored tobacco products to be less harmful than cigarettes. In studies that examined the role of flavors in experimentation and/or initiation (including three studies on e-cigarettes, one hookah study and one LCC study), participants mentioned flavors as specifically leading to their experimentation and/or initiation of flavored tobacco products. Given that many countries have not yet banned flavors in tobacco products, these findings add to existing research on why individuals use flavored tobacco products and how they perceive harm in flavored tobacco products, providing further support for banning non-menthol flavors in most tobacco products.

E-cigarette Dual Users, Exclusive Users and Perceptions of Tobacco Products

PubMed Central

Cooper, Maria; Case, Kathleen R.; Loukas, Alexandra; Creamer, MeLisa R.; Perry, Cheryl L.

2016-01-01

Objectives We examined differences in the characteristics of youth non-users, cigarette-only, e-cigarette-only, and dual e-cigarette and cigarette users. Methods Using weighted, representative data, logistic regression analyses were conducted to examine differences in demographic characteristics and tobacco use behaviors across tobacco usage groups. Multiple linear regression analyses were conducted to examine differences in harm perceptions of various tobacco products and perceived peer use of e-cigarettes by tobacco usage group. Results Compared to non-users, dual users were more likely to be white, male, and high school students. Dual users had significantly higher prevalence of current use of all products (except hookah) than e-cigarette-only users, and higher prevalence of current use of snus and hookah than the cigarette-only group. Dual users had significantly lower harm perceptions for all tobacco products except for e-cigarettes and hookah as compared to e-cigarette-only users. Dual users reported higher peer use of cigarettes as compared to both exclusive user groups. Conclusion Findings highlight dual users’ higher prevalence of use of most other tobacco products, their lower harm perceptions of most tobacco products compared to e-cigarette-only users, and their higher perceived peer use of cigarettes compared to exclusive users. PMID:26685819

Perceptions and Experiences with Flavored Non-Menthol Tobacco Products: A Systematic Review of Qualitative Studies

PubMed Central

Kowitt, Sarah D.; Meernik, Clare; Baker, Hannah M.; Osman, Amira; Huang, Li-Ling; Goldstein, Adam O.

2017-01-01

Although a few countries have banned flavored cigarettes (except menthol), flavors in most tobacco products remain unregulated across the globe. We conducted a systematic review of qualitative studies examining perceptions of and experiences with flavored non-menthol tobacco products. Of 20 studies on flavored tobacco products included in our qualitative systematic review, 10 examined hookah, six examined e-cigarettes, two examined little cigars and cigarillos (LCCs), and three examined other tobacco products, including cigarettes. The majority of studies, regardless of product type, reported positive perceptions of flavored tobacco products, particularly among young adults and adolescents. In six studies that assessed perceptions of harm (including hookah, LCCs, and other flavored tobacco products), participants believed flavored tobacco products to be less harmful than cigarettes. In studies that examined the role of flavors in experimentation and/or initiation (including three studies on e-cigarettes, one hookah study and one LCC study), participants mentioned flavors as specifically leading to their experimentation and/or initiation of flavored tobacco products. Given that many countries have not yet banned flavors in tobacco products, these findings add to existing research on why individuals use flavored tobacco products and how they perceive harm in flavored tobacco products, providing further support for banning non-menthol flavors in most tobacco products. PMID:28333107

E-cigarette Dual Users, Exclusive Users and Perceptions of Tobacco Products.

PubMed

Cooper, Maria; Case, Kathleen R; Loukas, Alexandra; Creamer, Melisa R; Perry, Cheryl L

2016-01-01

We examined differences in the characteristics of youth non-users, cigarette-only, e-cigarette-only, and dual e-cigarette and cigarette users. Using weighted, representative data, logistic regression analyses were conducted to examine differences in demographic characteristics and tobacco use behaviors across tobacco usage groups. Multiple linear regression analyses were conducted to examine differences in harm perceptions of various tobacco products and perceived peer use of e-cigarettes by tobacco usage group. Compared to non-users, dual users were more likely to be white, male, and high school students. Dual users had significantly higher prevalence of current use of all products (except hookah) than e-cigarette-only users, and higher prevalence of current use of snus and hookah than the cigarette-only group. Dual users had significantly lower harm perceptions for all tobacco products except for e-cigarettes and hookah as compared to e-cigarette-only users. Dual users reported higher peer use of cigarettes as compared to both exclusive user groups. Findings highlight dual users' higher prevalence of use of most other tobacco products, their lower harm perceptions of most tobacco products compared to e-cigarette-only users, and their higher perceived peer use of cigarettes compared to exclusive users.

Tobacco Use and Its Health Effects among Professional Athletes in Qatar

PubMed Central

Chaabane, Zaina; Mahfoud, Ziyad

2016-01-01

The objective of the study was to determine the effects of tobacco use on selected markers of health and lung function in professional athletes. A total of 108 male professional athletes participated in the study from ten ball game teams in the same sport league in Qatar (age = 26.4 ± 5.1 yrs, height = 190.6 ± 11.9 cm, and weight = 91.5 ± 16.4 kg). The athletes have been playing professionally for about 6.3 years on average. In addition to demographic and tobacco use status, the following clinical variables were measured: resting blood pressure, heart rate, FVC, FEV1 sec, and PEF. The prevalence of tobacco use among the athletes was 27.7%. The FVC, FVC%, and FEV1% were significantly lower among the smokers compared to the nonsmokers (p = 0.003, 0.044, and 0.001, resp.). There were no significant differences between cigarettes smokers and nonsmokers in BP, HR, FEV1, FEV1/FVC, PEF, and PEF%. Similarly, those who smoked shisha had lower FEV1% values as compared to those who did not smoke shisha (p = 0.001). The decrease of FEV1 and FVC among smokers compared to nonsmokers is similar to what has been reported in the literature about other populations. PMID:28025593

Prospective Predictors of Novel Tobacco and Nicotine Product Use in Emerging Adulthood

PubMed Central

Hampson, Sarah E.; Andrews, Judy A.; Severson, Herbert H.; Barckley, Maureen

2015-01-01

Objective To investigate whether risk factors for cigarette smoking assessed in adolescence predict the use of novel tobacco and nicotine products (hookah, little cigars, and e-cigarettes) in early emerging adulthood. Methods In a longitudinal study (N = 862), risk factors were measured in middle and high school and novel product use was measured in emerging adulthood (mean age 22.4 years). Structural equation modelling was used to test a model predicting lifetime use of any of hookah, little cigars, and e-cigarettes in early emerging adulthood from distal predictors (gender, maternal smoking through Grade 8, already tried alcohol, cigarettes, or marijuana by Grade 8, and sensation seeking at Grade 8), and potential mediators (intentions to smoke cigarettes, drink alcohol or smoke marijuana at Grade 9, and smoking trajectory across high school). Results The most prevalent novel tobacco product was hookah (21.7%), followed by little cigars (16.8%), and e-cigarettes (6.6%). Maternal smoking, having already tried substances, and sensation seeking each predicted the use of at least one of these products via an indirect path through intentions to use substances and membership in a high school smoking trajectory. Conclusions Risk factors for cigarette smoking were found to predict novel tobacco use, suggesting that interventions to prevent cigarette smoking could be extended to include common novel tobacco products. PMID:26206439

Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes.

PubMed

Albarracin, Dolores; Romer, Daniel; Jones, Christopher; Hall Jamieson, Kathleen; Jamieson, Patrick

2018-06-29

Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. This research revealed young people's reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed. ©Dolores Albarracin, Daniel Romer, Christopher Jones, Kathleen Hall Jamieson, Patrick Jamieson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.06.2018.

Public Health and Increased Tobacco Regulation

Cancer.gov

NCI’s Dr. Robert Croyle discusses the Food and Drug Administration’s release of a rule that extends its regulatory authority over tobacco products to include cigars, e-cigarettes, hookah tobacco, and others.

Flavoured non-cigarette tobacco product use among US adults: 2013-2014.

PubMed

Bonhomme, Michèle G; Holder-Hayes, Enver; Ambrose, Bridget K; Tworek, Cindy; Feirman, Shari P; King, Brian A; Apelberg, Benjamin J

2016-11-01

Limited data exist on flavoured non-cigarette tobacco product (NCTP) use among US adults. Data from the 2013 to 2014 National Adult Tobacco Survey (N=75 233), a landline and cellular telephone survey of US adults aged ≥18, were assessed to estimate past 30-day NCTP use, flavoured NCTP use and flavour types using bivariate analyses. During 2013-2014, 14.4% of US adults were past 30-day NCTP users. Nationally, an estimated 10.2 million e-cigarette users (68.2%), 6.1 million hookah users (82.3%), 4.1 million cigar smokers (36.2%) and 4.0 million smokeless tobacco users (50.6%) used flavoured products in the past 30 days. The most prevalent flavours reported were menthol/mint (76.9%) for smokeless tobacco; fruit (74.0%) for hookah; fruit (52.4%), candy/chocolate/other sweet flavours (22.0%) and alcohol (14.5%) for cigars/cigarillos/filtered little cigars; fruit (44.9%), menthol/mint (43.9%) and candy/chocolate/other sweet flavours (25.7%) for e-cigarettes and fruit (56.6%), candy/chocolate/other sweet flavours (26.5%) and menthol/mint (24.8%) for pipes. Except for hookah and pipes, past 30-day flavoured product use was highest among 18-24-year olds. By cigarette smoking, never smoking e-cigarette users (84.8%) were more likely to report flavoured e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current smokers (63.2%). Flavoured NCTP use is prominent among US adult tobacco users, particularly among e-cigarette, hookah and cigar users. Flavoured product use, especially fruit and sweet-flavoured products, was higher among younger adults. It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Prospective Predictors of Novel Tobacco and Nicotine Product Use in Emerging Adulthood.

PubMed

Hampson, Sarah E; Andrews, Judy A; Severson, Herbert H; Barckley, Maureen

2015-08-01

The purpose of this study was to investigate whether risk factors for cigarette smoking assessed in adolescence predict the use of novel tobacco and nicotine products (hookah, little cigars, and e-cigarettes) in early emerging adulthood. In a longitudinal study (N = 862), risk factors were measured in middle and high school, and novel product use was measured in emerging adulthood (mean age 22.4 years). Structural equation modeling was used to test a model predicting lifetime use of any of hookah, little cigars, and e-cigarettes in early emerging adulthood from distal predictors (gender, maternal smoking through Grade 8; already tried alcohol, cigarettes, or marijuana by Grade 8; and sensation seeking at Grade 8) and potential mediators (intentions to smoke cigarettes, drink alcohol or smoke marijuana at Grade 9, and smoking trajectory across high school). The most prevalent novel tobacco product was hookah (21.7%), followed by little cigars (16.8%) and e-cigarettes (6.6%). Maternal smoking, having already tried substances, and sensation seeking each predicted the use of at least one of these products via an indirect path through intentions to use substances and membership in a high-school smoking trajectory. Risk factors for cigarette smoking were found to predict novel tobacco use, suggesting that interventions to prevent cigarette smoking could be extended to include common novel tobacco products. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Using Twitter to Examine Smoking Behavior and Perceptions of Emerging Tobacco Products

PubMed Central

Myslín, Mark; Zhu, Shu-Hong; Chapman, Wendy

2013-01-01

Background Social media platforms such as Twitter are rapidly becoming key resources for public health surveillance applications, yet little is known about Twitter users’ levels of informedness and sentiment toward tobacco, especially with regard to the emerging tobacco control challenges posed by hookah and electronic cigarettes. Objective To develop a content and sentiment analysis of tobacco-related Twitter posts and build machine learning classifiers to detect tobacco-relevant posts and sentiment towards tobacco, with a particular focus on new and emerging products like hookah and electronic cigarettes. Methods We collected 7362 tobacco-related Twitter posts at 15-day intervals from December 2011 to July 2012. Each tweet was manually classified using a triaxial scheme, capturing genre, theme, and sentiment. Using the collected data, machine-learning classifiers were trained to detect tobacco-related vs irrelevant tweets as well as positive vs negative sentiment, using Naïve Bayes, k-nearest neighbors, and Support Vector Machine (SVM) algorithms. Finally, phi contingency coefficients were computed between each of the categories to discover emergent patterns. Results The most prevalent genres were first- and second-hand experience and opinion, and the most frequent themes were hookah, cessation, and pleasure. Sentiment toward tobacco was overall more positive (1939/4215, 46% of tweets) than negative (1349/4215, 32%) or neutral among tweets mentioning it, even excluding the 9% of tweets categorized as marketing. Three separate metrics converged to support an emergent distinction between, on one hand, hookah and electronic cigarettes corresponding to positive sentiment, and on the other hand, traditional tobacco products and more general references corresponding to negative sentiment. These metrics included correlations between categories in the annotation scheme (phihookah-positive=0.39; phie-cigs-positive=0.19); correlations between search keywords and

Health Status and Working Condition of Migrant Workers: Major Public Health Problems.

PubMed

Bener, Abdulbari

2017-01-01

Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type ( P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours ( P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms ( P < 0.01). Multiple logistic regression was used for predictors' health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services.

Importance of Survey Design for Studying the Epidemiology of Emerging Tobacco Product Use Among Youth.

PubMed

Delnevo, Cristine D; Gundersen, Daniel A; Manderski, Michelle T B; Giovenco, Daniel P; Giovino, Gary A

2017-08-15

Accurate surveillance is critical for monitoring the epidemiology of emerging tobacco products in the United States, and survey science suggests that survey response format can impact prevalence estimates. We utilized data from the 2014 New Jersey Youth Tobacco Survey (n = 3,909) to compare estimates of the prevalence of 4 behaviors (ever hookah use, current hookah use, ever e-cigarette use, and current e-cigarette use) among New Jersey high school students, as assessed using "check-all-that-apply" questions, with estimates measured by means of "forced-choice" questions. Measurement discrepancies were apparent for all 4 outcomes, with the forced-choice questions yielding prevalence estimates approximately twice those of the check-all-that-apply questions, and agreement was fair to moderate. The sensitivity of the check-all-that-apply questions, treating the forced-choice format as the "gold standard," ranged from 38.1% (current hookah use) to 58.3% (ever e-cigarette use), indicating substantial false-negative rates. These findings highlight the impact of question response format on prevalence estimates of emerging tobacco products among youth and suggest that estimates generated by means of check-all-that-apply questions may be biased downward. Alternative survey designs should be considered to avoid check-all-that-apply response formats, and researchers should use caution when interpreting tobacco use data obtained from check-all-that-apply formats. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Promotion of tobacco products on Facebook: policy versus practice.

PubMed

Jackler, Robert K; Li, Vanessa Y; Cardiff, Ryan A L; Ramamurthi, Divya

2018-04-05

Facebook has a comprehensive set of policies intended to inhibit promotion and sales of tobacco products. Their effectiveness has yet to be studied. Leading tobacco brands (388) were identified via Nielsen and Ranker databases and 108 were found to maintain brand-sponsored Facebook pages. Key indicators of alignment with Facebook policy were evaluated. Purchase links (eg, 'shop now' button) on brand-sponsored pages were found for hookah tobaccos (41%), e-cigarettes (74%), smokeless (50%) and cigars (31%). Sales promotions (eg, discount coupons) were present in hookah tobacco (48%), e-cigarette (76%) and cigar (69%) brand-sponsored pages. While conventional cigarettes did not maintain brand-sponsored pages, they were featured in 80% of online tobacco vendors' Facebook pages. The requirement for age gating, to exclude those <18 from viewing tobacco promotion, was absent in hookah tobacco (78%), e-cigarette (62%) and cigar (21%) brand-sponsored pages and for 90% of online tobacco stores which promote leading cigarette brands (eg, Marlboro, Camel). Many of the brand-sponsored tobacco product pages had thousands of 'likes'. It is laudable that Facebook has policies intended to interdict tobacco promotion throughout its platform. Nevertheless, widespread tobacco promotion and sales were found at variance with the company's policies governing advertising, commerce, page content and under age access. Vetting could be improved by automated screening in partnership with human reviewers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patterns of combustible tobacco use in U.S. young adults and potential response to graphic cigarette health warning labels.

PubMed

Villanti, Andrea C; Pearson, Jennifer L; Cantrell, Jennifer; Vallone, Donna M; Rath, Jessica M

2015-03-01

In the evolving landscape of tobacco use, it remains unclear how tobacco control efforts should be designed and promoted for maximum impact. The current study links the identification of latent classes of young adult combustible tobacco users with anticipated responses to graphic health warning labels (HWLs). Data were collected in January 2012 using an online address-based panel as part of the Legacy Young Adult Cohort Study, and analyses were conducted in 2013. Latent class analyses identified five groups of tobacco users in a national sample of 4,236 young adults aged 18-34years: (1) little cigar/cigarillo/bidi (LCC) and hookah users (4%); (2) nonusers, open to smoking (3%); (3) daily smokers who self-identify as "smokers" (11%); (4) nondaily, light smokers who self-identify as "social or occasional smokers" (9%); and (5) nonusers closed to smoking (73%). Of the nonusers closed to smoking, 23% may be better characterized as at risk for tobacco initiation. Results indicate differences in the potential effectiveness of HWLs across classes. Compared to the daily "smokers," LCC and hookah users (RRR=2.35) and nonusers closed to smoking (RRR=2.33) were more than twice as likely to report that new graphic HWLs would make them think about not smoking. This study supports the potential of graphic HWLs to prevent young nonusers from using tobacco products. It suggests that the extension of prominent HWLs to other tobacco products, including LCCs and hookah tobacco, may also serve a prevention function. Copyright © 2014 Elsevier Ltd. All rights reserved.

Waterpipe Smoking among College Students in the United States: A Review of the Literature

ERIC Educational Resources Information Center

Grekin, Emily R.; Ayna, Dinah

2012-01-01

Objective: To review the literature on college student waterpipe use with a focus on undergraduates in the United States. Participants: Undergraduate students. Methods: Studies were accessed using the databases PubMed, MEDLINE, PsycINFO, and Academic Search Premier. Searches included combinations of the following keywords: "waterpipe," "hookah,"…

Other Tobacco Product Use Among Sexual Minority Young Adult Bar Patrons.

PubMed

Fallin-Bennett, Amanda; Lisha, Nadra E; Ling, Pamela M

2017-09-01

Lesbian, gay, and bisexual (LGB) individuals smoke at rates 1.5-2 times higher than the general population, but less is known about LGB consumption of other tobacco products (OTPs) and gender differences. OTP use among young adult LGB bar patrons and the relationship among past quit attempts, intention to quit, and binge drinking with OTP use was examined. A cross-sectional survey of young adults (aged 18-26) in bars/nightclubs in seven U.S. cities between 2012 and 2014 (N=8,010; 1,101 LGB participants) was analyzed in 2016. Logistic regressions examined current use of five OTPs (cigarillos, electronic cigarettes, hookah, chewing tobacco, and snus) and sexual minority status, adjusting for demographics and comparing LB women and GB men with their heterosexual counterparts. LGB bar/nightclub patrons used all OTPs more than their heterosexual counterparts. LB women were more likely than heterosexual women to use cigarillos, electronic cigarettes, hookah, chew, and snus. GB men were more likely than heterosexual men to smoke cigarillos, electronic cigarettes, hookah, and use chew and snus. Past-year quit attempt was associated with increased odds of electronic cigarette use in men and women, and increased odds of dual use (cigarettes and OTPs) among men. Intention to quit was negatively associated with dual use among women. Binge drinking was associated with increased use of all OTPs across genders. LGB bar-going young adults are at higher risk for OTP use than their heterosexual counterparts. Bar-based interventions are needed to address all forms of tobacco use in this high-risk group. Copyright © 2017. Published by Elsevier Inc.

Flavored Tobacco Product Use Among Middle and High School Students--United States, 2014.

PubMed

Corey, Catherine G; Ambrose, Bridget K; Apelberg, Benjamin J; King, Brian A

2015-10-02

The 2009 Family Smoking Prevention and Tobacco Control Act prohibits "characterizing flavors" (e.g., candy, fruit, and chocolate) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products. Analyses of retail sales data suggest that U.S. consumption of flavored noncigarette tobacco products, including flavored cigars and flavored e-cigarettes, has increased in recent years. There is growing concern that widely marketed varieties of new and existing flavored tobacco products might appeal to youths (2) and could be contributing to recent increases in the use of tobacco products, including e-cigarettes and hookah, among youths. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine the prevalence of past 30 day use (current use) of flavored e-cigarette, hookah tobacco, cigar, pipe tobacco or smokeless tobacco products, and menthol cigarettes among middle and high school students, and the proportion of current tobacco product users who have used flavored products. An estimated 70.0% (3.26 million) of all current youth tobacco users had used at least one flavored tobacco product in the past 30 days. Among current users, 63.3%, (1.58 million) had used a flavored e-cigarette, 60.6%, (1.02 million) had used flavored hookah tobacco, and 63.5% (910,000) had used a flavored cigar in the past 30 days. Given the millions of current youth tobacco users, it is important for comprehensive tobacco prevention and control strategies to address all forms of tobacco use, including flavored tobacco products, among U.S. youths.

Media exposure and tobacco product addiction beliefs: Findings from the 2015 Health Information National Trends Survey (HINTS-FDA 2015).

PubMed

Donaldson, Elisabeth A; Hoffman, Allison C; Zandberg, Izabella; Blake, Kelly D

2017-09-01

Addiction beliefs about tobacco use are associated with intentions to use and use of tobacco products. Exposure to information about tobacco products in media sources may affect addiction beliefs. To examine the relationship between media exposure and tobacco product addiction beliefs. A nationally representative sample of US adults (n=3738) from the 2015 National Cancer Institute's Health Information National Trends Survey was used to examine addiction beliefs about cigarettes, cigars, smokeless tobacco, electronic cigarettes, hookah/waterpipe tobacco, and roll-your-own cigarettes. We used logistic regression to examine the relationship between media exposure and addiction beliefs. We defined media exposure by hours exposed, as well as exposure to tobacco use health effects information through media sources including social media. We categorized media sources by whether respondents actively or passively engaged with the source. A majority (60.6% to 87.3%) of respondents believed that cigarettes, cigars, roll-your-own cigarettes and smokeless tobacco are addictive. Less than half of respondents believed that electronic cigarettes or hookah/waterpipes are addictive (45.2% and 49.8%, respectively). Respondents exposed to messages about tobacco use health effects on active media channels (e.g., social media) had greater odds of believing that smokeless tobacco (adjusted odds ratio [AOR]=1.48), hookah/waterpipe (AOR=1.69), and roll-your-own cigarettes (AOR=1.61) are addictive. Respondents exposed to tobacco use health effects messages on passive media channels (e.g., television), had greater odds of believing that cigarettes (AOR=2.76) and electronic cigarettes (AOR=2.12) are addictive. US adult exposure to information about the health effects of tobacco use was associated with addiction beliefs about tobacco products. Published by Elsevier Ltd.

Young adults’ risk perceptions of various tobacco products relative to cigarettes – results from the National Young Adult Health Survey

PubMed Central

Delnevo, Cristine D.

2015-01-01

Objectives Tobacco product risk perceptions may influence whether individuals use those products instead of or in addition to regular cigarettes. This study aimed to explore risk perceptions of various tobacco products relative to traditional cigarettes with young adults, a group with higher rates of tobacco use. Methods We examined risk perception responses among a nationally representative sample of young adults (ages 18–34)(n=2871)(including tobacco and non-tobacco users) from the 2011 National Young Adult Health Survey. Results Most (57.8%) respondents believed that e-cigarettes were less risky than cigarettes. Respondents were more likely to rate combustible products hookah (24.5%) and cigars (13.9%) as being less risky compared to non-combustible snus (10%) and other smokeless tobacco (SLT) products (7.1%) relative to cigarettes. Few (2.5%) rated menthol cigarettes as less risky. For e-cigarettes, hookah, and SLT, less risky beliefs were significantly higher among ever or current versus never product users. Between 22–33% of all respondents believed that SLT, snus, menthol cigarettes and cigars were more risky than cigarettes, but differences in this belief between current and non-users of these products were small and insignificant. Younger young adults were more likely to rate e-cigarettes and hookah as being “less risky” and rate cigars and SLT as being “more risky” than older young adults. Conclusion The public’s views of comparative tobacco risk perceptions vary widely by tobacco product type, and age group. While “less risky” perceptions may be associated with product use, perceptions that products are “more risky” than cigarettes may not necessarily dissuade people from their use. PMID:26304709

Young Adults' Risk Perceptions of Various Tobacco Products Relative to Cigarettes: Results From the National Young Adult Health Survey.

PubMed

Wackowski, Olivia A; Delnevo, Cristine D

2016-06-01

Objectives Tobacco product risk perceptions may influence whether individuals use those products instead of or in addition to regular cigarettes. This study aimed to explore risk perceptions of various tobacco products relative to traditional cigarettes with young adults, a group with higher rates of tobacco use. Method We examined risk perception responses among a nationally representative sample of young adults (age 18-34 years; n = 2,871, including tobacco and non-tobacco users) from the 2011 National Young Adult Health Survey. Results Most (57.8%) respondents believed that e-cigarettes were less risky than cigarettes. Respondents were more likely to rate combustible products hookah (24.5%) and cigars (13.9%) as being less risky compared to noncombustible snus (10%) and other smokeless tobacco (SLT) products (7.1%) relative to cigarettes. Few (2.5%) rated menthol cigarettes as less risky. For e-cigarettes, hookah, and SLT, less risky beliefs were significantly higher among ever or current versus never product users. Between 22% and 33% of all respondents believed that SLT, snus, menthol cigarettes, and cigars were more risky than cigarettes, but differences in this belief between current and nonusers of these products were small and insignificant. Younger young adults were more likely to rate e-cigarettes and hookah as being "less risky" and rate cigars and SLT as being "more risky" than older young adults. Conclusion The public's views of comparative tobacco risk perceptions vary widely by tobacco product type and age-group. While "less risky" perceptions may be associated with product use, perceptions that products are "more risky" than cigarettes may not necessarily dissuade people from their use. © 2015 Society for Public Health Education.

Polytobacco, marijuana, and alcohol use patterns in college students: A latent class analysis

PubMed Central

Haardörfer, Regine; Berg, Carla J.; Lewis, Michael; Payne, Jackelyn; Pillai, Drishti; McDonald, Bennett; Windle, Michael

2016-01-01

Limited research has examined polysubstance use profiles among young adults focusing on the various tobacco products currently available. We examined use patterns of various tobacco products, marijuana, and alcohol using data from the baseline survey of a multiwave longitudinal study of 3418 students aged 18-25 recruited from seven U.S. college campuses. We assessed sociodemographics, individual-level factors (depression; perceptions of harm and addictiveness,), and sociocontextual factors (parental/friend use). We conducted a latent class analysis and multivariable logistic regression to examine correlates of class membership (Abstainers were referent group). Results indicated five classes: Abstainers (26.1% per past 4-month use), Alcohol only users (38.9%), Heavy polytobacco users (7.3%), Light polytobacco users (17.3%), and little cigar and cigarillo (LCC)/hookah/marijuana co-users (10.4%). The most stable was LCC/hookah/marijuana co-users (77.3% classified as such in past 30-day and 4-month timeframes), followed by Heavy polytobacco users (53.2% classified consistently). Relative to Abstainers, Heavy polytobacco users were less likely to be Black and have no friends using alcohol and perceived harm of tobacco and marijuana use lower. Light polytobacco users were older, more likely to have parents using tobacco, and less likely to have friends using tobacco. LCC/hookah/marijuana co-users were older and more likely to have parents using tobacco. Alcohol only users perceived tobacco and marijuana use to be less socially acceptable, were more likely to have parents using alcohol and friends using marijuana, but less likely to have friends using tobacco. These findings may inform substance use prevention and recovery programs by better characterizing polysubstance use patterns. PMID:27074202

Knowledge of and attitudes towards tobacco control among smoking and non-smoking physicians in 2 Gulf Arab states.

PubMed

Behbehani, Nasser N; Hamadeh, Randah R; Macklai, Nejma S

2004-05-01

The global health professional survey is a project organized by the World Health Organization, to determine the smoking habits, knowledge and attitude towards tobacco control of health professionals in several countries around the world. This paper presents data from Kuwait and Bahrain. The survey period was between May 2000 and March 2001. A questionnaire was distributed to all physicians in Bahrain and to a random sample from Kuwait. The responses to knowledge and attitude questions were on a scale of 1-5, (1 strongly agree, 2 agree, 3 unsure, 4 disagree and 5 strongly disagree). Four hundred and seventy physicians from Bahrain and 1095 from Kuwait completed the questionnaire. The prevalence of cigarette smoking in Kuwait was: current smokers 18.4%, previous smokers 15.8%, Bahrain 14.6% and 14.3%. The prevalence of shisha smoking was 12% and 6.4% for Kuwait and Bahrain, (p=0.004). The mean scores of agreement with the association between passive smoking and lung diseases, lower respiratory tract infections in children were 1.6, 1.7 and 1.8, 1.9 for non smoking physicians and smoking physicians (P<0.01). The mean scores of agreement with the following policies: large health warning on cigarette packages, complete ban on tobacco advertisement and an increase in the price of cigarette were 1.3, 1.4, 1.7 and 1.7, 1.7, 2.5 for smoking and non-smoking physicians (p<0.01). Smoking physicians have less knowledge and less favorable attitude towards tobacco control compared to non-smokers. There was no difference in the prevalence of cigarette smoking between Kuwait and Bahrain, but the prevalence of shisha smoking was higher in Kuwait.

Health Status and Working Condition of Migrant Workers: Major Public Health Problems

PubMed Central

Bener, Abdulbari

2017-01-01

Background: Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. Methods: This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. Results: There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type (P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours (P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms (P < 0.01). Multiple logistic regression was used for predictors’ health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. Conclusions: The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services. PMID:28966757

Visual observation of fishes and aquatic habitat [Chapter 17

Treesearch

Russell F. Thurow; C. Andrew Dolloff; J. Ellen Marsden

2012-01-01

Whether accomplished above the water surface or performed underwater by snorkel, scuba, or hookah divers or remotely operated vehicles (ROVs); direct observation techniques are among the most effective means for obtaining accurate and often unique information on aquatic organisms in their natural surroundings. Many types of studies incorporate direct observation...

Content Analysis of Tobacco-related Twitter Posts

PubMed Central

Myslín, Mark; Zhu, Shu-Hong; Conway, Michael

2013-01-01

Objective We present results of a content analysis of tobacco-related Twitter posts (tweets), focusing on tweets referencing e-cigarettes and hookah. Introduction Vast amounts of free, real-time, localizable Twitter data offer new possibilities for public health workers to identify trends and attitudes that more traditional surveillance methods may not capture, particularly in emerging areas of public health concern where reliable statistical evidence is not readily accessible. Existing applications include tracking public informedness during disease outbreaks [1]. Twitter-based surveillance is particularly suited to new challenges in tobacco control. Hookah and e-cigarettes have surged in popularity, yet regulation and public information remain sparse, despite controversial health effects [2,3]. Ubiquitous online marketing of these products and their popularity among new and younger users make Twitter a key resource for tobacco surveillance. Methods We collected 7,300 tobacco-related Twitter posts at 15-day intervals from December 2011 to July 2012, using ten general keywords such as cig* and hookah. Each tweet was manually classified using a tri-axial scheme, capturing genre (firsthand experience, joke, news, …), theme (underage usage, health, social image, …), and sentiment (positive, negative, neutral). Machine-learning classifiers were trained to detect tobacco-related vs. irrelevant tweets as well as each of the above categories, using Naïve Bayes, k-Nearest Neighbors, and Support Vector Machine algorithms. Finally, phi correlation coefficients were computed between each of the categories to discover emergent patterns. Results The most prevalent genre of tweets was personal experience, followed by categories such as opinion, marketing, and news. The most common themes were hookah, cessation, and social image, and sentiment toward tobacco was more positive (26%) than negative (20%). The most highly correlated categories were social image�

Prevalence of use and perceptions of risk of novel and other alternative tobacco products among sexual minority adults: Results from an online national survey, 2014-2015.

PubMed

Nayak, Pratibha; Salazar, Laura F; Kota, Krishna K; Pechacek, Terry F

2017-11-01

Sexual minority (lesbian, gay, and bisexual [LGB]) populations experience disparities in cigarette use, but sparse evidence exists about novel and other alternative tobacco product use. In this study, we compared rates of novel and other alternative tobacco product use, risk perceptions, and worldview between LGB and heterosexual (HET) adults. An online survey administered in 2014-2015, using a weighted probability sample of 11,525 U.S. adults, assessed awareness of tobacco products; ever and current use of e-cigarettes, cigars, little cigars and cigarillos, and hookahs; perceptions of e-cigarettes; and worldview (individualism vs. communitarianism). Bivariate and adjusted multivariable analyses were performed to determine differences between LGB and HET groups. In the adjusted analyses, LGB adults were 1.5 times more likely to have ever used e-cigarettes (95% CI 1.2-1.9) and 1.9 times more likely to have ever used hookahs (95% CI 1.5-2.4) as compared to HET adults. A lower percentage of LGB adults, as compared to HET adults (16.7% vs. 19.2%), believed that exposure to vapors from e-cigarettes was "harmful" and reported that they "did not know" of any harm (35.1% vs. 39.8%). LGB were 20% less likely than were HET adults to endorse an individualistic worldview. These results suggest that a disparity exists, whereby LGB adults are more likely to have used e-cigarettes and hookahs. In addition, although vapor from e-cigarettes contains nicotine and other chemicals, LGB adults are less likely to perceive exposure to secondhand vapor as harmful. Tailored awareness campaigns and interventions are needed to convey the risks and curb use of these products. Copyright © 2017 Elsevier Inc. All rights reserved.

Tobacco Product Use Among Sexual Minority Adults

PubMed Central

Johnson, Sarah E.; Holder-Hayes, Enver; Tessman, Greta K.; King, Brian A.; Alexander, Tesfa; Zhao, Xiaoquan

2016-01-01

Introduction A growing body of evidence reveals higher rates of tobacco use among sexual minority populations relative to non-minority (“straight”) populations. This study seeks to more fully characterize this disparity by examining tobacco use by distinct sexual identities and gender to better understand patterns of: (1) cigarette smoking and smoking history; and (2) use of other tobacco products including cigars, pipes, hookah, e-cigarettes, and smokeless tobacco. Methods Data from the 2012–2013 National Adult Tobacco Survey, a random-digit dialed landline and cellular telephone survey of U.S. adults aged ≥18 years, were analyzed in 2014. A sexual minority category was created by combining gay, lesbian, and bisexual responses, along with those who selected an option for other non-heterosexual identities. Results Smoking prevalence was higher among sexual minority adults (27.4%) than straight adults (17.3%). Cigarette smoking was particularly high among bisexual women (36.0%). Sexual minority women started smoking and transitioned to daily smoking earlier than their straight peers. Use of other tobacco products was higher among sexual minority women: prevalence of e-cigarette (12.4%), hookah (10.3%), and cigar use (7.2%) was more than triple that of their straight female peers (3.4%, 2.5%, and 1.3%, respectively). Likewise, prevalence of sexual minority men’s e-cigarette (7.9%) and hookah (12.8%) use exceeded that of straight men (4.7% and 4.5%, respectively). Conclusions Tobacco use is significantly higher among sexual minority than straight adults, particularly among sexual minority women. These findings underscore the importance of tobacco control efforts designed to reach sexual minorities and highlight the heterogeneity of tobacco use within this population. PMID:26526162

Multiple tobacco product use among US adolescents and young adults

PubMed Central

Soneji, Samir; Sargent, James; Tanski, Susanne

2016-01-01

Objective To assess the extent to which multiple tobacco product use among adolescents and young adults falls outside current Food and Drug Administration (FDA) regulatory authority. Methods We conducted a web-based survey of 1596 16–26-year-olds to assess use of 11 types of tobacco products. We ascertained current (past 30 days) tobacco product use among 927 respondents who ever used tobacco. Combustible tobacco products included cigarettes, cigars (little filtered, cigarillos, premium) and hookah; non-combustible tobacco products included chew, dip, dissolvables, e-cigarettes, snuff and snus. We then fitted an ordinal logistic regression model to assess demographic and behavioural associations with higher levels of current tobacco product use (single, dual and multiple product use). Results Among 448 current tobacco users, 54% were single product users, 25% dual users and 21% multiple users. The largest single use category was cigarettes (49%), followed by hookah (23%), little filtered cigars (17%) and e-cigarettes (5%). Most dual and multiple product users smoked cigarettes, along with little filtered cigars, hookah and e-cigarettes. Forty-six per cent of current single, 84% of dual and 85% of multiple tobacco product users consumed a tobacco product outside FDA regulatory authority. In multivariable analysis, the adjusted risk of multiple tobacco use was higher for males, first use of a non-combustible tobacco product, high sensation seeking respondents and declined for each additional year of age that tobacco initiation was delayed. Conclusions Nearly half of current adolescent and young adult tobacco users in this study engaged in dual and multiple tobacco product use; the majority of them used products that fall outside current FDA regulatory authority. This study supports FDA deeming of these products and their incorporation into the national media campaign to address youth tobacco use. PMID:25361744

Tobacco Product Use Among Youths With and Without Lifetime Asthma - Florida, 2016.

PubMed

Reid, Keshia M; Forrest, Jamie R; Porter, Lauren

2018-06-01

The increasing availability of diverse tobacco products has led to complex tobacco product use patterns among youths (1). Use by youths of products containing nicotine in any form is unsafe (2); among young persons with asthma, use of combustible tobacco products, particularly cigarettes, is associated with worsening symptoms, poor asthma control, and an increased need for medical management (3,4). Studies suggest that youths with asthma adopt health risk behaviors, including tobacco product use, at rates similar to or higher than those of youths without asthma (3-7); however, these studies are often limited to a partial list of tobacco product types among high school students. To assess current use (≥1 days during the past 30 days) of one or more of five tobacco product types (cigarettes, electronic cigarettes [defined as e-cigarettes, e-cigars, vape pipes, vaping pens, e-hookah, and hookah pens], hookah, smokeless tobacco, or cigars) among Florida middle school (grades 6-8) and high school (grades 9-12) students with or without a previous medical diagnosis of asthma, the Florida Department of Health analyzed data from the 2016 Florida Youth Tobacco Survey (FYTS). In 2016, 11.1% of middle school and 27.9% of high school students with asthma, and 7.9% of middle school and 24.2% of high school students without asthma, reported any current tobacco product use. Current use of each tobacco product type was considerably higher among students with asthma than among those without asthma. E-cigarettes were the most commonly used tobacco product type reported by middle and high school students with asthma (7.9% and 19.6%, respectively) and without asthma (5.8% and 17.2%, respectively). Statewide tobacco prevention strategies could help reduce all forms of tobacco product use among youths, particularly among those with asthma.

Polytobacco, marijuana, and alcohol use patterns in college students: A latent class analysis.

PubMed

Haardörfer, Regine; Berg, Carla J; Lewis, Michael; Payne, Jackelyn; Pillai, Drishti; McDonald, Bennett; Windle, Michael

2016-08-01

Limited research has examined polysubstance use profiles among young adults focusing on the various tobacco products currently available. We examined use patterns of various tobacco products, marijuana, and alcohol using data from the baseline survey of a multiwave longitudinal study of 3418 students aged 18-25 recruited from seven U.S. college campuses. We assessed sociodemographics, individual-level factors (depression; perceptions of harm and addictiveness,), and sociocontextual factors (parental/friend use). We conducted a latent class analysis and multivariable logistic regression to examine correlates of class membership (Abstainers were referent group). Results indicated five classes: Abstainers (26.1% per past 4-month use), Alcohol only users (38.9%), Heavy polytobacco users (7.3%), Light polytobacco users (17.3%), and little cigar and cigarillo (LCC)/hookah/marijuana co-users (10.4%). The most stable was LCC/hookah/marijuana co-users (77.3% classified as such in past 30-day and 4-month timeframes), followed by Heavy polytobacco users (53.2% classified consistently). Relative to Abstainers, Heavy polytobacco users were less likely to be Black and have no friends using alcohol and perceived harm of tobacco and marijuana use lower. Light polytobacco users were older, more likely to have parents using tobacco, and less likely to have friends using tobacco. LCC/hookah/marijuana co-users were older and more likely to have parents using tobacco. Alcohol only users perceived tobacco and marijuana use to be less socially acceptable, were more likely to have parents using alcohol and friends using marijuana, but less likely to have friends using tobacco. These findings may inform substance use prevention and recovery programs by better characterizing polysubstance use patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

Subgrouping of risky behaviors among Iranian college students: a latent class analysis

PubMed Central

Safiri, Saeid; Rahimi-Movaghar, Afarin; Yunesian, Masud; Sadeghi-Bazargani, Homayoun; Shamsipour, Mansour; Mansournia, Mohammad Ali; Fotouhi, Akbar

2016-01-01

Background Risky behaviors may interrupt development or cause considerable morbidity or mortality. This study’s purpose was to determine subgroups of students based on risky behaviors and assess the prevalence of risky behaviors in each of the subgroups. Participants and methods This anonymous cross-sectional study was carried out in October 2015 and November 2015, with 1,777 students from Tabriz University of Medical Sciences, through multistage random sampling method. The data were analyzed by latent class analysis. Results The prevalence rates of cigarette smoking (more than or equal to ten cigarettes), hookah use (≥1 time/month), and alcohol consumption (≥1 time/month) during the last year were 12.4% (95% confidence interval [CI]: 10.9–14.0), 11.6% (95% CI: 10.0–13.1), and 4.9% (95% CI: 3.8–5.9), respectively. The prevalence rates of illicit opioids (1.8%, 95% CI: 1.2–2.5), cannabis (1.2%, 95% CI: 0.7–1.7), methamphetamine (1.1%, 95% CI: 0.6–1.6), methylphenidate (2.5%, 95% CI: 1.7–3.2), and extramarital sex (5.5%, 95% CI: 4.5–6.6) over the last year were also estimated. Three latent classes were determined: 1) low risk; 2) cigarette and hookah smoker; and 3) high risk. It is worth mentioning that 3.7% of males and 0.4% of females were in the high risk group. Conclusion Subgrouping of college students showed that a considerable percentage of them, especially males, were classified into the high risk and cigarette and hookah smoker groups. Appropriate preventive measures that consider multiple different risky behaviors simultaneously are needed for this part of the population. PMID:27524898

Access to Tobacco Among California High School Students: The Role of Family Members, Peers, and Retail Venues.

PubMed

Meyers, Matthew J; Delucchi, Kevin; Halpern-Felsher, Bonnie

2017-09-01

The purpose of the study was to determine from whom and where adolescents obtained tobacco, including cigarettes, e-cigarettes, and hookah. California adolescents (N = 772; 63.19% female; mean age = 16.13 years, SD = 1.61; 26.44% white, 22.12% Asian/Pacific Islander, 36.65% Hispanic, and 14.79% other) were surveyed about their access to different tobacco products. Adolescents were significantly more likely to obtain tobacco from friends (54.9%) than family members or direct purchasing (p < .001). Smoke shops were the most common purchase location across products (44.3%), with adolescents significantly more likely to purchase hookah and e-cigarettes from smoke shops than gas stations, liquor stores, or drug stores (p < .02). The effective characterization of tobacco access patterns is critical to the development of comprehensive tobacco control. By demonstrating peers and smoke shops as the primary social and retail outlets, this study identifies targets for the optimization of regulation and messaging aimed at reducing adolescents' access to tobacco. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Associations between tobacco and nicotine product use and depressive symptoms among college students in Texas.

PubMed

Bandiera, Frank C; Loukas, Alexandra; Wilkinson, Anna V; Perry, Cheryl L

2016-12-01

There is a well-established link between cigarette smoking and depression; less is known about the potential association between alternative tobacco products, such as hookah, cigars, smokeless tobacco, and electronic cigarette (e-cigarette use) with depression. The Food and Drug Administration (FDA) is now regulating tobacco products and is interested in tobacco product use among those with mental health problems and other special populations such as college students. Cross-sectional statewide convenience sample study of 5438 college students in 24 colleges and universities in Texas. Past 30-day use of hookah, cigar, smokeless tobacco, cigarette, and e-cigarette use were measured by self-report. Depressive symptoms were measured by the 10-item short form of the Center for Epidemiologic Studies scale. Only e-cigarette use was positively associated with depressive symptoms, even after accounting for all other tobacco products and socio-demographics. There were no significant interactions between race/ethnicity or gender with each of the tobacco products on depressive symptoms. E-cigarette use was positively associated with depressive symptoms among college students in Texas. Further research is needed to determine causality, which may inform FDA regulatory planning. Copyright © 2016 Elsevier Ltd. All rights reserved.

Multiple tobacco product use among US adolescents and young adults.

PubMed

Soneji, Samir; Sargent, James; Tanski, Susanne

2016-03-01

To assess the extent to which multiple tobacco product use among adolescents and young adults falls outside current Food and Drug Administration (FDA) regulatory authority. We conducted a web-based survey of 1596 16-26-year-olds to assess use of 11 types of tobacco products. We ascertained current (past 30 days) tobacco product use among 927 respondents who ever used tobacco. Combustible tobacco products included cigarettes, cigars (little filtered, cigarillos, premium) and hookah; non-combustible tobacco products included chew, dip, dissolvables, e-cigarettes, snuff and snus. We then fitted an ordinal logistic regression model to assess demographic and behavioural associations with higher levels of current tobacco product use (single, dual and multiple product use). Among 448 current tobacco users, 54% were single product users, 25% dual users and 21% multiple users. The largest single use category was cigarettes (49%), followed by hookah (23%), little filtered cigars (17%) and e-cigarettes (5%). Most dual and multiple product users smoked cigarettes, along with little filtered cigars, hookah and e-cigarettes. Forty-six per cent of current single, 84% of dual and 85% of multiple tobacco product users consumed a tobacco product outside FDA regulatory authority. In multivariable analysis, the adjusted risk of multiple tobacco use was higher for males, first use of a non-combustible tobacco product, high sensation seeking respondents and declined for each additional year of age that tobacco initiation was delayed. Nearly half of current adolescent and young adult tobacco users in this study engaged in dual and multiple tobacco product use; the majority of them used products that fall outside current FDA regulatory authority. This study supports FDA deeming of these products and their incorporation into the national media campaign to address youth tobacco use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015.

PubMed

Watkins, Shannon Lea; Glantz, Stanton A; Chaffee, Benjamin W

2018-02-01

Approximately 90% of adult smokers first tried a cigarette by 18 years of age, and even infrequent smoking in adolescence is associated with established adult smoking. Noncigarette tobacco use is increasing and could stimulate subsequent conventional cigarette smoking in youths. To estimate the longitudinal association between noncigarette tobacco use and subsequent cigarette smoking initiation among US youth. In this prospective cohort study of the Population Assessment of Tobacco and Health (PATH) waves 1 (September 12, 2013, to December 14, 2014) and 2 (October 23, 2014, to October 30, 2015), a nationally representative sample of youths who never smoked a conventional cigarette at baseline and completed wave 2 follow-up (N = 10 384) was studied. PATH retention at follow-up was 87.9%. Ever use and past 30-day use of electronic cigarettes (e-cigarettes), hookah, noncigarette combustible tobacco, or smokeless tobacco at baseline. Ever use and past 30-day use of cigarettes at follow-up. The present analysis was based on the 10 384 PATH youth respondents who reported never having smoked a cigarette in wave 1 and whose cigarette ever or past 30-day use was reported in wave 2 (mean [SD] age, 14.3 [1.7] years; age range, 12-17 years; 5087 [49.1%] female; 4829 [52.5%] white). At 1-year follow-up, 469 (4.6%) of all baseline never-smoking youths had tried a cigarette and 219 (2.1%) had smoked a cigarette within the past 30 days. Cigarette ever use at follow-up was higher among youths who had ever used e-cigarettes (78 [19.1%]), hookah (60 [18.3%]), noncigarette combustible tobacco (45 [19.2%]), or smokeless tobacco (29 [18.8%]) at baseline. After adjusting for sociodemographic, environmental, and behavioral smoking risk factors and for baseline ever use of other tobacco products, the odds of past 30-day cigarette use at follow-up were approximately twice as high among baseline ever users of e-cigarettes (odds ratio [OR], 1.87; 95% CI, 1.15-3.05), hookah (OR, 1

Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults.

PubMed

Jamil, H; Templin, T; Fakhouri, M; Rice, V H; Khouri, R; Fakhouri, H; Al-Omran, Hasan; Al-Fauori, Ibrahim; Baker, Omar

2009-08-01

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

[Old and new tobacco products].

PubMed

Arvers, P; Mathern, G; Dautzenberg, B

2018-05-29

Tobacco use is not just about manufactured cigarettes. Rolling tobacco, highly prized in the wake of price increases, is estimated to carry more toxic agents than its counterpart. This study shows that the use of cigar, pipe, cigarillos and narghile also leads to a cohort of pathologies similar to or more than what is known for smoking single cigarettes. Exotic, liquid or heated forms do just as much. The non-smoked tobacco, often fallen into disuse in France is very used in the United States and especially in Scandinavia. Denuded of inhaled products, it is often pointed as a form of reduction of smoking risks. Its use by athletes in all countries as a doping attitude, especially in ski disciplines, required a campaign of prevention within the federations concerned. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

DECOY: Documenting Experiences with Cigarettes and Other Tobacco in Young Adults

PubMed Central

Berg, Carla J.; Haardörfer, Regine; Lewis, Michael; Getachew, Betelihem; Lloyd, Steven A.; Thomas, Sarah Fretti; Lanier, Angela; Trepanier, Kelleigh; Johnston, Teresa; Grimsley, Linda; Foster, Bruce; Benson, Stephanie; Smith, Alicia; Barr, Dana Boyd; Windle, Michael

2016-01-01

Objectives We examined psychographic characteristics associated with tobacco use among Project DECOY participants. Methods Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. Results Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p < .001) and intellectual curiosity (p = .010) and less interest in tangible creation (p = .002) and social conservatism (p < .001). Correlates of LCC use included greater novelty seeking (p < .001) and greater fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p < .001). Correlates of e-cigarette use included greater novelty seeking (p < .001) and less social conservatism (p = .002). Correlates of hookah use included greater novelty seeking (p < .001), fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). Conclusions Psychographic characteristics distinguish users of different tobacco products. PMID:27103410

Early pulmonary events of nose-only water pipe (shisha) smoking exposure in mice

PubMed Central

Nemmar, Abderrahim; Hemeiri, Ahmed Al; Hammadi, Naser Al; Yuvaraju, Priya; Beegam, Sumaya; Yasin, Javed; Elwasila, Mohamed; Ali, Badreldin H; Adeghate, Ernest

2015-01-01

Water pipe smoking (WPS) is increasing in popularity and prevalence worldwide. Convincing data suggest that the toxicants in WPS are similar to that of cigarette smoke. However, the underlying pathophysiologic mechanisms related to the early pulmonary events of WPS exposure are not understood. Here, we evaluated the early pulmonary events of nose-only exposure to mainstream WPS generated by commercially available honey flavored “moasel” tobacco. BALB/c mice were exposed to WPS 30 min/day for 5 days. Control mice were exposed using the same protocol to atmospheric air only. We measured airway resistance using forced oscillation technique, and pulmonary inflammation was evaluated histopathologically and by biochemical analysis of bronchoalveolar lavage (BAL) fluid and lung tissue. Lung oxidative stress was evaluated biochemically by measuring the level of reactive oxygen species (ROS), lipid peroxidation (LPO), reduced glutathione (GSH), catalase, and superoxide dismutase (SOD). Mice exposed to WPS showed a significant increase in the number of neutrophils (P < 0.05) and lymphocytes (P < 0.001). Moreover, total protein (P < 0.05), lactate dehydrogenase (P < 0.005), and endothelin (P < 0.05) levels were augmented in bronchoalveolar lavage fluid. Tumor necrosis factor α (P < 0.005) and interleukin 6 (P < 0.05) concentrations were significantly increased in lung following the exposure to WPS. Both ROS (P < 0.05) and LPO (P < 0.005) in lung tissue were significantly increased, whereas the level and activity of antioxidants including GSH (P < 0.0001), catalase (P < 0.005), and SOD (P < 0.0001) were significantly decreased after WPS exposure, indicating the occurrence of oxidative stress. In contrast, airway resistance was not increased in WPS exposure. We conclude that subacute, nose-only exposure to WPS causes lung inflammation and oxidative stress without affecting pulmonary function suggesting that inflammation and oxidative stress are early markers of WPS exposure that precede airway dysfunction. Our data provide information on the initial steps involved in the respiratory effects of WPS, which constitute the underlying causal chain of reactions leading to the long-term effects of WPS. PMID:25780090

Early pulmonary events of nose-only water pipe (shisha) smoking exposure in mice.

PubMed

Nemmar, Abderrahim; Al Hemeiri, Ahmed; Al Hammadi, Naser; Yuvaraju, Priya; Beegam, Sumaya; Yasin, Javed; Elwasila, Mohamed; Ali, Badreldin H; Adeghate, Ernest

2015-03-01

Water pipe smoking (WPS) is increasing in popularity and prevalence worldwide. Convincing data suggest that the toxicants in WPS are similar to that of cigarette smoke. However, the underlying pathophysiologic mechanisms related to the early pulmonary events of WPS exposure are not understood. Here, we evaluated the early pulmonary events of nose-only exposure to mainstream WPS generated by commercially available honey flavored "moasel" tobacco. BALB/c mice were exposed to WPS 30 min/day for 5 days. Control mice were exposed using the same protocol to atmospheric air only. We measured airway resistance using forced oscillation technique, and pulmonary inflammation was evaluated histopathologically and by biochemical analysis of bronchoalveolar lavage (BAL) fluid and lung tissue. Lung oxidative stress was evaluated biochemically by measuring the level of reactive oxygen species (ROS), lipid peroxidation (LPO), reduced glutathione (GSH), catalase, and superoxide dismutase (SOD). Mice exposed to WPS showed a significant increase in the number of neutrophils (P < 0.05) and lymphocytes (P < 0.001). Moreover, total protein (P < 0.05), lactate dehydrogenase (P < 0.005), and endothelin (P < 0.05) levels were augmented in bronchoalveolar lavage fluid. Tumor necrosis factor α (P < 0.005) and interleukin 6 (P < 0.05) concentrations were significantly increased in lung following the exposure to WPS. Both ROS (P < 0.05) and LPO (P < 0.005) in lung tissue were significantly increased, whereas the level and activity of antioxidants including GSH (P < 0.0001), catalase (P < 0.005), and SOD (P < 0.0001) were significantly decreased after WPS exposure, indicating the occurrence of oxidative stress. In contrast, airway resistance was not increased in WPS exposure. We conclude that subacute, nose-only exposure to WPS causes lung inflammation and oxidative stress without affecting pulmonary function suggesting that inflammation and oxidative stress are early markers of WPS exposure that precede airway dysfunction. Our data provide information on the initial steps involved in the respiratory effects of WPS, which constitute the underlying causal chain of reactions leading to the long-term effects of WPS. © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Tobacco use among middle and high school students - United States, 2011-2014.

PubMed

Arrazola, René A; Singh, Tushar; Corey, Catherine G; Husten, Corinne G; Neff, Linda J; Apelberg, Benjamin J; Bunnell, Rebecca E; Choiniere, Conrad J; King, Brian A; Cox, Shanna; McAfee, Tim; Caraballo, Ralph S

2015-04-17

Tobacco use and addiction most often begin during youth and young adulthood. Youth use of tobacco in any form is unsafe. To determine the prevalence and trends of current (past 30-day) use of nine tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and bidis) among U.S. middle (grades 6-8) and high school (grades 9-12) students, CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2014 National Youth Tobacco Surveys (NYTS). In 2014, e-cigarettes were the most commonly used tobacco product among middle (3.9%) and high (13.4%) school students. Between 2011 and 2014, statistically significant increases were observed among these students for current use of both e-cigarettes and hookahs (p<0.05), while decreases were observed for current use of more traditional products, such as cigarettes and cigars, resulting in no change in overall tobacco use. Consequently, 4.6 million middle and high school students continue to be exposed to harmful tobacco product constituents, including nicotine. Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use. For this reason, comprehensive and sustained strategies are needed to prevent and reduce the use of all tobacco products among youths in the United States.

Spousal concordance in the use of alternative tobacco products: A multi-country investigation.

PubMed

Roberts, Megan E; Banse, Rainer; Ebbeler, Christine; Ferketich, Amy K

2017-02-01

Married couples often share similar health-related characteristics and behaviors, including cigarette smoking status. Despite their rising popularity in the U.S., little research has examined the patterns of spousal concordance (SC) for alternative tobacco products (ATPs), such as e-cigarettes, cigars, and hookah. The purpose of this project was to examine the roles of age, gender, and culture in the strength of SC for these ATPs. Analyses focused on a diverse community sample of married individuals in Ohio, U.S. (N=278), but also examined patterns in Austria, Greece, Israel, the Netherlands, and Slovakia. All participants completed a survey in which they indicated both their own, and their spouse's ever-use of various tobacco products. For the U.S. sample, SC was highest for e-cigarettes, flavored e-cigarettes, flavored cigarettes, and hookah (ϕs=0.48- 0.61); SC appeared to be stronger among younger couples, and when there was only a small female vs. male differences in use. Similar patterns were found in the other countries, with a few key exceptions. In particular, there was low SC for e-cigarettes and flavored e-cigarettes in the other countries, where e-cigarettes had been federally regulated by the time of data collection. Overall, these findings have implications for the continued spreading popularity of these tobacco use behaviors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Electronic Cigarette Use Among Adolescents in the Russian Federation.

PubMed

Kong, Grace; Idrisov, Bulat; Galimov, Artur; Masagutov, Radik; Sussman, Steve

2017-02-23

Information on e-cigarettes among youth in the Russian Federation is lacking. We examined prevalence of and factors associated with youth e-cigarette use in the Russian Federation. A cross-sectional, anonymous survey, conducted among 716 (females 51.5%) high school students in three cities (i.e., Ufa, Sterlitamak, Karagaevo) within the Republic of Bashkortostan, Russian Federation in 2015, assessed e-cigarette use and its correlates (i.e., sex, age, ethnicity, family structure, parents' highest degrees, antisocial behaviors, stress coping strategies, lifetime cigarette, hookah, alcohol, and marijuana use). Lifetime use of e-cigarettes was 28.6% and past-30-day use was 2.2%. Multilevel modeling showed that belonging to Tatar/Bashkir ethnicity relative to Russian ethnicity (OR = 1.60) and lifetime use of cigarettes (OR = 21.64), hookah (OR = 4.21), and alcohol (OR = 1.90) was associated with greater odds of lifetime use of e-cigarettes. Furthermore, use of social support coping strategies (i.e., utilizing parents for support) were associated with lower odds of lifetime use of e-cigarettes (OR = 0.94). Despite high lifetime e-cigarette use, past-30-day use was low. Greater knowledge of the reasons for e-cigarette discontinuation through continued surveillance is needed in the Russian Federation. Social coping strategies involving parents may inform e-cigarette use prevention.

Association of socioeconomic status with consumption of cigarettes, illicit drugs, and alcohol.

PubMed

Marzban, Maryam; Hadji, Maryam; Gholipour, Mahin; Rashidian, Hamideh; Rezaianzadeh, Abbas; Hasanzadeh, Jafar; Haghdoost, Ali Akbar; Rahimi-Movaghar, Afarin; Ghiasvand, Reza; Moradi, Abdolvahab; Khavari-Daneshvar, Hossein; Weiderpass, Elisabete; Kamangar, Farin; Zendehdel, Kazem

2017-08-18

Socioeconomic Status (SES) is considered as one of the important factors associated with use of various drugs. The present study aimed to investigate the effect of SES on cigarette smoking, alcohol use, drug use, and passive exposure to opium and cigarette smoke. In this study, which is part of a multicenter case-control study, the research hypothesis was checked among controls who had referred to hospitals. Data were collected through a questionnaire and laboratory tests to determine the actual consumers of opium and other illicit drugs. Then, the data were analyzed using STATA 13. This study was performed on 364 individuals within the age range of 30 to 75 years. More than 55% of the participants had a history of life-time consumption of cigarettes and hookah as well as alcohol and drugs. The results revealed an inverse relationship between SES and life-time consumption of hookah and alcohol. Furthermore, individuals with higher SES were more likely to deny their drug use. The results revealed little robust evidence supporting the assumption that SES level can have an important effect on illicit drug use. On the other hand, the participants' characteristics could have a prominent effect on precise evaluation of the relationship between SES and drug use. Further multicenter studies are needed with samples diversified in terms of age and ethnicity to identify these confounding relationships.

Systematic review on international practices in controlling waterpipe tobacco smoking.

PubMed

Tee, Guat Hiong; Hairi, Noran N; Nordin, Fauziah; Choo, Wan Yuen; Chan, Ying Ying; Kaur, Gurpreet; Veerasingam, Pathma Devi; Bulgiba, Awang

2015-01-01

Waterpipe tobacco smoking has becoming popular especially among young people worldwide. Smokers are attracted by its sweeter, smoother smoke, social ambience and the misconception of reduced harm. The objective of this study was to systematically review the effects of waterpipe tobacco policies and practices in reducing its prevalence. A systematic review was conducted electronically using the PubMed, OVID, Science Direct, Proquest and Embase databases. All possible studies from 1980 to 2013 were initially screened based on titles and abstracts. The selected articles were subjected to data extraction and quality rating. Three studies met the inclusion criteria and were eligible for this review. Almost all of the waterpipe tobacco products and its accessories did not comply with the regulations on health warning labelling practices as stipulated under Article 11 of WHO FCTC. In addition, the grisly new warning labels for cigarettes introduced by Food and Drug Administration did not affect hookah tobacco smoking generally. Indoor air quality in smoking lounges was found to be poor and some hookah lounges were operated without smoke shop certification. Our findings revealed the availability of minimal information on the practices in controlling waterpipe smoking in reducing its prevalence. The lack of comprehensive legislations or practices in controlling waterpipe smoking warrants further research and policy initiatives to curb this burgeoning global epidemic, especially among the vulnerable younger population.

K2 and Spice use among a cohort of college students in southeast region of the USA.

PubMed

Egan, Kathleen L; Suerken, Cynthia K; Reboussin, Beth A; Spangler, John; Wagoner, Kimberly G; Sutfin, Erin L; Debinski, Beata; Wolfson, Mark

2015-01-01

K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults. This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college. In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights. Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort's fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use. Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.

K2 and Spice use among a cohort of college students in southeast region of the USA

PubMed Central

Egan, Kathleen L.; Suerken, Cynthia K.; Reboussin, Beth A.; Spangler, John; Wagoner, Kimberly G.; Sutfin, Erin L.; Debinski, Beata; Wolfson, Mark

2015-01-01

Background K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults. Objectives This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college. Methods In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights. Results Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort’s fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use. Conclusion Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances. PMID:26030768

Use of and Reasons for Using Multiple Other Tobacco Products in Daily and Nondaily Smokers: Associations with Cigarette Consumption and Nicotine Dependence

PubMed Central

Dunbar, Michael S.; Shadel, William G.; Tucker, Joan S.; Edelen, Maria O.

2016-01-01

Background Use of other tobacco products (OTPs) among smokers is increasing. Little is known about types of OTP used and the reasons for use, and how OTP use and reasons for use correlate with smoking patterns and nicotine dependence in daily and nondaily smokers. This paper addresses these gaps in the literature. Methods 656 daily smokers and 203 nondaily smokers provided information on their use of different OTPs (hookah, e-cigarettes, chew/snuff, snus, cigars, dissolvables), and reasons for using OTPs (e.g., “to cut down on smoking”), as well as their cigarette consumption and nicotine dependence. Logistic regression models assessed the association of smoking status with OTP use (ever and current) and reasons for use. Within each smoking group, separate logistic regression models examined the associations of OTP use and reasons for use with cigarette consumption and nicotine dependence. Results Compared to daily smokers, nondaily smokers were more likely to use hookah and cigars, less likely to use dissolvables, and less likely to endorse using OTPs to reduce their smoking. Among non-daily smokers, nicotine dependence was associated with a higher likelihood of current OTP use (OR=1.04 [95% CI 1.01–1.07]; p < .05), whereas cigarette consumption was not. Conclusions Results suggest OTP use in nondaily smokers does not correlate with less frequent smoking, but may correlate with higher nicotine dependence. Use of combustible OTPs among nondaily smokers may offset any potential benefits achieved through less frequent cigarette consumption. Providers should explicitly address OTP use when discussing cigarette cessation and reduction. PMID:27664553

The association between alcohol, marijuana use, and new and emerging tobacco products in a young adult population.

PubMed

Cohn, Amy; Villanti, Andrea; Richardson, Amanda; Rath, Jessica M; Williams, Valerie; Stanton, Cassandra; Mermelstein, Robin

2015-09-01

Young adults have the highest rates of alcohol, tobacco, and other drug use relative to any other age group. Few studies have examined the co-occurrence of substance use with new and emerging tobacco products in this vulnerable group, or the underlying personality factors that may explain these associations. To address this gap, this study examined the association of current alcohol and marijuana use with the use of cigarettes and emerging tobacco products in a nationally representative sample of young adults. Data were drawn from 18 to 24year olds in Wave 4 (January 2013; n=1609) of the Legacy Young Adult Cohort, a nationally-representative sample of men and women. Never, ever (lifetime), and past 30-day use of little cigars/cigarillos (LCCs), hookah, e-cigarettes, and cigarettes were assessed separately in current (everyday or some days) alcohol and marijuana users. Using weighted estimates, multivariable multinomial logistic regression models showed that current alcohol and marijuana use were associated with lifetime and past 30-day use of cigarettes, LCCs, e-cigarettes, and hookah, with different magnitudes of association found across each product. Post-hoc exploratory analyses showed that sensation-seeking traits moderated the relationship of alcohol (but not marijuana) use to current use of select tobacco products. Marijuana and alcohol use may enhance risk for emerging tobacco products use in young adulthood. Prevention and intervention programs may need to target poly-use of alcohol, marijuana, and tobacco rather than focusing on a single risk behavior during these critical years. Copyright © 2015 Elsevier Ltd. All rights reserved.

Use of and reasons for using multiple other tobacco products in daily and nondaily smokers: Associations with cigarette consumption and nicotine dependence.

PubMed

Dunbar, Michael S; Shadel, William G; Tucker, Joan S; Edelen, Maria O

2016-11-01

Use of other tobacco products (OTPs) among smokers is increasing. Little is known about types of OTP used and the reasons for use, and how OTP use and reasons for use correlate with smoking patterns and nicotine dependence in daily and nondaily smokers. This paper addresses these gaps in the literature. 656 daily smokers and 203 nondaily smokers provided information on their use of different OTPs (hookah, e-cigarettes, chew/snuff, snus, cigars, dissolvables), and reasons for using OTPs (e.g., "to cut down on smoking"), as well as their cigarette consumption and nicotine dependence. Logistic regression models assessed the association of smoking status with OTP use (ever and current) and reasons for use. Within each smoking group, separate logistic regression models examined the associations of OTP use and reasons for use with cigarette consumption and nicotine dependence. Compared to daily smokers, nondaily smokers were more likely to use hookah and cigars, less likely to use dissolvables, and less likely to endorse using OTPs to reduce their smoking. Among non-daily smokers, nicotine dependence was associated with a higher likelihood of current OTP use (OR=1.04 [95% CI 1.01-1.07]; p<0.05), whereas cigarette consumption was not. Results suggest OTP use in nondaily smokers does not correlate with less frequent smoking, but may correlate with higher nicotine dependence. Use of combustible OTPs among nondaily smokers may offset any potential benefits achieved through less frequent cigarette consumption. Providers should explicitly address OTP use when discussing cigarette cessation and reduction. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Knowledge, Beliefs, Behaviors, and Social Norms Related to Use of Alternative Tobacco Products Among Undergraduate and Graduate Nursing Students in an Urban U.S. University Setting.

PubMed

VanDevanter, Nancy; Zhou, Sherry; Katigbak, Carina; Naegle, Madeline; Sherman, Scott; Weitzman, Michael

2016-03-01

The purpose of the study was to assess nursing students' knowledge, beliefs, behaviors, and social norms regarding use of alternative tobacco products (ATPs). This anonymous online survey was conducted with all students enrolled in a college of nursing. The survey utilized measures from several national tobacco studies to assess knowledge and beliefs about ATPs (hookahs, cigars or cigarillos, bidis, kreteks, smokeless tobacco, electronic cigarettes) compared to cigarettes, health effects of ATPs, personal use of ATPs, and social norms. Data were analyzed in SPSS 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics and frequencies were performed for basic sociodemographic data. Paired samples t tests were performed to determine differences for scaled measures. Nursing students demonstrated very low levels of knowledge about ATPs and their health consequences, despite high rates of ATP personal use. About 76% of participants reported use of one or more ATPs once or more in their lifetimes. A greater proportion of students had used hookahs or waterpipes (39.6%) compared to cigarettes (32.7%). Nurses' lack of knowledge about the emerging use and health threats associated with ATPs may undermine their ability to provide appropriate tobacco cessation counseling. Research is needed to identify gaps in nurses' education regarding tobacco cessation counseling and to develop new counseling approaches specific to use of ATPs. Nurses play critical roles in counseling their patients for tobacco cessation. Further research and education about the risks presented by ATPs are critical to reducing excess tobacco-related mortality. © 2016 Sigma Theta Tau International.

Decreasing carbon monoxide in the diving air of artisanal fishermen in the Yucatán peninsula by separation of engine exhaust from compressor intake.

PubMed

Chin, Walter; Huchim-Lara, Oswaldo; Salas, Silvia

2016-01-01

Artisanal fishermen in the Yucatán Peninsula utilize hookah dive systems (HDS). The air compressors in these HDS are not filtered, and the intake is near the engine exhaust. This proximity allows carbon monoxide (CO) from the exhaust to directly enter the HDS volume tank and contaminate the fishermen diver's air supply. Conservative safety standards permit a diver's air supply to contain 10 parts per million (ppm) of CO. This study quantified the levels of CO in the diver's air supply both before and after physical separation of the engine exhaust from the compressor intake. CO levels in seven volume tanks were analyzed before and after a 1-inch hose was attached to the compressor intake and elevated 5 feet above the engine exhaust. The tanks were drained and refilled before collecting each set of pre- and post-intervention gas samples. Four CO measurements were collected before and after the intervention from each volume tank. A C-Squared© CO Analyzer (± 1 ppm), calibrated with a Praxair 70 ppm CON2 gas (± 5%), was used to analyze the gas samples. A paired samples t-test shows a statistically significant difference in average CO values before and after the intervention (t = 6.8674, df: 27; p⟨0.0001). The physical separation of the engine exhaust from the compressor intake reduced the CO contamination of the diver air supply by 72%. This intervention could be applied to the hookah systems in the rest of the fishing cooperative to reduce the divers' risk of CO poisoning. Copyright© Undersea and Hyperbaric Medical Society.

Maternal smoking: determinants and associated morbidity in two areas in Lebanon.

PubMed

Bachir, Rana; Chaaya, Monique

2008-05-01

This study assessed the factors related to smoking during pregnancy in two areas in Lebanon, and the association of smoking to selected maternal and newborn health related factors. This was a secondary analysis of data on 538 women who delivered in nine hospitals in two areas in Lebanon. Women were interviewed about their smoking practices, and on demographic and psychosocial variables. 396 women were followed up and re-interviewed about their smoking status, and the mother's and baby's health after delivery. Smoking during pregnancy included both cigarettes and narghile smoking. About 25.7% of women were smoking some kind of tobacco during pregnancy. Older women, Muslim women, women with poor education, those who had financial difficulty, nervousness, lower support, and delay in seeking prenatal care were more likely to smoke during pregnancy. Women who smoked during pregnancy were more likely to have a low birth weight baby and to stop breastfeeding. It is important to address smoking among women in general, and not only during pregnancy. We discuss the role of public and private sectors in smoking cessation and interventions.

Tobacco consumption in the Kingdom of Saudi Arabia, 2013: findings from a national survey.

PubMed

Moradi-Lakeh, Maziar; El Bcheraoui, Charbel; Tuffaha, Marwa; Daoud, Farah; Al Saeedi, Mohammad; Basulaiman, Mohammed; Memish, Ziad A; AlMazroa, Mohammad A; Al Rabeeah, Abdullah A; Mokdad, Ali H

2015-07-05

Tobacco consumption is a major risk factor for morbidity and mortality. The Saudi Ministry of Health started a national tobacco control program in 2002 with increased and intensified efforts after joining the World Health Organization Framework Convention for Tobacco Control in 2005. In order to assess the status of tobacco consumption in the Kingdom of Saudi Arabia (KSA), we conducted a survey on 10735 individuals aged 15 years or older (5253 men and 5482 women) which was performed between April and June 2013. The Saudi Health Interview Survey had a multistage sampling and was nationally representative. Data were collected through face-to-face interviews. The survey included questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions. Overall prevalence of current smoking was 12.2 % and males were more likely to smoke than females (21.5 % vs. 1.1 %). Mean age of smoking initiation was 19.1 years (±6.5 years) with 8.9 % of ever smokers starting before the age of 15 years. Daily shisha smoking was reported by 4.3 % of the population (7.3 % of men and 1.3 % of women). Around 1.4 % of population (2.6 % of men and 0.1 % of women) were daily smokers of cigarette/cigar and shisha. Receiving advice for quitting smoking by health care professionals during the last 12 months was reported by 53.2 % (95 % confidence interval [CI]: 49.8-56.5) of ever smokers. Among ever smokers, 51.3 % of individuals reportedly attempted to quit smoking during the last 12 months. Of those, 25.3 % were successful by the time of the survey. Around 23.3 % of the entire population, 32.3 % of men and 13.5 % of women, were exposed to secondhand smoke for at least one day during the past 7 days at home, work, or school. Although the indicators of tobacco consumption in KSA are better than most of the countries of the Middle East region and high-income countries, there

Multiple tobacco product use among young adult bar patrons in New Mexico

PubMed Central

Kalkhoran, Sara; Padilla, James L.; Neilands, Torsten B.; Ling, Pamela M.

2017-01-01

Introduction Use of non-cigarette tobacco products is common, and e-cigarette use is increasing among young adults. We aimed to identify use of other tobacco products among young adult bar patrons in the context of a bar-based intervention to decrease cigarette smoking. Methods 2291 cross-sectional surveys were collected from young adults in bars in Albuquerque, New Mexico using time–location sampling between 2011 and 2013 (N = 1142 in 2011, N = 1149 in 2012–2013), 2 and 3 years into an intervention to reduce cigarette use, and analyzed in 2014–2015. Participants reported current (i.e. past 30-day) use of cigarettes, snus, dip, cigarillos, hookah, and e-cigarettes, demographics, and tobacco-related attitudes. Multiple imputation was used to account for planned missing data. Logistic regression determined correlates of multiple tobacco product use. Results Cigarette smoking in the population decreased during the intervention from 43% to 37%. Over 60% of current cigarette smokers reported poly-use, most frequently with e-cigarettes (46%) and hookah (44%), followed by cigarillos (24%), dip (15%), and snus (14%) in 2012–2013. Among cigarette smokers, current e-cigarette use increased, while use of other products decreased during the intervention. Odds of poly-use (versus smoking cigarettes only) were greater among males and those reporting past 30-day binge drinking, and lower in those who strongly believed secondhand smoke exposure is harmful. Conclusions Among young adult bar patrons in Albuquerque, New Mexico, most cigarette smokers reported currently using at least one other tobacco product. Public health interventions should address use of all tobacco products, use of which may rise despite decreased cigarette use. PMID:26666395

Multiple tobacco product use among young adult bar patrons in New Mexico.

PubMed

Kalkhoran, Sara; Padilla, James L; Neilands, Torsten B; Ling, Pamela M

2016-02-01

Use of non-cigarette tobacco products is common, and e-cigarette use is increasing among young adults. We aimed to identify use of other tobacco products among young adult bar patrons in the context of a bar-based intervention to decrease cigarette smoking. 2291 cross-sectional surveys were collected from young adults in bars in Albuquerque, New Mexico using time-location sampling between 2011 and 2013 (N=1142 in 2011, N=1149 in 2012-2013), 2 and 3years into an intervention to reduce cigarette use, and analyzed in 2014-2015. Participants reported current (i.e. past 30-day) use of cigarettes, snus, dip, cigarillos, hookah, and e-cigarettes, demographics, and tobacco-related attitudes. Multiple imputation was used to account for planned missing data. Logistic regression determined correlates of multiple tobacco product use. Cigarette smoking in the population decreased during the intervention from 43% to 37%. Over 60% of current cigarette smokers reported poly-use, most frequently with e-cigarettes (46%) and hookah (44%), followed by cigarillos (24%), dip (15%), and snus (14%) in 2012-2013. Among cigarette smokers, current e-cigarette use increased, while use of other products decreased during the intervention. Odds of poly-use (versus smoking cigarettes only) were greater among males and those reporting past 30-day binge drinking, and lower in those who strongly believed secondhand smoke exposure is harmful. Among young adult bar patrons in Albuquerque, New Mexico, most cigarette smokers reported currently using at least one other tobacco product. Public health interventions should address use of all tobacco products, use of which may rise despite decreased cigarette use. Copyright © 2015. Published by Elsevier Inc.

Alcohol-flavoured tobacco products.

PubMed

Jackler, Robert K; VanWinkle, Callie K; Bumanlag, Isabela M; Ramamurthi, Divya

2018-05-01

In 2009, the Food and Drug Administration (FDA) banned characterising flavours in cigarettes (except for menthol) due to their appeal to teen starter smokers. In August 2016, the agency deemed all tobacco products to be under its authority and a more comprehensive flavour ban is under consideration. To determine the scope and scale of alcohol-flavoured tobacco products among cigars & cigarillos, hookahs and electronic cigarettes (e-cigarettes). Alcohol-flavoured tobacco products were identified by online search of tobacco purveyors' product lines and via Google search cross-referencing the various tobacco product types versus a list of alcoholic beverage flavours (eg, wine, beer, appletini, margarita). 48 types of alcohol-flavoured tobacco products marketed by 409 tobacco brands were identified. Alcohol flavours included mixed drinks (n=25), spirits (11), liqueurs (7) and wine/beer (5). Sweet and fruity tropical mixed drink flavours were marketed by the most brands: piña colada (96), mojito (66) and margarita (50). Wine flavours were common with 104 brands. Among the tobacco product categories, brands offering alcohol-flavoured e-cigarettes (280) were most numerous, but alcohol-flavoured products were also marketed by cigars & cigarillos (88) and hookah brands (41). Brands by major tobacco companies (eg, Philip Morris, Imperial Tobacco) were well represented among alcohol-flavoured cigars & cigarillos with five companies offering a total of 17 brands. The widespread availability of alcohol-flavoured tobacco products illustrates the need to regulate characterising flavours on all tobacco products. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Openness to Using Non-cigarette Tobacco Products Among U.S. Young Adults

PubMed Central

Mays, Darren; Arrazola, René A.; Tworek, Cindy; Rolle, Italia V.; Neff, Linda J.; Portnoy, David B.

2017-01-01

Introduction National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using non-cigarette tobacco products and associated factors among U.S. young adults. Methods In 2014, National Adult Tobacco Survey data (2012–2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18–29 years (N=5,985): cigars; electronic cigarettes (“e-cigarettes”); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. Results Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18–24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus. Conclusions There is substantial openness to trying non-cigarette tobacco products among U.S. young adults. Young adults are an important population to consider for interventions targeting non-cigarette tobacco product use. PMID:26549502

Openness to Using Non-cigarette Tobacco Products Among U.S. Young Adults.

PubMed

Mays, Darren; Arrazola, René A; Tworek, Cindy; Rolle, Italia V; Neff, Linda J; Portnoy, David B

2016-04-01

National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using non-cigarette tobacco products and associated factors among U.S. young adults. In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus. There is substantial openness to trying non-cigarette tobacco products among U.S. young adults. Young adults are an important population to consider for interventions targeting non-cigarette tobacco product use. Published by Elsevier Inc.

Association Between Electronic Cigarette Use and Openness to Cigarette Smoking Among US Young Adults

PubMed Central

Apelberg, Benjamin J.; Ambrose, Bridget K.; Green, Kerry M.; Choiniere, Conrad J.; Bunnell, Rebecca; King, Brian A.

2015-01-01

Introduction: Use of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes), is increasing. One concern is the appeal of these products to youth and young adults and the potential to influence perceptions and use of conventional cigarettes. Methods: Using data from the 2012–2013 National Adult Tobacco Survey, characteristics of adults aged 18–29 years who had never established cigarette smoking behavior were examined by ever use of e-cigarettes, demographics, and ever use of other tobacco products (smokeless tobacco, cigars, hookah, and cigarettes). Multivariate logistic regression was used to examine the relationship between e-cigarette use and openness to cigarette smoking among young adults, defined as the lack of a firm intention not to smoke soon or in the next year. Results: Among young adults who had never established cigarette smoking behavior (unweighted n = 4,310), 7.9% reported having ever tried e-cigarettes, and 14.6% of those who reported having ever tried e-cigarettes also reported current use of the product. Ever e-cigarette use was associated with being open to cigarette smoking (adjusted odds ratio = 2.4; 95% confidence interval = 1.7, 3.3), as was being male, aged 18–24 years, less educated, and having ever used hookah or experimented with conventional cigarettes. Conclusions: Ever use of e-cigarettes and other tobacco products was associated with being open to cigarette smoking. This study does not allow us to assess the directionality of this association, so future longitudinal research is needed to illuminate tobacco use behaviors over time as well as provide additional insight on the relationship between ENDS use and conventional cigarette use among young adult populations. PMID:25378683

Prevalence and Correlates of Tobacco and Nicotine Containing Product Use in a Sample of United States Air Force Trainees

PubMed Central

Derefinko, Karen J.; Bursac, Zoran; Ebbert, Jon O.; Colvin, Lauren; Talcott, Gerald W.; Hryshko-Mullen, Ann S.; Richey, Phyllis A.; Klesges, Robert C.

2016-01-01

Introduction: Although there is increasing attention to the prevalence of new and emerging tobacco products in the civilian population, remarkably little is known about the current prevalence of these products in a military population. Methods: The current investigation was designed to determine the prevalence of tobacco and nicotine containing products (TNCP) and correlates of use across multiple cohorts of trainees undergoing Technical Training in the US Air Force between April 2013 and December 2014. Chi-square test, Cochran–Armitage test for linear trend, and logistic regression models were applied to test differences and linear trends across time for TNCP use as well as correlates of use in a cross-sectional sample of 13 685 Airmen (final analytic sample). Results: Over a quarter (26.9%) of Airmen reported regular use of a TNCP. The two most prevalent products were cigarettes (11.2%) and hookah (10.5%). Among correlates of use, Airmen that regularly use TNCPs were more likely to be male, younger, non-Hispanic white, and single with a high school degree or General Education Development. Hookah was the most endorsed for intentions to use, and along with e-cigarettes, had the lowest perception of harm. While prevalence of most products remained constant across entering cohorts, the prevalence of e-cigarettes showed significant linear increase. Conclusions: The prevalence of TNCP use is high across cohorts of Airmen. Remarkably high estimates of future intentions to use and low perceptions of harm for emerging products suggest that intervention efforts should be directed at multiple forms of TNCP use to address this important public health issue. PMID:25895952

Identifying "social smoking" U.S. young adults using an empirically-driven approach.

PubMed

Villanti, Andrea C; Johnson, Amanda L; Rath, Jessica M; Williams, Valerie; Vallone, Donna M; Abrams, David B; Hedeker, Donald; Mermelstein, Robin J

2017-07-01

The phenomenon of "social smoking" emerged in the past decade as an important area of research, largely due to its high prevalence in young adults. The purpose of this study was to identify classes of young adult ever smokers based on measures of social and contextual influences on tobacco use. Latent class models were developed using social smoking measures, and not the frequency or quantity of tobacco use. Data come from a national sample of young adult ever smokers aged 18-24 (Truth Initiative Young Adult Cohort Study, N=1564). The optimal models identified three latent classes: Class 1 - nonsmokers (52%); Class 2 - social smokers (18%); and Class 3 - smokers (30%). Nearly 60% of the "social smoker" class self-identified as a social smoker, 30% as an ex-smoker/tried smoking, and 12% as a non-smoker. The "social smoker" class was most likely to report using tobacco mainly or only with others. Past 30-day cigarette use was highest in the "smoker" class. Hookah use was highest in the "social smoker" class. Other tobacco and e-cigarette use was similar in the "social smoker" and "smoker" classes. Past 30-day tobacco and e-cigarette use was present for all products in the "non-smoker" class. Young adult social smokers emerge empirically as a sizable, distinct class from other smokers, even without accounting for tobacco use frequency or intensity. The prevalence of hookah use in "social smokers" indicates a group for which the social aspect of tobacco use could drive experimentation and progression to regular use. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa.

PubMed

Feng, B-J; Khyatti, M; Ben-Ayoub, W; Dahmoul, S; Ayad, M; Maachi, F; Bedadra, W; Abdoun, M; Mesli, S; Bakkali, H; Jalbout, M; Hamdi-Cherif, M; Boualga, K; Bouaouina, N; Chouchane, L; Benider, A; Ben-Ayed, F; Goldgar, D E; Corbex, M

2009-10-06

The lifestyle risk factors for nasopharyngeal carcinoma (NPC) in North Africa are not known. From 2002 to 2005, we interviewed 636 patients and 615 controls from Algeria, Morocco and Tunisia, frequency-matched by centre, age, sex, and childhood household type (urban/rural). Conditional logistic regression was used to evaluate the association of lifestyles with NPC risk, controlling for socioeconomic status and dietary risk factors. Cigarette smoking and snuff (tobacco powder with additives) intake were significantly associated with differentiated NPC but not with undifferentiated carcinoma (UCNT), which is the major histological type of NPC in these populations. As demonstrated by a stratified permutation test and by conditional logistic regression, marijuana smoking significantly elevated NPC risk independently of cigarette smoking, suggesting dissimilar carcinogenic mechanisms between cannabis and tobacco. Domestic cooking fumes intake by using kanoun (compact charcoal oven) during childhood increased NPC risk, whereas exposure during adulthood had less effect. Neither alcohol nor shisha (water pipe) was associated with risk. Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa.

Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa

PubMed Central

Feng, B-J; Khyatti, M; Ben-Ayoub, W; Dahmoul, S; Ayad, M; Maachi, F; Bedadra, W; Abdoun, M; Mesli, S; Bakkali, H; Jalbout, M; Hamdi-Cherif, M; Boualga, K; Bouaouina, N; Chouchane, L; Benider, A; Ben-Ayed, F; Goldgar, D E; Corbex, M

2009-01-01

Background: The lifestyle risk factors for nasopharyngeal carcinoma (NPC) in North Africa are not known. Methods: From 2002 to 2005, we interviewed 636 patients and 615 controls from Algeria, Morocco and Tunisia, frequency-matched by centre, age, sex, and childhood household type (urban/rural). Conditional logistic regression was used to evaluate the association of lifestyles with NPC risk, controlling for socioeconomic status and dietary risk factors. Results: Cigarette smoking and snuff (tobacco powder with additives) intake were significantly associated with differentiated NPC but not with undifferentiated carcinoma (UCNT), which is the major histological type of NPC in these populations. As demonstrated by a stratified permutation test and by conditional logistic regression, marijuana smoking significantly elevated NPC risk independently of cigarette smoking, suggesting dissimilar carcinogenic mechanisms between cannabis and tobacco. Domestic cooking fumes intake by using kanoun (compact charcoal oven) during childhood increased NPC risk, whereas exposure during adulthood had less effect. Neither alcohol nor shisha (water pipe) was associated with risk. Conclusion: Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa. PMID:19724280

Prevalence of Cannabis Use Disorder and Associated Factors among Cannabis Young Adult Users at Shashemene Town, Oromia Region, Ethiopia, 2016

PubMed Central

Tullu, Mikiyas; Azale, Telake; Solomon, Haddis; Habtamu, Yodit

2018-01-01

Introduction Cannabis users are at high risk of developing cannabis use disorder which is a problematic pattern of cannabis use leading to clinically significant impairment or distress. Objective To assess the magnitude of cannabis use disorder and associated factors among young adults using cannabis at Shashemene Town, Oromia Region, Ethiopia. Methods A cross-sectional study was conducted at Shashemene Town, from May to June 2016. Young adults aged 18–25 who use cannabis and are permanent residents of Shashemene were included in the study. Using single proportion formula, 423 participants were selected using exponential discriminative snow ball sampling. Result This study revealed that the magnitude of cannabis use disorder was 42.2%. The most contributing factors that remained to be statistically significant with cannabis use disorder were common mental disorder (AOR = 2.125, 95% CI: 1.218, 3.708), current cigarette smoking (AOR = 6.118, 95% CI: 2.13, 17.575), and current use of shisha (AOR = 4.313, 95% CI: 2.427, 7.664). Conclusion The magnitude of cannabis use disorder among young adults using cannabis was high. PMID:29670893

Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence

PubMed Central

Leventhal, Adam M.; Strong, David R.; Kirkpatrick, Matthew G.; Unger, Jennifer B.; Sussman, Steve; Riggs, Nathaniel R.; Stone, Matthew D.; Khoddam, Rubin; Samet, Jonathan M.; Audrain-McGovern, Janet

2016-01-01

Importance Exposure to nicotine in electronic (e-) cigarettes is common among adolescents who report never having smoked combustible tobacco. Objectives To evaluate whether e-cigarette ever-use among 14-year-olds who have never tried combustible tobacco is associated with risk of initiating use of three combustible tobacco products (i.e., cigarettes, cigars, and hookah). Design Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, Mean age=14.1) and 6-month (spring 2014, 9th grade) and 12-month (fall 2014, 10th grade) follow-ups. Setting and Participants Ten public high schools in Los Angeles, CA were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and underwent follow-up assessment (N=2,530). At each time point, students completed self-report surveys during in-classroom data collections. Exposure Self-report of e-cigarette ever-use (yes/no) at baseline. Main Outcome Measures Six- and 12-month follow-up reports of use of each of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes/no); (2) combustible cigarettes (yes/no), (3) cigars (yes/no); (4) hookah (yes/no); and (5) number of combustible tobacco products (range: 0–3). Results Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever-users (N=222) than never-users (N=2,308) at the 6-month (30.7% vs. 8.1%, % difference [95% CI]=22.7[16.4, 28.9]) and 12-month (25.2% vs. 9.3%, % difference [95% CI]= 15.9[10.0, 21.8]) follow-ups. Baseline ever e-cigarette use was associated with greater likelihood of combustible tobacco use averaged across the two follow-ups in unadjusted analyses (OR[95% CI]=4.27[3.19, 5.71]) and in analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR[95% CI]=2.73[2.00, 3.73]). Product-specific analyses showed that baseline e-cigarette ever-use was

[Spatio-temporal dynamics of fishing effort in a multi-species artisanal diving fishery and its effects on catch variability: insights for sustainable management].

PubMed

Naranjo Madrigall, Helven; Salas Marquez, Silvia

2014-12-01

Artisanal diving fisheries are a source of income, employment and food security of coastal areas in many countries. Understanding the dynamics of these fisheries, including the spatial and temporal dynamics of fishing effort, gears and species can help to address the challenges involved in fisheries management. We aimed to analyze the differences in fishing strategies undertaken by fishers that use two different diving methods (hookah and free diving), the conditions and their potential impacts on catches when adjustments to those strategies are applied over time. For this, detailed information of fishing operations from artisanal boats in the North Pacific coast of Costa Rica was analyzed in two fishing seasons (2007-2008 and 2011-2012). Data were collected by onboard observers (fishing site, fishing time, species composition, depth and visibility). Additionally, interviews with divers were applied to obtain information of price per species, species volume and fishing operations. From the total number of trips during both seasons, hookah diving was represented by a sample size of 69.3%, while free diving, with a sample of 41.9%. More than 15 species were identified in each fishing season. Nevertheless, three categories had substantial contributions in both seasons with differences in the proportions for each case: green lobster (Panulirus gracilis), octopus (Octopus sp.) and parrotfish (Scarus perrico and S. ghobban). It is worth noting that an important proportion of catch was retained by fishers for personal consumption purposes, including species of high commercial value. Additional night diving activity, increased the number of dives from one season to another. Besides, cooperation processes in free diving fishing operations, and changes in fishing effort between seasons, defined important changes in fishing strategies. Potential causes of changes in fishing strategies and the implications for management to ensure the sustainability of these fisheries in the

Alternative tobacco product use and smoking cessation among homeless youth in los angeles county.

PubMed

Tucker, Joan S; Shadel, William G; Golinelli, Daniela; Ewing, Brett

2014-11-01

Approximately 70% of homeless youth smoke cigarettes, but their use of alternative tobacco products (ATPs) is unknown. This paper reports on ATP use among past-month smokers in Los Angeles County, including whether it differs by demographic characteristics, homelessness severity, past-year quit attempts, and readiness to quit smoking. Given the growing popularity of e-cigarettes, we also report on perceptions of harm and reasons for using this product. We surveyed 292 unaccompanied homeless youth who were randomly sampled from street sites. Participants had smoked at least 100 cigarettes during their lifetime and 1 cigarette during the past month. Seventy-two percent of youth reported past-month ATP use (e-cigarettes = 51%; little cigars/cigarillos = 46%; hookah = 31%; other smokeless tobacco product = 24%; chewing tobacco/moist snuff = 19%). Current ATP use was unrelated to most demographic characteristics or having a past-year quit attempt. However, youth who planned to quit smoking in the next 30 days were significantly less likely to report current use of hookahs, other smokeless tobacco products, or e-cigarettes. Among lifetime e-cigarette users, the most common reasons for use included not having to go outside to smoke (38%) and being able to deal with situations or places where they cannot smoke (36%); it was less common to report using e-cigarettes to quit smoking (17%-18%). Dual use of ATPs among homeless youth smokers is common and is more likely among those who have no immediate plans to quit smoking. Effective and easily disseminable strategies for reducing all forms of tobacco use among homeless youth are urgently needed. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Association between electronic cigarette use and openness to cigarette smoking among US young adults.

PubMed

Coleman, Blair N; Apelberg, Benjamin J; Ambrose, Bridget K; Green, Kerry M; Choiniere, Conrad J; Bunnell, Rebecca; King, Brian A

2015-02-01

Use of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes), is increasing. One concern is the appeal of these products to youth and young adults and the potential to influence perceptions and use of conventional cigarettes. Using data from the 2012-2013 National Adult Tobacco Survey, characteristics of adults aged 18-29 years who had never established cigarette smoking behavior were examined by ever use of e-cigarettes, demographics, and ever use of other tobacco products (smokeless tobacco, cigars, hookah, and cigarettes). Multivariate logistic regression was used to examine the relationship between e-cigarette use and openness to cigarette smoking among young adults, defined as the lack of a firm intention not to smoke soon or in the next year. Among young adults who had never established cigarette smoking behavior (unweighted n = 4,310), 7.9% reported having ever tried e-cigarettes, and 14.6% of those who reported having ever tried e-cigarettes also reported current use of the product. Ever e-cigarette use was associated with being open to cigarette smoking (adjusted odds ratio = 2.4; 95% confidence interval = 1.7, 3.3), as was being male, aged 18-24 years, less educated, and having ever used hookah or experimented with conventional cigarettes. Ever use of e-cigarettes and other tobacco products was associated with being open to cigarette smoking. This study does not allow us to assess the directionality of this association, so future longitudinal research is needed to illuminate tobacco use behaviors over time as well as provide additional insight on the relationship between ENDS use and conventional cigarette use among young adult populations. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Susceptibility to tobacco product use among youth in wave 1 of the population Assessment of tobacco and health (PATH) study.

PubMed

Trinidad, Dennis R; Pierce, John P; Sargent, James D; White, Martha M; Strong, David R; Portnoy, David B; Green, Victoria R; Stanton, Cassandra A; Choi, Kelvin; Bansal-Travers, Maansi; Shi, Yuyan; Pearson, Jennifer L; Kaufman, Annette R; Borek, Nicolette; Coleman, Blair N; Hyland, Andrew; Carusi, Charles; Kealey, Sheila; Leas, Eric; Noble, Madison L; Messer, Karen

2017-08-01

The purpose of this study was to investigate susceptibility and ever use of tobacco products among adolescents and young adults in the US. Cross-sectional analysis of Wave 1(2013-2014) adolescent (12-17year-olds; n=13,651) and young adult (18-24year-olds; n=9112) data from the nationally-representative Population Assessment of Tobacco and Health (PATH) Study was conducted. At 12years, 5% were ever tobacco users and 36% were susceptible to use. Seventy percent were susceptible at age 17years, and the same proportion were ever users at age 22years. Susceptibility levels were comparable for cigarettes and e-cigarette (28.6% and 27.4%, respectively), followed by hookah (22.0%), pipes (17.5%), cigars (15.2%), and smokeless tobacco (9.7%). Non-Hispanic (NH) Black (Adjusted Odds Ratio [ORadj]=1.36; 95% Confidence Limit [CL], 1.18-1.56) and Hispanic (ORadj=1.34: 95% CL,1.19-1.49) adolescent never- users were more likely to be susceptible to future use of a tobacco product than NH Whites. Susceptibility was higher with age (15-17yrs. vs 12-14yrs.: OR adj =1.69; 95% CL, 1.55-1.85) and parental education (college graduates vs less than HS education: OR adj =1.22, 95% CL, 1.08-1.39). Compared to exclusive users of hookah, cigars, or smokeless products, larger proportions of exclusive e-cigarette ever users were also susceptible to cigarette use. Among adolescents, lower levels of ever use of tobacco products are often counterbalanced by higher levels of susceptibility for future use, which may suggest delayed initiation in some groups. Ever users of a given tobacco product were more susceptible to use other tobacco products, putting them at risk for future multiple tobacco product use. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of clinical factors in the association of gestational diabetes amongst women aged 15-49 years residing in Yazd-Iran.

PubMed

Lotfi, Mohammad Hasan; Fallahzadeh, Hossein; Rahmanian, Masoud; Lashkardoost, Hossein; Hamedi, Andishe

2018-04-16

Gestational diabetes mellitus (GDM) has occurred in Fourteen percent of all pregnancies in the world. Epidemiological evidences about risk factors of GDM may be different from region to region and are unknown, exactly. This study examines the role of clinical factors in the association of gestational diabetes in Yazd, Iran. This study was carried out on 168 women with gestational diabetes and 168 women as controls after matching for age and place of residence. Each participant was interviewed about her pregnancy history and tobacco consumption. Information including BMI, weight before pregnancy and background of underlying diseases were recorded from information system in Health Centers. Finally, data were analyzed by using chi-square test, logistic regression and multiple correspondence analyze(MCA). History of gestational diabetes in past pregnancy OR = 3.2[95%CI:1.1, 9.7], a family history of gestational diabetes OR = 3.7 [95%CI:1.1, 11.5], a history of hookah smoking OR = 3.6 [95%CI:1.06, 12.3], being obese before pregnancy OR = 1.9[95%CI:1.01, 3.5], and weight gain during pregnancy OR = 0.5[95%CI:0.2, 0.9], were the most important determinants of gestational diabetes. There were not significant relation between GDM and underlying diseases, history of stillbirth, abortion, twinning, cigarette smoking, alcohol and drug abuse. In this research modifiable risk factors for gestational diabetes were high BMI before pregnancy, weight gain during pregnancy and history of hookah consumption. We advise that appropriate education, avoiding sedentary lifestyle, diet improvement and advertising which focus on tobacco consumption is playing as an important role in developing the chronic diseases, including GDM. Copyright © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Changes in use of cigarettes and non-cigarette alternative products among college students.

PubMed

Loukas, Alexandra; Batanova, Milena; Fernandez, Alejandra; Agarwal, Deepti

2015-10-01

The present study examined change in use of various smoked and smokeless non-cigarette alternative products in a sample of college students, stratified by current, or past 30-day, cigarette smoking status. Participants were 698 students from seven four-year colleges in Texas. Participants completed two waves of online surveys regarding tobacco use, knowledge, and attitudes, with 14 months between each wave. The most prevalent products used by the entire sample at Wave 1 were cigarettes, followed by hookah, cigars/cigarillos/little cigars, and electronic cigarettes (e-cigarettes). At Wave 2, prevalence of e-cigarette use surpassed use of cigars/cigarillos/little cigars. Snus and chew/snuff/dip were relatively uncommon at both waves. Examination of change in use indicated that e-cigarette use increased across time among both current cigarette smokers and non-cigarette smokers. Prevalence of current e-cigarette use doubled across the 14-month period to 25% among current smokers and tripled to 3% among non-cigarette smokers. Hookah use also increased across time, but only among non-cigarette smokers, whereas it decreased among current cigarette smokers. Use of all other non-cigarette alternatives remained unchanged across time. Logistic regression analysis was used to examine the socio-demographic predictors of Wave 2 e-cigarette use, the only product that increased in use among both current cigarette smokers and non-cigarette smokers. Results indicated that Wave 1 current cigarette use and Wave 1 current e-cigarette use, but not gender, age, or race/ethnicity, were significantly associated with Wave 2 e-cigarette use. Findings underscore the need to track changes in the use of non-cigarette alternatives and call for additional research examining the factors contributing to change in use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tobacco marketing receptivity and other tobacco product use among young adult bar patrons

PubMed Central

Thrul, Johannes; Lisha, Nadra E.; Ling, Pamela M.

2016-01-01

Purpose Use of other tobacco products (smokeless tobacco, hookah, cigarillo, e-cigarettes) is increasing, particularly among young adults, and there are few regulations on marketing for these products. We examined the associations between tobacco marketing receptivity and other tobacco product (OTP) use among young adult bar patrons (aged 18-26 years). Methods Time-location sampling was used to collect cross-sectional surveys from 7,540 young adult bar patrons from January 2012 through March of 2014. Multivariable logistic regression analyses in 2015 examined if tobacco marketing receptivity was associated (1) with current (past 30 day) OTP use controlling for demographic factors, and (2) with dual/poly use among current cigarette smokers (n=3,045), controlling for demographics and nicotine dependence. Results Among the entire sample of young adult bar patrons (Mage=23.7, SD=1.8; 48.1% female), marketing receptivity was consistently associated with current use of all OTP including smokeless tobacco (adjusted odds ratio [AOR]= 2.49, 95% confidence interval [CI] 1.90-3.27, p<.001), hookah (AOR=1.97, 95% CI 1.58-2.43, p<.001), cigarillos/cigars (AOR=3.00, 95% CI 2.21-4.08, p<.001), electronic cigarettes (AOR=2.43, 95% CI 1.93-3.04, p<.001), and multiple tobacco products (AOR=2.93, 95% CI 2.45-3.51, p<.001). Among current smokers, marketing receptivity was significantly associated with use of smokeless tobacco (AOR=1.44, 95% CI 1.05-1.98, p<.05), cigarillos/cigars (AOR=1.81, 95% CI 1.22-2.70, p<.01), and multiple tobacco products (AOR=1.58, 95% CI 1.27-1.97, p<.001). Conclusions OTP use is common among young adult bar patrons and it is associated with tobacco marketing receptivity. Efforts to limit tobacco marketing should address OTP in addition to cigarettes. PMID:27707516

Co-occurrence of tobacco product use, substance use, and mental health problems among adults: Findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study.

PubMed

Conway, Kevin P; Green, Victoria R; Kasza, Karin A; Silveira, Marushka L; Borek, Nicolette; Kimmel, Heather L; Sargent, James D; Stanton, Cassandra; Lambert, Elizabeth; Hilmi, Nahla; Reissig, Chad J; Jackson, Kia J; Tanski, Susanne E; Maklan, David; Hyland, Andrew J; Compton, Wilson M

2017-08-01

Although non-cigarette tobacco product use is increasing among U.S. adults, their associations with substance use and mental health problems are unclear. This study examined co-occurrence of tobacco use, substance use, and mental health problems, and its moderation by gender, among 32,202U.S. adults from Wave 1 (2013-2014) of the nationally representative longitudinal Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported current cigarette, e-cigarette, traditional cigar, cigarillo, filtered cigar, hookah, smokeless tobacco and other tobacco product use; past year alcohol, marijuana, and other drug use; and past year substance use, internalizing and externalizing problems. Compared to non-current tobacco users, current users were more likely to report alcohol or drug use (adjusted odds ratio (AOR)=2.6; 95% confidence interval (CI): 2.3, 2.9), with the strongest associations observed for cigarillo and hookah users. Across all tobacco product groups, users were more likely to report internalizing (AOR=1.9; 95% CI: 1.7, 2.1), externalizing (AOR=1.6; 95% CI: 1.5, 1.8), and substance use (AOR=3.4; 95% CI: 2.9, 4.1) problems than non-users. Gender moderated many of these associations and, of these, all non-cigarette tobacco product associations were stronger among females. This nationally representative study of U.S. adults is the first to comprehensively document tobacco use, substance use, and mental health comorbidities across the range of currently available tobacco products, while also demonstrating that female tobacco users are at increased risk for substance use and mental health problems. These findings may point to gender differences in vulnerability and suggest that interventions incorporate gender-specific approaches. Copyright © 2017 Elsevier B.V. All rights reserved.

Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence.

PubMed

Leventhal, Adam M; Strong, David R; Kirkpatrick, Matthew G; Unger, Jennifer B; Sussman, Steve; Riggs, Nathaniel R; Stone, Matthew D; Khoddam, Rubin; Samet, Jonathan M; Audrain-McGovern, Janet

2015-08-18

Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted

The Protective Effect of Selenium on Oxidative Stress Induced by Waterpipe (Narghile) Smoke in Lungs and Liver of Mice.

PubMed

Charab, Mohamad A; Abouzeinab, Noura S; Moustafa, Mohamed E

2016-12-01

Waterpipe smoking is common in the Middle East populations and results in health problems. In this study, we investigated the effects of exposure of mice to waterpipe smoke on oxidative stress in lungs and liver and the effects of selenium administration before smoke exposure on the oxidative stress. Twenty-four mice were divided equally into four groups: (i) the control mice received no exposure or treatment; (ii) mice exposed to waterpipe smoke; (iii) mice received intraperitoneal injection of 0.59 μg selenium/kg body weight as sodium selenite 15 min before the exposure to waterpipe smoke; and (iv) mice received intraperitoneal injection of 1.78 μg selenium/kg body weight as sodium selenite 15 min before the exposure to waterpipe smoke. Mice were exposed to waterpipe smoke every other day for four times within 8 successive days. Malondialdehyde and nitric oxide levels were significantly higher in the lungs and liver, while the activities of superoxide dismutase, glutathione peroxidase-1, and catalase were significantly lower in the waterpipe smoke group when compared to control mice. Treating mice with 1.78 μg selenium/kg body weight significantly restored the normal levels of these parameters. Histological examinations of lungs and liver confirmed the protective actions of selenium against the effects of exposure to waterpipe smoke. In conclusion, exposure of mice to waterpipe smoke-induced oxidative stress in lungs and liver. Administration of low level of selenium, 1.78 μg selenium/kg body weight as sodium selenite, exerted protective effects against oxidative stress induced by exposure to waterpipe smoke.

Alternative tobacco use among college students: who is at highest risk?

PubMed

Enofe, Nosayaba; Berg, Carla J; Nehl, Eric J

2014-03-01

To examines smoking status, substance use, sociodemographics, and psychosocial characteristics in relation to alternative tobacco use among college students. Current tobacco use (cigarettes, cigar-like products, hookah, chew, snus) and correlates (sociodemographics, sensation-seeking, attitudes toward tobacco and smokers, social factors) were assessed among students aged 18-25 at 6 Southeastern US colleges using an online survey. Those who were younger, male, black, cigarette and marijuana users, and demonstrating at-risk psychosocial factors were at increased risk of alternative tobacco product use (p < .001). Among current smokers, never daily nondaily smokers were 3 times as likely as former daily non-daily smokers and daily smokers to use alternative tobacco products (p < .001). Important risk factors for alternative tobacco use included important sociodemographic and psychosocial characteristics.

Harm perception, attitudes and predictors of waterpipe (shisha) smoking among secondary school adolescents in Al-Hassa, Saudi Arabia.

PubMed

Amin, Tarek Tawfik; Amr, Mostafa Abdel Monem; Zaza, Burhan Omar; Suleman, Wassem

2010-01-01

This study aimed to determine the prevalence and social determinants of waterpipe (WP) smoking among secondary school students in Al-Hassa, Saudi Arabia and to assess their health related knowledge and attitudes toward WP. A cross-sectional study was conducted with 1,652 Saudi secondary school students of both genders aged between 15-19 years selected by multistage sampling method. A self-administered anonymous Arabic version of Global Youth Tobacco Survey modified with items dedicated to WP smoking and to assess perception of health related hazards and attitudes towards WP was employed for data collection. Prevalence of current smokers 'all forms' was 30.3% among males (C.I= 27.5- 33.2%) and 8.5% in females (C.I= 6.6-10.9%). WP was used by 53.9% of the current tobacco users, significantly higher among older age students. Of the regular WP smokers, 20.7% smoked WP on daily basis, 23.8% weekly, 64.2% stated using flavored " Muassel " tobacco. Primary motives for WP smoking were outings with friends, company, boredom and wasting time. Of the total, 49.7% of students stated that WP smoking is less harmful than cigarettes, 60.5% believed that harmful substances were purified through water filtration, with non-addictive properties in 67.8%. Knowledge about health hazards of WP smoking was low, irrespective of student's smoking status. WP smoking is more socially acceptable than cigarettes (52.1%), represents a good opportunity for gathering of friends and family (33.8%), and smoking of WP can relieve stress and tensions (37.8%). Hierarchical regression analysis showed that socializing motives, cigarette smoking, smoking among close family and friends, male gender and increasing age were positive predictors for WP smoking. Social acceptability, poor knowledge of WP health related hazards and certain socio demographics are favoring the increasing current trend of WP use among adolescents in Al Hassa, Saudi Arabia.

Tobacco Marketing Receptivity and Other Tobacco Product Use Among Young Adult Bar Patrons.

PubMed

Thrul, Johannes; Lisha, Nadra E; Ling, Pamela M

2016-12-01

Use of other tobacco products (smokeless tobacco, hookah, cigarillo, and e-cigarettes) is increasing, particularly among young adults, and there are few regulations on marketing for these products. We examined the associations between tobacco marketing receptivity and other tobacco product (OTP) use among young adult bar patrons (aged 18-26 years). Time-location sampling was used to collect cross-sectional surveys from 7,540 young adult bar patrons from January 2012 through March of 2014. Multivariable logistic regression analyses in 2015 examined if tobacco marketing receptivity was associated (1) with current (past 30 day) OTP use controlling for demographic factors and (2) with dual/poly use among current cigarette smokers (n = 3,045), controlling for demographics and nicotine dependence. Among the entire sample of young adult bar patrons (Mean age  = 23.7, standard deviation = 1.8; 48.1% female), marketing receptivity was consistently associated with current use of all OTP including smokeless tobacco (adjusted odds ratio [AOR]= 2.56, 95% confidence interval [CI] 2.08-3.16, p < .001), hookah (AOR = 1.97, 95% CI 1.58-2.43, p < .001), cigarillos (AOR = 3.00, 95% CI 2.21-4.08, p < .001), electronic cigarettes (AOR = 2.43, 95% CI 1.93-3.04, p < .001), and multiple tobacco products (AOR = 2.93, 95% CI 2.45-3.51, p < .001). Among current smokers, marketing receptivity was significantly associated with use of smokeless tobacco (AOR = 1.63, 95% CI 1.22-2.18, p < .01), cigarillos (AOR = 1.81, 95% CI 1.22-2.70, p < .01), and multiple tobacco products (AOR = 1.58, 95% CI 1.27-1.97, p < .001). OTP use is common among young adult bar patrons, and it is associated with tobacco marketing receptivity. Efforts to limit tobacco marketing should address OTP in addition to cigarettes. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Adolescents’ Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia

PubMed Central

Zin, Faridah Mohd; Hillaluddin, Azlin Hilma; Mustaffa, Jamaludin

2016-01-01

Purpose: The present qualitative study explored adolescents’ perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability. PMID:28122443

Social Media Use for Public Health Campaigning in a Low Resource Setting: The Case of Waterpipe Tobacco Smoking

PubMed Central

Abass, Jooman; Akl, Elie A.

2015-01-01

Introduction. Waterpipe tobacco smoking prevalence is increasing worldwide despite its documented health effects. A general belief that it is less harmful than cigarettes may be fuelled by the lack of media campaigns highlighting its health effects. We aimed to create and assess the impact of a social media campaign about dangers of waterpipe smoking. Methods. The “ShishAware” campaign included three social media (Facebook, Twitter, and YouTube) and a website. Nine months after launch we collected data to assess use of, and reaction to, our media accounts. Results. Requiring limited maintenance resources, Facebook attracted campaign supporters but YouTube attracted opposers. Twitter enabled the most organisation-based contact but Facebook was the most interactive medium. Facebook users were more likely to “like” weekday than weekend statuses and more likely to comment on “shisha fact” than “current affairs” statuses. Follower subscription increased as our posting rate increased. Our YouTube video gained 19,428 views (from all world continents) and 218 comments (86% from pro-waterpipe smokers). Conclusions. Social media campaigns can be created and maintained relatively easily. They are innovative and have the potential for wide and rapid diffusion, especially towards target audiences. There is a need for more rigorous evaluation of their effects, particularly among the youth. PMID:26273631

Social Media Use for Public Health Campaigning in a Low Resource Setting: The Case of Waterpipe Tobacco Smoking.

PubMed

Jawad, Mohammed; Abass, Jooman; Hariri, Ahmad; Akl, Elie A

2015-01-01

Waterpipe tobacco smoking prevalence is increasing worldwide despite its documented health effects. A general belief that it is less harmful than cigarettes may be fuelled by the lack of media campaigns highlighting its health effects. We aimed to create and assess the impact of a social media campaign about dangers of waterpipe smoking. The "ShishAware" campaign included three social media (Facebook, Twitter, and YouTube) and a website. Nine months after launch we collected data to assess use of, and reaction to, our media accounts. Requiring limited maintenance resources, Facebook attracted campaign supporters but YouTube attracted opposers. Twitter enabled the most organisation-based contact but Facebook was the most interactive medium. Facebook users were more likely to "like" weekday than weekend statuses and more likely to comment on "shisha fact" than "current affairs" statuses. Follower subscription increased as our posting rate increased. Our YouTube video gained 19,428 views (from all world continents) and 218 comments (86% from pro-waterpipe smokers). Social media campaigns can be created and maintained relatively easily. They are innovative and have the potential for wide and rapid diffusion, especially towards target audiences. There is a need for more rigorous evaluation of their effects, particularly among the youth.

Exploring the Predictive Validity of the Susceptibility to Smoking Construct for Tobacco Cigarettes, Alternative Tobacco Products, and E-Cigarettes.

PubMed

Cole, Adam G; Kennedy, Ryan David; Chaurasia, Ashok; Leatherdale, Scott T

2017-12-06

Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes. This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and non-current use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use one and two years after baseline measurement were calculated. At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct. A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a two-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth. This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for

Deniers and Admitters: Examining Smoker Identities in a Changing Tobacco Landscape.

PubMed

Kingsbury, John H; Parks, Michael J; Amato, Michael S; Boyle, Raymond G

2016-11-01

Smoking prevalence has declined considerably over the past 30 years. This decline has coincided with a growing stigma against smokers and a trend toward nondaily or occasional smoking. Some individuals now deny being a smoker despite current cigarette use-i.e., "deniers"; conversely, occasional smokers who admit to being a smoker are defined as "admitters." Although the "denier" phenomenon has been the focus of recent research, no studies have examined smoker identity in the context of emerging tobacco products and ongoing, statewide tobacco control programs. Recent data from the 2014 Minnesota Adult Tobacco Survey provided an opportunity to address these research gaps. Using the Minnesota Adult Tobacco Survey, participants were 242 adults who reported smoking 100 cigarettes lifetime, currently smoking "some days," and past 30-day smoking. Questions also assessed smoker identity, emerging product use and perceptions, and changes in smoking behavior in response to a recent statewide tobacco tax increase. Regression models revealed no difference in e-cigarette or hookah use between deniers and admitters, but deniers were more likely to perceive that hookah use was less harmful than smoking cigarettes. In response to the tax increase, we found that admitters were more likely than deniers to report thinking about quitting, reducing cigarette amount, and making a quit attempt. Findings suggest that deniers perceive lower harm from using tobacco products. Tax increases may be less effective at motivating quit attempts in deniers compared to admitters, implying that cessation programs tailored to specific smoking identities could usefully complement tax increases. Findings from this study suggest that tobacco tax increases should be coordinated with health promotion interventions to address occasional and social smoking. The denier phenomenon in particular is an important identity-based construct that population-level public health practice should consider in order to

Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique.

PubMed

Katurji, M; Daher, N; Sheheitli, H; Saleh, R; Shihadeh, A

2010-11-01

While narghile water pipe smoking has become a global phenomenon, knowledge regarding its toxicant content and delivery, addictive properties, and health consequences is sorely lagging. One challenge in measuring toxicant content of the smoke in the laboratory is the large number of simplifying assumptions that must be made to model a "typical" smoking session using a smoking machine, resulting in uncertainty over the obtained toxicant yields. In this study, we develop an alternative approach in which smoke generated by a human water pipe user is sampled directly during the smoking session. The method, dubbed real-time in situ sampling (RINS), required developing a self-powered portable instrument capable of automatically sampling a fixed fraction of the smoke generated by the user. Instrument performance was validated in the laboratory, and the instrument was deployed in a field study involving 43 ad libitum water pipe use sessions in Beirut area cafés in which we measured inhaled nicotine, carbon monoxide (CO), and water pipe ma'ssel-derived "tar." We found that users drew a mean of 119 L of smoke containing 150 mg of CO, 4 mg of nicotine, and 602 mg of ma'ssel-derived "tar" during a single use session (mean duration = 61 min). These first direct measurements of toxicant delivery demonstrate that ordinary water pipe use involves inhaling large quantities of CO, nicotine, and dry particulate matter. Results are compared with those obtained using the Beirut method smoking machine protocol.

Midwakh/dokha tobacco use in the Middle East: much to learn

PubMed Central

Vupputuri, S; Hajat, C; Al-Houqani, M; Osman, O; Sreedharan, J; Ali, R; Crookes, A E; Zhou, S; Sherman, S E; Weitzman, M

2016-01-01

Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally. PMID:25342581

Tobacco Cessation Strategies: It Takes a Village.

PubMed

Chiu Qua, Debbie Anne

2017-01-01

Smoking is the leading cause of preventable death and chronic diseases in the U.S. Identifying smokers and providing appropriate intervention is therefore an integral part of each clinic visit. A combination of pharmacotherapy as well as behavioral counseling provides the best results. Pharmacotherapy includes nicotine replacement (patch, gum, lozenges), bupropion and varenicline. More recently, electronic nicotinic delivery systems (such as e-cigarettes, vaporizers/vape pens, and hookah pens) have become popular. Behavioral counseling includes identifying barriers to quitting or risk factors for relapse, and developing effective strategies to deal with these issues. A successful program requires a team-based approach, enlisting the help of adjuvant staff to reinforce cessation counseling and provide support services. The South Dakota Quitline is one of many good resources that the clinician can utilize to help with cessation and has one of the best quit rates in the nation. Copyright© South Dakota State Medical Association.

Availability and Placement of Electronic Nicotine Delivery Systems at the Point-of-Sale.

PubMed

Wagoner, Kimberly G; Song, Eunyoung; King, Jessica; Egan, Kathleen L; Debinski, Beata; Wolfson, Mark; Spangler, John; Sutfin, Erin L

2017-09-09

Electronic nicotine delivery systems (ENDS) are widely available and come in a variety of forms, including disposable cigalikes and refillable tank systems. However, little is known about their placement at the point-of-sale. We explored the placement of various ENDS types among tobacco retailers. Systematic assessments at the point-of-sale were completed by trained data collectors in 90 tobacco retailers, including grocery stores, convenience stores, and pharmacies in North Carolina, U.S. Availability and placement of various ENDS types including cigalikes, e-hookahs, tank systems and e-liquids was recorded. Almost all retailers (97.8%) sold cigalikes; 41.4% sold devices labeled as e-hookahs; 54.4% sold tank systems and 56.2% sold e-liquids. Fewer than half of stores placed ENDS exclusively behind the counter; significant differences in ENDS placement were found by store type. Grocery stores carried cigalikes, tank systems and e-liquids and placed them exclusively behind the counter. Pharmacies only sold cigalikes; most placed them exclusively behind the counter (91.7%) with cessation aids and other tobacco products. Convenience stores carried all ENDS types and placed them with other tobacco products (55.1%) and candy (17.4%). Only about one-third of convenience stores placed ENDS exclusively behind the counter. This exploratory study shows ENDS availability and placement at the point-of-sale varies by retailer type. Pharmacies placed cigalikes with cessation aids behind the counter suggesting their ability to aid in smoking cessation. Most convenience stores placed ENDS in self-service locations, making them easily accessible to youth. Findings highlight the need for ENDS regulation at the point-of-sale. Our study highlights the need for regulatory efforts aimed at ENDS placement at the point-of-sale. While pharmacies and grocery stores offered fewer ENDS types and typically placed them in clerk-assisted locations, all ENDS types were found at convenience stores

Social Influences on College Student Use of Tobacco Products, Alcohol, and Marijuana.

PubMed

Windle, Michael; Haardörfer, Regine; Lloyd, Steven A; Foster, Bruce; Berg, Carla J

2017-07-29

This study investigated associations between the use of alternative tobacco products (e.g., cigarettes, little cigars/cigarillos, hookah, e-cigarettes), alcohol, and marijuana among college students and use by their parents, siblings, and friends. A large literature exists for social influences on adolescent substance use, but few studies have focused on college samples. 3,418 college students from seven universities in the state of Georgia participated in this study. Web-based surveys were completed by students (45-60 minutes) during the fall semester, 2014. Findings largely indicated specificity of associations between college student use and use by social influences for similar tobacco products and other substances. For each tobacco product or substance, the highest associations were for friends' use. Structural equation analyses further supported the specificity of associations and highlighted the relative strength of friends' use on student use. Similar to findings with adolescents, the use of alternative tobacco products, alcohol, and marijuana by parents, siblings, and friends is associated with higher levels of use among college students, and friends' use was the most potent correlate for this phase of the lifespan.

Midwakh/dokha tobacco use in the Middle East: much to learn.

PubMed

Vupputuri, S; Hajat, C; Al-Houqani, M; Osman, O; Sreedharan, J; Ali, R; Crookes, A E; Zhou, S; Sherman, S E; Weitzman, M

2016-03-01

Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy?

PubMed Central

Suter, Melissa A.; Mastrobattista, Joan; Sachs, Maike; Aagaard, Kjersti

2016-01-01

Background Use of electronic cigarettes (e-cigarettes) and other nicotine containing products is increasing among women of reproductive age. The short- and long-term effects of these products on both mother and fetus are unknown. Methods Because e-cigarettes are nicotine delivery systems, we sought to conduct a comprehensive review of the effects of nicotine on the fetus. Results In utero nicotine exposure in animal models is associated with adverse effects for the offspring lung, cardiovascular system and brain. In the lung, this included reduced surface area, weight, and volume, as well as emphysema-like lesions. In adulthood, exposed offspring demonstrate elevated blood pressure and increased perivascular adipose tissue. In the brain, exposure alters offspring serotonergic, dopaminergic, and norepinephrine networks, which in turn are associated with behavioral and cognitive impairments. We also review current data on the lack of efficacy of nicotine replacement therapy in pregnant women, and highlight different nicotine containing products such as snuff, snus, and hookah. Conclusion We conclude that no amount of nicotine is known to be safe during pregnancy, and studies specifically addressing this risk are crucial and an imminent public health issue. PMID:25366492

Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014.

PubMed

Roberts, Megan E; Doogan, Nathan J; Stanton, Cassandra A; Quisenberry, Amanda J; Villanti, Andrea C; Gaalema, Diann E; Keith, Diana R; Kurti, Allison N; Lopez, Alexa A; Redner, Ryan; Cepeda-Benito, Antonio; Higgins, Stephen T

2017-10-01

To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products. Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country. Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates. Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen.

Social Influences on College Student Use of Tobacco Products, Alcohol, and Marijuana

PubMed Central

Windle, Michael; Haardörfer, Regine; Lloyd, Steven A.; Foster, Bruce; Berg, Carla J.

2017-01-01

Objective This study investigated associations between the use of alternative tobacco products (e.g., cigarettes, little cigars/cigarillos, hookah, e-cigarettes), alcohol, and marijuana among college students and use by their parents, siblings, and friends. A large literature exists for social influences on adolescent substance use, but few studies have focused on college samples. Participants 3,418 college students from seven universities in the state of Georgia participated in this study. Methods Web-based surveys were completed by students (45–60 minutes) during the fall semester, 2014. Results Findings largely indicated specificity of associations between college student use and use by social influences for similar tobacco products and other substances. For each tobacco product or substance, the highest associations were for friends'use. Structural equation analyses further supported the specificity of associations and highlighted the relative strength of friends' use on student use. Conclusion Similar to findings with adolescents, the use of alternative tobacco products, alcohol, and marijuana by parents, siblings, and friends is associated with higher levels of use among college students, and friends' use was the most potent correlate for this phase of the lifespan. PMID:28524716

Online E-cigarette Marketing Claims: A Systematic Content and Legal Analysis.

PubMed

Klein, Elizabeth G; Berman, Micah; Hemmerich, Natalie; Carlson, Cristen; Htut, SuSandi; Slater, Michael

2016-07-01

Electronic nicotine delivery systems (ENDS), or e-cigarettes, are heavily marketed online. The purpose of our study was to perform a systematic identification and evaluation of claims made within ENDS retailer and manufacturer websites, and the legal status of such claims. We employed a systematic search protocol with popular search engines using 6 terms: (1) e-cigarettes; (2) e-cigs; (3) e-juice; (4) e-liquid; (5) e-hookah; and (6) vape pen. We analyzed English-language websites where ENDS are sold for implicit and explicit health-related claims. A legal analysis determined whether such claims are permissible under the US Food and Drug Administration's regulations. The vast majority of ENDS manufacturer (N = 78) and retailer (N = 32) websites made at least one health-related claim (77% and 65%, respectively). Modified risk claims and secondhand smoke-related claims were most prevalent, with an average of 2 claims per site. Health-related claims are plentiful within ENDS manufacturer and retailer websites. Results demonstrate that these sites focus on potential benefits while minimizing or eliminating information about possible harmful effects of ENDS. These claims are subject to the current regulatory authority by the FDA, and pose a risk of misinforming consumers.

Is there evidence for potential harm of electronic cigarette use in pregnancy?

PubMed

Suter, Melissa A; Mastrobattista, Joan; Sachs, Maike; Aagaard, Kjersti

2015-03-01

Use of electronic cigarettes (e-cigarettes) and other nicotine containing products is increasing among women of reproductive age. The short- and long-term effects of these products on both mother and fetus are unknown. Because e-cigarettes are nicotine delivery systems, we sought to conduct a comprehensive review of the effects of nicotine on the fetus. In utero nicotine exposure in animal models is associated with adverse effects for the offspring lung, cardiovascular system and brain. In the lung, this included reduced surface area, weight, and volume, as well as emphysema-like lesions. In adulthood, exposed offspring demonstrate elevated blood pressure and increased perivascular adipose tissue. In the brain, exposure alters offspring serotonergic, dopaminergic, and norepinephrine networks, which in turn are associated with behavioral and cognitive impairments. We also review current data on the lack of efficacy of nicotine replacement therapy in pregnant women, and highlight different nicotine containing products such as snuff, snus, and hookah. We conclude that no amount of nicotine is known to be safe during pregnancy, and studies specifically addressing this risk are crucial and an imminent public health issue. © 2014 Wiley Periodicals, Inc.

Ischaemic heart disease in pregnancy

PubMed Central

Bondagji, Nabeel S.

2012-01-01

Ischaemic heart disease (IHD) in pregnancy, particularly myocardial infarction (MI), is a rare yet potentially fatal condition for the mother and the foetus. With delays in the age of conception, the changes in some social habits among females including cigarette and shisha smoking in addition to an increased prevalence of diabetes mellitus, IHD may represent a real hazard among pregnant women in the near future. The difficulty in the diagnosis emerges from the similarity of the signs and symptoms of ischaemia and infarct to some of the physiological adaptations that occur in a normal pregnancy. The physiological changes that are normal in pregnancy may aggravate pre-existing disease and may unmask some underlying unrecognized coronary vascular changes; therefore, the diagnosis requires a high index of suspicion and careful assessment of the underlying risk factors. The management of IHD always requires a multidisciplinary team approach. The management of each patient should be individualized according to the clinical condition, the risk factors, and the availability of the necessary support. Pregnancy after MI may be an acceptable and reasonably safe option provided the cited criteria are met. A systematic PubMed search was performed to identify all published data including cases reports, small series and systematic reviews in the existing literature. These publications were comprised of both retrospective and cross sectional population studies to maximize the number of cases considered in order to reach conclusions and make recommendations based on the best available evidence considering the rare occurrence of this event. The epidemiology, diagnosis, medical and surgical treatment, and prognosis of IHD in pregnancy are the subjects of the present review. PMID:23960678

Toward Real-Time Infoveillance of Twitter Health Messages.

PubMed

Colditz, Jason B; Chu, Kar-Hai; Emery, Sherry L; Larkin, Chandler R; James, A Everette; Welling, Joel; Primack, Brian A

2018-06-21

There is growing interest in conducting public health research using data from social media. In particular, Twitter "infoveillance" has demonstrated utility across health contexts. However, rigorous and reproducible methodologies for using Twitter data in public health are not yet well articulated, particularly those related to content analysis, which is a highly popular approach. In 2014, we gathered an interdisciplinary team of health science researchers, computer scientists, and methodologists to begin implementing an open-source framework for real-time infoveillance of Twitter health messages (RITHM). Through this process, we documented common challenges and novel solutions to inform future work in real-time Twitter data collection and subsequent human coding. The RITHM framework allows researchers and practitioners to use well-planned and reproducible processes in retrieving, storing, filtering, subsampling, and formatting data for health topics of interest. Further considerations for human coding of Twitter data include coder selection and training, data representation, codebook development and refinement, and monitoring coding accuracy and productivity. We illustrate methodological considerations through practical examples from formative work related to hookah tobacco smoking, and we reference essential methods literature related to understanding and using Twitter data. (Am J Public Health. Published online ahead of print June 21, 2018: e1-e6. doi:10.2105/AJPH.2018.304497).

Epidemiology of Lung Cancer.

PubMed

Schwartz, Ann G; Cote, Michele L

2016-01-01

Lung cancer continues to be one of the most common causes of cancer death despite understanding the major cause of the disease: cigarette smoking. Smoking increases lung cancer risk 5- to 10-fold with a clear dose-response relationship. Exposure to environmental tobacco smoke among nonsmokers increases lung cancer risk about 20%. Risks for marijuana and hookah use, and the new e-cigarettes, are yet to be consistently defined and will be important areas for continued research as use of these products increases. Other known environmental risk factors include exposures to radon, asbestos, diesel, and ionizing radiation. Host factors have also been associated with lung cancer risk, including family history of lung cancer, history of chronic obstructive pulmonary disease and infections. Studies to identify genes associated with lung cancer susceptibility have consistently identified chromosomal regions on 15q25, 6p21 and 5p15 associated with lung cancer risk. Risk prediction models for lung cancer typically include age, sex, cigarette smoking intensity and/or duration, medical history, and occupational exposures, however there is not yet a risk prediction model currently recommended for general use. As lung cancer screening becomes more widespread, a validated model will be needed to better define risk groups to inform screening guidelines.

Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study

PubMed Central

Bascombe, Ta Misha S.; Scott, Kimberly N.; Ballard, Denise; Smith, Samantha A.; Thompson, Winifred; Berg, Carla J.

2016-01-01

Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products. PMID:26802106

A Descriptive Study of Television News Coverage of Tobacco in the United States: Frequency of Topics, Frames, Exemplars, and Efficacy

PubMed Central

BLAKE, KELLY D.; KAUFMAN, ANNETTE R.; LORENZO, JOSHUA; AUGUSTSON, ERIK M.

2015-01-01

There is a positive correlation between recall of tobacco-related television news and perceived risks of smoking and thoughts about quitting. The authors used Cision US, Inc., to create a sampling frame (N =61,027) of local and national television news coverage of tobacco from October 1, 2008, to September 30, 2009, and to draw a nationally representative sample (N =730) for content analysis. The authors conducted a descriptive study to determine the frequency and proportion of stories containing specified tobacco topics, frames, sources, and action messages, and the valence of the coverage. Valence was generally neutral; 68% of stories took a balanced stance, with 26% having a tenor supportive of tobacco control and 6% opposing tobacco control. The most frequently covered topics included smoking bans (n =195) and cessation (n =156). The least covered topics included hookah (n =1) and menthol (n =0). The majority of coverage lacked quoting any source (n =345); government officials (n =144) were the most quoted sources. Coverage lacked action messages or resources; 29 stories (<4%) included a message about cessation or advocacy, and 8 stories (1%) contained a resource such as a quitline. Television news can be leveraged by health communication professionals to increase awareness of underrepresented topics in tobacco control. PMID:26176379

Driving Behaviors in Iran: A Descriptive Study Among Drivers of Mashhad City in 2014

PubMed Central

Bazzaz, Mojtaba Mousavi; Zarifian, Ahmadreza; Emadzadeh, Maryam; Vakili, Veda

2015-01-01

Background: Driver-related behaviors are substantial causes for motor vehicle accidents. It has been estimated that about 95% of all accidents are due to driver-related dangerous behaviors and approximately 60% of accidents are directly caused by driving behaviors. The aim of this study was to assess driving behaviors and its possible related factors among drivers in Mashhad city, Iran. Method: In a cross-sectional design, a total number of 514 drivers in Mashhad, Iran Surveyed. Manchester driver behavior questionnaire with 50 questions evaluated dangerous driving behaviors in 4 categories “aggressive violations”, “ordinary violations”, “errors” and “lapses”. Results: In this study, the median age of drivers was 31. Besides, 58.2% of men mentioned having a history of driving accident. Our study indicated smoking and alcohol drinking as risk factors of having more accidents. Hookah abuse is a predictor of aggressive violations and errors. Conclusion: This is the first study to assess the relation of personal car and its market value with the likelihood of having accidents. Due to major influences of driving fines, cigarette smoking, alcohol consumption and addiction on violations and errors, we recommend pivotal measures to be taken by road safety practitioners regarding driving surveillance. PMID:26153202

Online E-cigarette Marketing Claims: A Systematic Content and Legal Analysis

PubMed Central

Klein, Elizabeth G.; Berman, Micah; Hemmerich, Natalie; Carlson, Cristen; Htut, SuSandi; Slater, Michael

2016-01-01

Objectives Electronic nicotine delivery systems (ENDS), or e-cigarettes, are heavily marketed online. The purpose of our study was to perform a systematic identification and evaluation of claims made within ENDS retailer and manufacturer websites, and the legal status of such claims. Methods We employed a systematic search protocol with popular search engines using 6 terms: (1) e-cigarettes; (2) e-cigs; (3) e-juice; (4) e-liquid; (5) e-hookah; and (6) vape pen. We analyzed English-language websites where ENDS are sold for implicit and explicit health-related claims. A legal analysis determined whether such claims are permissible under the US Food and Drug Administration’s regulations. Results The vast majority of ENDS manufacturer (N = 78) and retailer (N = 32) websites made at least one health-related claim (77% and 65%, respectively). Modified risk claims and secondhand smoke-related claims were most prevalent, with an average of 2 claims per site. Conclusions Health-related claims are plentiful within ENDS manufacturer and retailer websites. Results demonstrate that these sites focus on potential benefits while minimizing or eliminating information about possible harmful effects of ENDS. These claims are subject to the current regulatory authority by the FDA, and pose a risk of misinforming consumers. PMID:27446984

Transportation behaviors in Shiraz, Iran.

PubMed

Vakili, Veda; Danaei, Mina; Askarian, Mehrdad; Palenik, Charles John; Abdollahifard, Gholamreza

2012-01-01

Motor vehicle accidents can occur as a result of improper driver behavior. There needs to be a comprehensive collection of information concerning driver behavior and its predisposing factors. Study participants (500 males and 500 females ≥18 years old) living in Shiraz, Iran, were selected using a multistage sampling methodology. Data came from questionnaires completed using a face-to-face interview process. Independent variables such as age, gender, marital status, occupation, educational level, socioeconomic status (SES), and history of smoking and stress levels were compared to the dependent variables using a private automobile, public transportation, or motorcycle, wearing a seat belts, wearing safety helmets, and obeying the speed limit. Statistical significance was set at a P value of .05 or less. In general, female, better educated persons, and those with higher SES reported better driving behaviors. Better drivers also did not use tobacco or hookah. Compliance with driving safety factors was disappointing 49.8 percent always wore a seat belt, 22.4 percent always wore a safety helmet (29.4% never wore a helmet), and 49.4 percent always observed the speed limit. There is a need to improve driver safety compliance in Shiraz, Iran. One factor that can be addressed concerns regulation of male drivers, especially among lower SES groups.

Texas Adolescent Tobacco and Marketing Surveillance System’s Design

PubMed Central

Pérez, Adriana; Harrell, Melissa B.; Malkani, Raja I.; Jackson, Christian D.; Delk, Joanne; Allotey, Prince A.; Matthews, Krystin J.; Martinez, Pablo; Perry, Cheryl L.

2017-01-01

Objectives To provide a full methodological description of the design of the wave I and II (6-month follow-up) surveys of the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal surveillance study of 6th, 8th, and 10th grade students who attended schools in Bexar, Dallas, Tarrant, Harris, or Travis counties, where the 4 largest cities in Texas (San Antonio, Dallas, Fort Worth, Houston, and Austin, respectively) are located. Methods TATAMS used a complex probability design, yielding representative estimates of these students in these counties during the 2014–2015 academic year. Weighted prevalence of the use of tobacco products, drugs and alcohol in wave I, and the percent of: (i) bias, (ii) relative bias, and (iii) relative bias ratio, between waves I and II are estimated. Results The wave I sample included 79 schools and 3,907 students. The prevalence of current cigarette, e-cigarette and hookah use at wave I was 3.5%, 7.4%, and 2.5%, respectively. Small biases, mostly less than 3.5%, were observed for nonrespondents in wave II. Conclusions Even with adaptions to the sampling methodology, the resulting sample adequately represents the target population. Results from TATAMS will have important implications for future tobacco policy in Texas and federal regulation. PMID:29098172

[Nutrition, physical activity and substance use in children and adolescents : Representative results of the federal state module Thuringia in KiGGS wave 1].

PubMed

Krause, Laura; Anding, Christine; Kamtsiuris, Panagiotis

2016-08-01

The term health behaviour combines both health-promoting and health-risk components. In this study, the health behaviour of children and adolescents in Thuringia is analysed. The database was a representative subsample of the federal state module Thuringia, which was conducted by the Robert Koch Institute as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 1 (2010-2012; n = 4,096; 3-17 years). Health behaviour was described based on nine indicators: fruit and vegetable consumption, soft drink consumption, breakfast at home, physical activity, sport, swimming ability, alcohol consumption, smoking and water pipe consumption (shisha smoking). Prevalence and mean values with 95 % confidence intervals were reported, and based on logistic or linear regression, the significance of the group differences was examined. The results show that 43.4 % of children and adolescents in Thuringia ate fruits and vegetables daily, 44.5 % consumed soft drinks less than once a week, and 67.9 % had breakfast at home every weekday. In addition, 31.0 % of children and adolescents in Thuringia were physically active at least 60 min a day, 69.8 % did sports for at least 2 h a week, and 81.5 % can swim. Additionally, 15.9 % of adolescents in Thuringia had hazardous alcohol consumption, 14.4 % currently smoked, and 20.0 % smoked a water pipe. Differences existed with regard to gender, age, socio-economic status (SES) of the family and residence (urban/rural). In summary, many of the children and adolescents in Thuringia demonstrate relatively positive health behaviour. However, the results also indicate groups at higher risk of unhealthy behaviour, such as children and adolescents from families with low SES.

Patterns, Perception and Behavior of Electronic Nicotine Delivery Systems Use and Multiple Product Use Among Young Adults.

PubMed

Martinasek, Mary P; Bowersock, Amy; Wheldon, Christopher W

2018-03-27

Electronic nicotine delivery systems (ENDS) are battery-operated devices used to inhale vaporized or aerosolized nicotine. There is increasing research uncovering negative health effects of these devices. Less is known about the social and behavioral aspects among college students. This cross-sectional study was conducted at a mid-sized private university in Florida. The survey was sent via e-mail to the student body of undergraduates. A final sample size of 989 students was analyzed to understand demographic differences between users and nonusers, initiation factors, and influencers, as well as multiple product behaviors. Approximately 51.4% ( n = 508) of participants reported ever using an ENDS and other tobacco consumption. Males were significantly more likely to be users of ENDS. Polytobacco use, or the use of multiple tobacco products, was also more common among participants who have tried ENDS ( P < .001). Perceptions of harm of both the primary and secondary vapor were considered to be less than that of conventional cigarettes. Peers were the primary influencer for initial use. A 4-class latent variable model differentiated between usage patterns characterized as abstainers (70%), hookah users only (14%), ENDS only (11%), and polytobacco users (4%). ENDS are not commonly used as a quit tool among college students, but rather as a secondary source of nicotine, most commonly in current smokers. Copyright © 2018 by Daedalus Enterprises.

Perceived Discrimination as a Risk Factor for Use of Emerging Tobacco Products: More Similarities Than Differences Across Demographic Groups and Attributions for Discrimination.

PubMed

Unger, Jennifer B

2018-01-17

Perceived discrimination has been associated with cigarette smoking and other substance use among members of disadvantaged minority groups. However, most studies have focused on a single minority group, have not considered the individual's attribution for the discrimination, and have not considered emerging tobacco products. This study examined the associations between perceived discrimination and use of six tobacco products (cigarettes, e-cigarettes, cigars, pipe tobacco, hookah, and smokeless tobacco) in a diverse sample of 1,068 adults in the United States. Participants were recruited on Amazon's Mechanical Turk and participated in an online survey. Logistic regression models were used to examine the association between perceived discrimination and use of each tobacco product. Interactions between discrimination and demographic characteristics, and between discrimination and perceived reasons for discrimination, were evaluated. Controlling for age, sex, race/ethnicity, education, and socioeconomic status, perceived discrimination was a risk factor for current use of five of the six tobacco products. These associations were consistent across racial/ethnic groups and regardless of the individual's attribution for the reason for the discrimination. Results indicate that perceived discrimination is a risk factor for the use of multiple tobacco products, and that this association is not limited to particular demographic groups or types of discrimination. Public health programs could potentially reduce tobacco-related disease by teaching healthier ways to cope with discrimination.

Use of Electronic Nicotine Delivery Systems Among Adolescents: Status of the Evidence and Public Health Recommendations.

PubMed

Kamat, Aarti D; Van Dyke, Alison L

2017-02-01

Although the prevalence of tobacco smoking has been declining in recent years, the use of electronic nicotine delivery systems (ENDS) such as of electronic cigarettes, vaporizers, and hookahs has been steadily rising, especially among adolescents. ENDS are not only advertised to children, but their sale via the Internet has made them easily accessible to youth. In general, children perceive ENDS as safe, or at least safer than smoking traditional combustible tobacco products; however, exposure to nicotine may have deleterious effects on the developing brain. Concern also persists that ENDS may be a "starter" drug that may lead to further tobacco, drug, and/or alcohol use. In contrast to this precautionary stance that is associated with calls for legislative oversight of ENDS marketing and sales, harm reductionists claim that the risks posed by ENDS are minor in comparison with those of combustible tobacco products and that ENDS may be used as a means of nicotine replacement for smoking cessation, despite no concrete evidence to support this assertion. Many medical and health-related organizations have produced position statements concerning ENDS use, including among adolescents. This article summarizes the advantages and disadvantages of using ENDS espoused in these position statements, especially as they relate to use among adolescents. [Pediatr Ann. 2017;46(2):e69-e77.]. Copyright 2017, SLACK Incorporated.

The Changing Tobacco Landscape: What Dental Professionals Need To Know

PubMed Central

Couch, Elizabeth T.; Chaffee, Benjamin W.; Gansky, Stuart A.; Walsh, Margaret M.

2016-01-01

Background Recently, the range of tobacco products available in the United States and the patterns of tobacco product use have changed. While cigarette smoking prevalence has declined, dental professionals are likely to encounter many more users of new and alternative tobacco products among their patients. Approach This paper reviews conventional and new tobacco products currently available, their adverse oral and systemic health effects, and their prevalence of use in the US. Results Tobacco products other than cigarettes currently account for a substantial portion of tobacco use. For this reason, tobacco prevention and cessation counseling provided by dental professionals must address all tobacco products, including cigarettes, cigars, waterpipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. Practical Implications Dental professionals regularly treat patients who use tobacco or who are at risk of initiating use. Therefore, it is essential that dental professionals are knowledgeable about tobacco products currently available and are able to answer patients' questions and to provide them with evidence-based tobacco-related counseling. PMID:26988178

Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study.

PubMed

Bascombe, Ta Misha S; Scott, Kimberly N; Ballard, Denise; Smith, Samantha A; Thompson, Winifred; Berg, Carla J

2016-06-01

Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Electronic Cigarettes as an Introductory Tobacco Product Among Eighth and 11th Grade Tobacco Users - Oregon, 2015.

PubMed

Hines, Jonas Z; Fiala, Steven C; Hedberg, Katrina

2017-06-16

During 2011-2015, increased electronic cigarette (e-cigarette) and hookah use offset declines in cigarette and other tobacco product use among youths (persons aged <18 years) (1). Limited information exists about which tobacco product introduced youths to tobacco product use. Patterns of first use of e-cigarettes among Oregon youths who were tobacco users were assessed in the Oregon Healthy Teens 2015 survey, a cross-sectional survey of eighth and 11th grade students in Oregon. Respondents were asked, "The very first time you used any tobacco or vaping product, which type of product did you use?" Among students who had ever used any tobacco product (ever users), e-cigarettes were the most common introductory tobacco product reported by both eighth (43.5%) and 11th (34.4%) grade students. Among students who used a tobacco product for ≥1 day during the past 30 days (current users), e-cigarettes were the most common introductory tobacco product reported by eighth grade students (44.4%) and the second most common introductory tobacco product reported by 11th grade students (31.0%). Introductory use of e-cigarettes was commonly reported among youths in Oregon who were ever or current tobacco users, underscoring the importance of proven interventions to prevent all forms of tobacco use among youths (2,3).

Asthma and Allergic Rhinitis Correlation in Palm Tree Workers of Jahrom City in 2016.

PubMed

Farahmand Fard, Mohammad Amin; Khanjani, Narges; Arabi Mianroodi, Aliasghar; Ashrafi Asgarabad, Ahad

2017-05-01

Allergic rhinitis and asthma can be related to occupation. The present study aimed to investigate the correlation between asthma or allergic rhinitis and employment in the palm tree gardens of Jahrom, Iran. This was a cross-sectional study including 50 palm tree garden workers and a control group of 50 office employees. Data collection included demographics, as well as standard International Study of Asthma and Allergies in Childhood (ISAAC) and A New Symptom-Based Questionnaire for Predicting the Presence of Asthma (ASQ) questionnaires. Data were analyzed using SPSS22. Descriptive statistics, chi-square test, t-test, and logistics regression were used to analyze data. The correlation between asthma and occupation was significant ( P=0.046); and asthma prevalence was higher in palm tree garden workers. However, no relationship was observed between age, duration of employment, smoking cigarettes, hookah, or opium addiction with asthma. Furthermore, in this study, no significant relation was observed between the prevalence of asthma and contact with dust, contact with pets' skin and hair, family history of asthma, or the use of perfume and air freshener. The symptoms of allergic rhinitis (including sneezing, runny nose, and blocked nose) were significantly greater in palm tree garden workers (P=0.038). These symptoms in both workers and office employees were higher in spring. In our study, allergic rhinitis and asthma were more common in palm tree garden workers than in the general population. According to our study, people working in this occupation should take necessary precautions.

Young adults' perceptions about established and emerging tobacco products: results from eight focus groups.

PubMed

Wray, Ricardo J; Jupka, Keri; Berman, Susan; Zellin, Stacie; Vijaykumar, Santosh

2012-02-01

In order to sustain their market, tobacco producers target young adults through novel product design and marketing strategies. Public health professionals need to understand young adults' risks perceptions about and use of new tobacco products to best inform tobacco control interventions. In 2009, researchers conducted 8 focus groups with 67 young adults stratified by self-reported tobacco use and nonuse, residence in rural and urban areas, and living in a state with or without a statewide smoking restriction policy. Participants provided feedback about their knowledge and risk perceptions about and use of tobacco products and marketing. Participants reported a high level of familiarity with a wide range of novel tobacco products. A great deal of confusion and disagreement appeared with regard to absolute and relative risk of different tobacco products. Participants readily discussed using smokeless tobacco products as alternatives to smoking when smoking is prohibited. Fewer differences in tobacco-related knowledge risk perceptions and use were found between urban and rural participants and those in smoke-free policy and nonpolicy states than between user and nonuser groups. Both users and nonusers were familiar with and skeptical about tobacco marketing and prevention efforts. Young adults are familiar with many tobacco products, but they convey little understanding of relative risks of new or trendy tobacco products, such as snus or hookah. Mindful of industry innovation, tobacco control advocates must continuously update prevention efforts, seeking new strategies to limit promotion, marketing, and use of new and conventional products.

Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure.

PubMed

Zhou, Sherry; Rosenthal, David G; Sherman, Scott; Zelikoff, Judith; Gordon, Terry; Weitzman, Michael

2014-09-01

The purpose of this review is to examine the rapidly expanding literature regarding the effects of prenatal tobacco and postnatal secondhand smoke (SHS) exposure on child health and development. Mechanisms of SHS exposure are reviewed, including critical periods during which exposure to tobacco products appears to be particularly harmful to the developing fetus and child. The biological, biochemical, and neurologic effects of the small fraction of identified components of SHS are described. Research describing these adverse effects of both in utero and childhood exposure is reviewed, including findings from both animal models and humans. The following adverse physical outcomes are discussed: sudden infant death syndrome, low birth weight, decreased head circumference, respiratory infections, otitis media, asthma, childhood cancer, hearing loss, dental caries, and the metabolic syndrome. In addition, the association between the following adverse cognitive and behavioral outcomes and such exposures is described: conduct disorder, attention-deficit/hyperactivity disorder, poor academic achievement, and cognitive impairment. The evidence supporting the adverse effects of SHS exposure is extensive yet rapidly expanding due to improving technology and increased awareness of this profound public health problem. The growing use of alternative tobacco products, such as hookahs (a.k.a. waterpipes), and the scant literature on possible effects from prenatal and secondhand smoke exposure from these products are also discussed. A review of the current knowledge of this important subject has implications for future research as well as public policy and clinical practice. Published by Mosby, Inc.

Perceptions of non-traditional tobacco products between asthmatic and non-asthmatic college students.

PubMed

Martinasek, Mary P; White, Robin M; Wheldon, Christopher W; Gibson-Young, Linda

2018-05-01

Electronic nicotine delivery systems (ENDS) use is common among college students and there are perceptions that ENDS are not as harmful as traditional cigarettes. The aim of this study was to examine differences in ENDS use, risk perceptions and co-occurring smoking behaviors between college students with and without asthma. The study consisted of a cross-sectional online survey with a final sample size of 898 college students. The voluntary participation survey was disseminated to all undergraduate and graduate students at a mid-sized liberal arts university in the Southeast U.S. in the fall of 2014. Approximately 19.7% reported that they had been previously diagnosed with asthma. Forty three percent of participants (n = 384) used ENDS in the past 30 days. Equivalent percentages of college students with asthma (46.9%) and college students without asthma (46.9%) have tried ENDS. Overall participants indicated that they perceived ENDS use as less (44%) or equally (38%) as harmful as cigarettes. College students with asthma had 2.85 (95% CI: 1.18-6.89) greater odds of being in the poly user class, which was characterized by dual use of ENDS, combustible cigarettes, hookah, and marijuana. In this study, college students with asthma were similar to their peers with regard to their use of ENDS and related risk perceptions; however, a small subsample of those with asthma exhibited problematic smoking behaviors characterized by dual use of multiple tobacco products including marijuana.

Drug Vaping: From the Dangers of Misuse to New Therapeutic Devices

PubMed Central

Varlet, V.

2016-01-01

Users of e-cigarettes are unwitting volunteers participating in a worldwide epidemiological study. Because of the obvious benefits of e-cigarettes compared with traditional cigarette smoking, these electronic devices have been introduced all around the world to support tobacco smoking cessation. Same potential harm reduction could be considered by cannabis vaping for marijuana smokers. However, the toxicities of liquids and aerosols remain under investigation because although the use of e-cigarettes is likely to be less harmful than traditional cigarette smoking, trace levels of contaminants have been identified. Simultaneously, other electronic devices, such as e-vaporisers, e-hookahs or e-pipes, have been developed and commercialised. Consequently, misuse of electronic devices has increased, and experimentation has been documented on Internet web fora. Although legal and illegal drugs are currently consumed with these e-devices, no scientific papers are available to support the observations reported by numerous media and web fora. Moreover, building on illegal drug vaping and vaporisation with e-devices (vaping misuse), legal drug vaping (an alternative use of vaping) could present therapeutic benefits, as occurs with medical cannabis vaporisation with table vaporisers. This review seeks to synthesise the problems of e-cigarette and liquid refill toxicity in order to introduce the dangers of illegal and legal drugs consumed using vaping and vaporisation for recreational purposes, and finally, to present the potential therapeutic benefits of vaping as a new administration route for legal drugs. PMID:29051432

The Changing Face of Tobacco Use Among United States Youth

PubMed Central

Lauterstein, Dana; Hoshino, Risa; Gordon, Terry; Watkins, Beverly-Xaviera; Weitzman, Michael; Zelikoff, Judith

2015-01-01

Tobacco use, primarily in the form of cigarettes, is the leading cause of preventable morbidity and mortality in the United States (U.S.). The adverse effects of tobacco use began to be recognized in the 1940’s and new hazards of active smoking and secondhand smoke (SHS) exposure from cigarettes continue to be identified to this day. This has led to a sustained and wide-ranging array of highly effective regulatory, public health, and clinical efforts that have been informed by extensive scientific data, resulting in marked decreases in the use of cigarettes. Unfortunately, the dramatic recent decline in cigarette use in the U.S., has been accompanied by an upsurge in adolescent and young adult use of new, non-cigarette tobacco and nicotine-delivery products, commonly referred to as alternative tobacco products (ATPs). Commonly used ATPs include hookah, cigars, smokeless tobacco, and electronic cigarettes. While there have been a number of review articles that focus on adult ATP use, the purpose of this review is to provide an overview of what is, and is not known about emerging ATP use among U.S. adolescents on a national scale; as well as to identify research gaps in knowledge, and discuss future health and policy needs for this growing public health concern. This paper is not meant to systemically review all published survey data, but to present clear depiction of selected ATP usage in youth populations using national survey data. PMID:25323124

Smoke-Free and Tobacco-Free Policies in Colleges and Universities - United States and Territories, 2017.

PubMed

Wang, Teresa W; Tynan, Michael A; Hallett, Cynthia; Walpert, Laura; Hopkins, Maggie; Konter, Darryl; King, Brian A

2018-06-22

Each year in the United States, cigarette smoking causes an estimated 480,000 deaths, including approximately 41,000 deaths from secondhand smoke exposure among nonsmoking adults (1). Smoke-free policies protect nonsmokers from secondhand smoke exposure, reduce the social acceptability of smoking, help in preventing youth and young adult smoking initiation, and increase smokers' efforts to quit smoking (1,2). Given that 99% of adult cigarette smokers first start smoking before age 26 years and many smokers transition to regular, daily use during young adulthood (2),* colleges and universities represent an important venue for protecting students, faculty, staff members, and guests from secondhand smoke exposure through tobacco control policies (3). To assess smoke-free and tobacco-free policies in U.S. colleges and universities, CDC and the American Nonsmokers' Rights Foundation (ANRF) determined the number of campuses nationwide that completely prohibit smoking (smoke-free) or both smoking and smokeless tobacco product use (tobacco-free) in all indoor and outdoor areas. As of November 2017, at least 2,082 U.S. college and university campuses had smoke-free policies. Among these campuses, 1,743 (83.7%) were tobacco-free; 1,658 (79.6%) specifically prohibited electronic cigarette (e-cigarette) use; and 854 (41.0%) specifically prohibited hookah smoking. Smoke-free and tobacco-free policies on college and university campuses can help reduce secondhand smoke exposure, tobacco use initiation, and the social acceptability of tobacco use (1-3).

Drug Vaping: From the Dangers of Misuse to New Therapeutic Devices.

PubMed

Varlet, V

2016-12-16

Users of e-cigarettes are unwitting volunteers participating in a worldwide epidemiological study. Because of the obvious benefits of e-cigarettes compared with traditional cigarette smoking, these electronic devices have been introduced all around the world to support tobacco smoking cessation. Same potential harm reduction could be considered by cannabis vaping for marijuana smokers. However, the toxicities of liquids and aerosols remain under investigation because although the use of e-cigarettes is likely to be less harmful than traditional cigarette smoking, trace levels of contaminants have been identified. Simultaneously, other electronic devices, such as e-vaporisers, e-hookahs or e-pipes, have been developed and commercialised. Consequently, misuse of electronic devices has increased, and experimentation has been documented on Internet web fora. Although legal and illegal drugs are currently consumed with these e-devices, no scientific papers are available to support the observations reported by numerous media and web fora. Moreover, building on illegal drug vaping and vaporisation with e-devices (vaping misuse), legal drug vaping (an alternative use of vaping) could present therapeutic benefits, as occurs with medical cannabis vaporisation with table vaporisers. This review seeks to synthesise the problems of e-cigarette and liquid refill toxicity in order to introduce the dangers of illegal and legal drugs consumed using vaping and vaporisation for recreational purposes, and finally, to present the potential therapeutic benefits of vaping as a new administration route for legal drugs.

Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.

PubMed

Smith-Simone, Stephanie; Maziak, Wasim; Ward, Kenneth D; Eissenberg, Thomas

2008-02-01

Despite evidence of increasing waterpipe tobacco smoking prevalence among U.S. young adults, little is known about the knowledge, attitudes, beliefs, and smoking patterns of waterpipe users in this population. To address this lack of knowledge, two convenience samples of U.S. waterpipe users were surveyed--one from a Richmond, Virginia, waterpipe café (n=101), the other from an Internet forum called HookahForum.com (n=100). Sixty percent reported first-time waterpipe use at or before age 18. Daily waterpipe use was reported by 19%, weekly use by 41%, and monthly use by 29%. Waterpipe use was more common during the weekend (75%) than during weekdays (43%). Forty-four percent reported spending >or=60 min smoking tobacco during a waterpipe session. The majority of waterpipe users owned a waterpipe (57%) and purchased it on the Internet (71%). Many waterpipe users smoked the sweetened and flavored tobacco (i.e., maassel), and fruit flavors were the most popular (54%). Past month use of cigarettes, tobacco products other than cigarettes or waterpipe, and alcohol was 54%, 33%, and 80% respectively, and 36% reported past-month marijuana use. Most waterpipe users were confident about their ability to quit (96%), but only a minority (32%) intended to quit. Most waterpipe users believed waterpipe tobacco smoking was less harmful and addictive than cigarettes. These results are from small convenience samples; more detailed study of a larger group of randomly sampled U.S. waterpipe tobacco smokers will be valuable in understanding this behavior and developing effective strategies to prevent it.

E-cigarette use among women of reproductive age: Impulsivity, cigarette smoking status, and other risk factors.

PubMed

Chivers, Laura L; Hand, Dennis J; Priest, Jeff S; Higgins, Stephen T

2016-11-01

The study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant. Survey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24-44years from the US. Half (n=400) reported current, daily smoking and half (n=400) reported smoking <100 cigarettes lifetime. Participants completed questionnaires regarding sociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and e-cigarette use were examined using logistic regression. Daily cigarette smoking was associated with greater impulsivity, lower education, past illegal drug use, and White race/ethnicity. E-cigarette use in the overall sample was associated with being a cigarette smoker and greater education. E-cigarette use among current smokers was associated with increased nicotine dependence and quitting smoking; among never smokers it was associated with greater impulsivity and illegal drug use. E-cigarette use was associated with hookah use, and for never smokers only with use of cigars and other nicotine products. E-cigarette use among women of reproductive age varies by smoking status, with use among current smokers reflecting attempts to quit smoking whereas among non-smokers use may be a marker of a more impulsive repertoire that includes greater use of alternative tobacco products and illegal drugs. Copyright © 2016 Elsevier Inc. All rights reserved.

Testing anti-smoking messages for Air Force trainees

PubMed Central

Popova, Lucy; Linde, Brittany D.; Bursac, Zoran; Talcott, G. Wayne; Modayil, Mary V.; Little, Melissa A.; Ling, Pamela M.; Glantz, Stanton A.; Klesges, Robert C.

2015-01-01

Introduction Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing anti-smoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing anti-smoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees. Methods In a pretest-posttest experiment, 782 Airmen were randomized to view anti-smoking advertisements in one of six conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry, or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes (e-cigarettes), smokeless tobacco, hookah and cigarillos from pretest to posttest with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions). Results Anti-smoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions. Conclusion Anti-smoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing anti-smoking advertising may be a cost-effective tool to educate young adults in the military. PMID:26482786

A Study of the Use, Knowledge, and Beliefs About Cigarettes and Alternative Tobacco Products Among Students at One U.S. Medical School

PubMed Central

Zhou, Sherry; Van Devanter, Nancy; Fenstermaker, Michael; Cawkwell, Philip; Sherman, Scott; Weitzman, Michael

2016-01-01

Purpose In the United States, the prevalence of the use of alternative tobacco products (ATPs) (e.g., hookahs, e-cigarettes, cigars/cigarillos) has increased sharply. As future health care providers, medical students will play a critical role in health promotion and disease prevention. This study investigated medical students’ use, knowledge, and beliefs about cigarettes and ATPs. Method In 2014, the authors surveyed all students enrolled at one medical school in New York City. The survey included questions about personal use of tobacco products, perceptions about the harms of ATPs and their role in disease causation, education about ATPs, and cessation training and practices related to ATPs and cigarettes. The authors compared results across medical school classes. Results Of 720 students, 431 (59.9%) completed the survey. Of those, 64 (14.7%) were current users of tobacco or smoking products, including cigarettes (17, 3.9%), ATPs (21, 4.8%), or marijuana (39, 8.9%). Many believed that ATPs contributed less than cigarettes to various diseases. Respondents received less cessation intervention training regarding ATPs than cigarettes (P < .0001). They felt less confident providing ATP cessation counseling than cigarette cessation counseling (P < .0001) and were less likely to report counseling patients on ATP cessation than cigarette cessation (46, 10.7% vs. 280, 64.8%, P < .0001). Conclusions A concerning percentage of surveyed medical students use tobacco products, including ATPs, and lack the knowledge, education, and cessation counseling skills to provide accurate information about them to patients. ATP education should be added to medical school curricula to address this gap. PMID:26308126

Prevalence and harm perceptions of various tobacco products among college students.

PubMed

Latimer, Lara A; Batanova, Milena; Loukas, Alexandra

2014-05-01

Although use of non-cigarette alternative tobacco products (ATPs) is increasingly prevalent in the United States, little is known about the varying patterns of tobacco use among college students. This study examined prevalence of ATP use and differences across 4 groups of students (nontobacco, cigarette-only, polytobacco, and ATP-only users) on perceptions of danger and beliefs about government safety evaluation of tobacco products. An online survey was administered to 5,028 students attending 7 public universities within a larger university system (M age = 20.5 years, 59.6% female, 54.6% Hispanic/Latino). Multivariate analyses were conducted to investigate differences between the 4 groups on perceived danger of tobacco products and beliefs regarding government safety evaluation of these products. Prevalence of ATP use among the sample ranged from 0.4% for dissolvable tobacco to 10.8% for hookah. Group membership was significantly associated with perceived danger of each tobacco product, whereby cigarette-only and ATP-only users reported significantly higher levels of perceived danger for most ATPs than did polytobacco users. Furthermore, cigarette-only, polytobacco, and ATP-only users were significantly more likely than nonusers to believe that the government evaluates some tobacco products for safety. ATP use among young adult college students is prevalent. Furthermore, students who use ATPs in conjunction with cigarettes (i.e., polytobacco users) appear to be at highest risk for the continuation and subsequent dependence on nicotine, given their danger perceptions and beliefs of government evaluation. Future research examining trajectories of use, particularly among polytobacco users, is needed.

Awareness and Use of South Asian Tobacco Products Among South Asians in New Jersey.

PubMed

Hrywna, Mary; Jane Lewis, M; Mukherjea, Arnab; Banerjee, Smita C; Steinberg, Michael B; Delnevo, Cristine D

2016-12-01

South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities.

Awareness and Use of South Asian Tobacco Products Among South Asians in New Jersey

PubMed Central

Hrywna, Mary; Lewis, M. Jane; Mukherjea, Arnab; Banerjee, Smita C.; Steinberg, Michael B.; Delnevo, Cristine D.

2016-01-01

South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities. PMID:27256410

Cross‐cultural adaptation of a tobacco questionnaire for Punjabi, Cantonese, Urdu and Sylheti speakers: qualitative research for better clinical practice, cessation services and research

PubMed Central

Hanna, Lisa; Hunt, Sonja; Bhopal, Raj S

2006-01-01

Objective To develop cross‐culturally valid and comparable questionnaires for use in clinical practice, tobacco cessation services and multiethnic surveys on tobacco use. Methods Key questions in Urdu, Cantonese, Punjabi and Sylheti on tobacco use were compiled from the best existing surveys. Additional items were translated by bilingual coworkers. In one‐to‐one and group consultations, lay members of the Pakistani, Chinese, Indian Sikh and Bangladeshi communities assessed the appropriateness of questions. Questionnaires were developed and field tested. Cross‐cultural comparability was judged in a discussion between the researchers and coworkers, and questionnaires were finalised. Questionnaires in Cantonese (written and verbal forms differ) and Sylheti (no script in contemporary use) were written as spoken to avoid spot translations by interviewers. Results The Chinese did not use bidis, hookahs or smokeless tobacco, so these topics were excluded for them. It was unacceptable for Punjabi Sikhs to use tobacco. For the Urdu speakers and Sylheti speakers there was no outright taboo, particularly for men, but it was not encouraged. Use of paan was common among women and men. Many changes to existing questions were necessary to enhance cultural and linguistic appropriateness—for example, using less formal language, or rephrasing to clarify meaning. Questions were modified to ensure comparability across languages, including English. Conclusion Using theoretically recommended approaches, a tobacco‐related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control. The methods and lessons are applicable internationally. PMID:17108298

Prevalence of Substance Abuse Among Dormitory Students of Shahid Beheshti University of Medical Sciences, Tehran, Iran.

PubMed

Babaei Heydarabadi, Akbar; Ramezankhani, Ali; Barekati, Hasan; Vejdani, Marjan; Shariatinejad, Keyvan; Panahi, Rahman; Kashfi, Seyed Hanan; Imanzad, Masoumeh

2015-06-01

Adolescence is a risky period with high tendency towards drug abuse. Addressing the problem of drug abuse among students is essential. This study was carried out in 2013 with the purpose of investigating the prevalence of substance abuse among dormitory students of Shahid Beheshti University of Medical Sciences. In this descriptive analytical study, which was carried out in 2013, a total of 604 students living at dormitories of Shahid Beheshti University of Medical Sciences were selected by random sampling method. A questionnaire designed by the researcher was used to collect the data. Data were analyzed using descriptive statistics and chi-square test. The prevalence of substance abuse among the students was 15.4%. With respect to the types of the drug used by students, the highest frequencies belonged to smoking 4.47% and hookah with 42.9%. Forty-eight percent of the students, who used drugs, started it for the first time when they were 18 years old or younger. About 58% of students used drugs for the first time in dormitories and parks. Students' meetings and parties with friends were frequent occasions for substance abuse (47.5%). Students are considered one of the most vulnerable groups of society. The students living in dormitories are more vulnerable to drug abuse due to the lack of parental supervision and the impact of peer pressure. Therefore, localization of acceptance at Universities in order to prevent cultural mixing of students and education programs for teaching life skills to students efficiently reduce their substance abuse.

Prevalence of Substance Abuse Among Dormitory Students of Shahid Beheshti University of Medical Sciences, Tehran, Iran

PubMed Central

Babaei Heydarabadi, Akbar; Ramezankhani, Ali; Barekati, Hasan; Vejdani, Marjan; Shariatinejad, Keyvan; Panahi, Rahman; Kashfi, Seyed Hanan; Imanzad, Masoumeh

2015-01-01

Background: Adolescence is a risky period with high tendency towards drug abuse. Addressing the problem of drug abuse among students is essential. Objectives: This study was carried out in 2013 with the purpose of investigating the prevalence of substance abuse among dormitory students of Shahid Beheshti University of Medical Sciences. Patients and Methods: In this descriptive analytical study, which was carried out in 2013, a total of 604 students living at dormitories of Shahid Beheshti University of Medical Sciences were selected by random sampling method. A questionnaire designed by the researcher was used to collect the data. Data were analyzed using descriptive statistics and chi-square test. Results: The prevalence of substance abuse among the students was 15.4%. With respect to the types of the drug used by students, the highest frequencies belonged to smoking 4.47% and hookah with 42.9%. Forty-eight percent of the students, who used drugs, started it for the first time when they were 18 years old or younger. About 58% of students used drugs for the first time in dormitories and parks. Students’ meetings and parties with friends were frequent occasions for substance abuse (47.5%). Conclusions: Students are considered one of the most vulnerable groups of society. The students living in dormitories are more vulnerable to drug abuse due to the lack of parental supervision and the impact of peer pressure. Therefore, localization of acceptance at Universities in order to prevent cultural mixing of students and education programs for teaching life skills to students efficiently reduce their substance abuse. PMID:26405679

Flavour preferences in youth versus adults: a review

PubMed Central

Hoffman, Allison C; Salgado, Raydel Valdes; Dresler, Carolyn; Faller, Rachel Williams; Bartlett, Christopher

2016-01-01

Objective To understand the available evidence of how children and adults differ in their preferences for flavours that may be used in tobacco products. Data sources A total of 474 articles published between 1931 and August 2015 were retrieved through searches conducted in PubMed, EMBASE, Web of Science and PsycINFO. Study selection and extraction A 2-phase relevancy review process resulted in the identification of 59 articles and information was extracted by 2 independent reviewers. Data synthesis Findings were grouped by taste and smell preferences, which are important components of overall flavour. For taste, evidence is summarised in the following categories: sweet, salty, sour, bitter, umami and fat; within each of them, findings are organised by age categories. For smell, evidence is summarised as follows: fruit/herbal/spices, tobacco and coffee and other odours. Major findings from this search indicated that sweet preference in children and adolescents was higher than in adults. Examples of preferred food-related tastes and odours for young people included cherry, candy, strawberry, orange, apple and cinnamon. Currently, all these are used to flavour cigars, cartridges for electronic cigarettes, hookah (waterpipe) and smokeless tobacco products. Conclusions Infants and children exhibited elevated sweet and salty preference relative to adults. Age-related changes in bitter, sour, umami and fat taste were not clear and more research would be useful. ‘Sweet’ food odours were highly preferred by children. Tobacco products in flavours preferred by young people may impact tobacco use and initiation, while flavours preferred by adults may impact product switching or dual use. PMID:27633764

A Study of the Use, Knowledge, and Beliefs About Cigarettes and Alternative Tobacco Products Among Students at One U.S. Medical School.

PubMed

Zhou, Sherry; Van Devanter, Nancy; Fenstermaker, Michael; Cawkwell, Philip; Sherman, Scott; Weitzman, Michael

2015-12-01

In the United States, the prevalence of the use of alternative tobacco products (ATPs) (e.g., hookahs, e-cigarettes, cigars/cigarillos) has increased sharply. As future health care providers, medical students will play a critical role in health promotion and disease prevention. This study investigated medical students' use, knowledge, and beliefs about cigarettes and ATPs. In 2014, the authors surveyed all students enrolled at one medical school in New York City. The survey included questions about personal use of tobacco products, perceptions about the harms of ATPs and their role in disease causation, education about ATPs, and cessation training and practices related to ATPs and cigarettes. The authors compared results across medical school classes. Of 720 students, 431 (59.9%) completed the survey. Of those, 64 (14.7%) were current users of tobacco or smoking products, including cigarettes (17; 3.9%), ATPs (21; 4.8%), or marijuana (39; 8.9%). Many believed that ATPs contributed less than cigarettes to various diseases. Respondents received less cessation training regarding ATPs than cigarettes (P < .0001). They felt less confident providing ATP cessation counseling than cigarette cessation counseling (P < .0001) and were less likely to report counseling patients on ATP cessation than cigarette cessation (46 [10.7%] versus 280 [64.8%], P < .0001). A concerning percentage of surveyed medical students use tobacco products, including ATPs, and lack the knowledge, education, and cessation counseling skills to provide accurate information about them to patients. ATP education should be added to medical school curricula to address this gap.

E-cigarette Use Among Women of Reproductive Age: Impulsivity, Cigarette Smoking Status, and Other Risk Factors

PubMed Central

Chivers, Laura L.; Hand, Dennis J.; Priest, Jeff S.; Higgins, Stephen T.

2016-01-01

Introduction The study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant. Method Survey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24–44 years from the US. Half (n = 400) reported current, daily smoking and half (n = 400) reported smoking less than 100 cigarettes lifetime. Participants completed questionnaires regarding sociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and e-cigarette use were examined using logistic regression. Results Daily cigarette smoking was associated with greater impulsivity, lower education, past illegal drug use, and White race/ethnicity. E-cigarette use in the overall sample was associated with being a cigarette smoker and greater education. E-cigarette use among current smokers was associated with increased nicotine dependence and quitting smoking; among never smokers it was associated with greater impulsivity and illegal drug use. E-cigarette use was associated with hookah use, and for never smokers only with use of cigars and other nicotine products. Conclusions E-cigarette use among women of reproductive age varies by smoking status, with use among current smokers reflecting attempts to quit smoking whereas among non-smokers use may be a marker of a more impulsive repertoire that includes greater use of alternative tobacco products and illegal drugs. PMID:27492277

Sponge divers of the Aegean and medical consequences of risky compressed-air dive profiles.

PubMed

Toklu, Akin Savas; Cimsit, Maide

2009-04-01

Historically, Turkey once had a substantial number of professional sponge divers, a population known for a relatively high incidence of diving-related conditions such as decompression sickness (DCS) and dysbaric osteonecrosis (DON). Sponge diving ended in the mid-1980s when nearly all of the sponges in the Aegean and Mediterranean Seas contracted a bacterial disease and the occupation became unprofitable. We reviewed the records of Turkish sponge divers for information on their level of knowledge, diving equipment, dive profiles, and occupational health problems. Information was collected by: 1) interviewing former sponge divers near Bodrum, where most of them had settled; 2) reviewing the relevant literature; and 3) examining the medical records of sponge divers who underwent recompression treatment. These divers used three types of surface-supplied equipment, including hard helmets, Fernez apparatus, and hookahs; the latter were preferred because they allowed divers the greatest freedom of movement while harvesting sponges underwater. These divers used profiles that we now know involved a high risk for DCS and DON. We were able to access the records of 58 divers who had received recompression treatment. All of the cases involved severe DCS and delays from dive to recompression that averaged 72 h. Complete resolution of symptoms occurred in only 11 cases (19%). Thus, we were able to document the several factors that contributed to the risks in this occupational group, including unsafe dive profiles, resistance to seeking treatment, long delays before recompression, and the fact that recompression treatment used air rather than oxygen.

Factors associated with experimentation of electronic cigarettes among Parisian teenagers in 2013.

PubMed

Dautzenberg, Bertrand; Berlin, Ivan; Tanguy, Marie-Laure; Rieu, Nicole; Birkui, Pierre

2015-01-01

Electronic cigarettes (e-cig.) became widely used among adults. Data are insufficient about e-cig. experimentation among youth. To assess prevalence of e-cig. experimentation and associated factors among the 12 to 19 years old we analyse a cross sectional school based survey in the city of Paris, France in 2013 on a randomly selected sample of 2 % of schoolchildren (n = 3 279). Self-report questionnaire include demographic, individual and family smoking characteristics and questions about e-cig: "Have you ever used an e-cigarette?"- "Did you use e-cigarette in the last 30 days?"-"Did you try e-cigarette as a first tobacco product?". In 2013, 17.9 % (564) schoolchildren reported having experienced the e-cig (boys: 19.0 %, girls: 16.8 %) compared to 9.8 % in 2012. Experimentation rate increases from 5 % among the 12 to 30 % among the 16-year-old. E-cig. experimentation was significantly associated with 11 parameters including : age >15 years (OR: 0.66 (IC95 % = 0.46-0.94)); smoking 10 cigarettes or more (OR = 5.67 (IC95 % = 3.11-10.34)), best friends and siblings smoker (OR = 1.54 (IC95 % = 1.11-2.14)) and (OR = 1.88 (IC95 % = 1.41-2.52)); experimentation of shisha (OR = 2.60 (IC95 % = 1.75-3.86)), cannabis use (OR = 1.90 (IC95 % = 1.32-2.72)); having two parents who forbid smoking (OR = 2.32 (IC95 % = 1.63-3.30)). Only 5.6 % of the study population (and 32.5 % of e-cig. experimenters (183/564)) have used it in the last 30 days; 1.7 % of the study population and 10.0 % of e-cig. experimenters were non-smokers (56/564). Rate of e-cig. experimentation among schoolchildren increased by 8.1 % in 1 year. Non-smoking youth may use e-cig. Prospective studies are urgently needed to assess the evolution of e-cig. use both among smoking and non-smoking youth.

Toward the stereochemical identification of prohibited characterizing flavors in tobacco products: the case of strawberry flavor.

PubMed

Paschke, Meike; Hutzler, Christoph; Henkler, Frank; Luch, Andreas

2015-08-01

With the revision of the European Tobacco Products Directive (2014/40/EU), characterizing flavors such as strawberry, candy, vanillin or chocolate will be prohibited in cigarettes and fine-cut tobacco. Product surveillance will therefore require analytical means to define and subsequently detect selected characterizing flavors that are formed by supplemented flavors within the complex matrix tobacco. We have analyzed strawberry-flavored tobacco products as an example for characterizing fruit-like aroma. Using this approach, we looked into aroma components to find indicative patterns or features that can be used to satisfy obligatory product information as requested by the European Directive. Accordingly, a headspace solid-phase microextraction (HS-SPME) technique was developed and coupled to subsequent gas chromatography-mass spectrometry (GC/MS) to characterize different strawberry-flavored tobacco products (cigarettes, fine-cut tobacco, liquids for electronic cigarettes, snus, shisha tobacco) for their volatile additives. The results were compared with non-flavored, blend characteristic flavored and other fruity-flavored cigarettes, as well as fresh and dried strawberries. Besides different esters and aldehydes, the terpenes linalool, α-terpineol, nerolidol and limonene as well as the lactones γ-decalactone, γ-dodecalactone and γ-undecalactone could be verified as compounds sufficient to convey some sort of strawberry flavor to tobacco. Selected flavors, i.e., limonene, linalool, α-terpineol, citronellol, carvone and γ-decalactone, were analyzed further with respect to their stereoisomeric composition by using enantioselective HS-SPME-GC/MS. These experiments confirmed that individual enantiomers that differ in taste or physiological properties can be distinguished within the tobacco matrix. By comparing the enantiomeric composition of these compounds in the tobacco with that of fresh and dried strawberries, it can be concluded that non-natural strawberry

Waterpipe product packaging and labelling at the 3rd international Hookah Fair; does it comply with Article 11 of the Framework Convention on Tobacco Control?

PubMed

Jawad, Mohammed; Darzi, Andrea; Lotfi, Tamara; Nakkash, Rima; Hawkins, Ben; Akl, Elie A

2017-08-01

We assessed compliance of waterpipe product packaging and labelling with the Framework Convention on Tobacco Control's Article 11. We evaluated samples collected at a trade fair against ten domains: health warning location, size, use of pictorials, use of colour, and packaging information on constituents and emissions. We also evaluated waterpipe accessories (e.g., charcoal) for misleading claims. Ten of 15 tobacco products had health warnings on their principal display areas, covering a median of 22.4 per cent (interquartile range 19.4-27.4 per cent) of those areas. Three had pictorial, in-colour health warnings. We judged all packaging information on constituents and emissions to be misleading. Eight of 13 charcoal products displayed environmentally friendly descriptors and/or claims of reduced harm that we judged to be misleading. Increased compliance with waterpipe tobacco regulation is warranted. An improved policy framework for waterpipe tobacco should also consider regulation of accessories such as charcoal products.

College students and use of K2: an emerging drug of abuse in young persons

PubMed Central

2011-01-01

Background K2 or "spice" has emerged as a popular legal alternative to marijuana among adolescents and young adults. However, no data has been published assessing prevalence of and associations with ever K2 use in any population. This study's aims were to examine prevalence of ever K2 use among a sample of college students, to determine characteristics of persons who use K2, and to access the association between K2 and other drug use. Findings Ever use of K2 was reported by 69 (8%) of the sample of 852 college students. Response rate was 36%. Bivariate and multivariate analyses assessed whether sociodemographic characteristics and other drug use were associated with ever use of K2. Ever use of K2 was reported by 69 (8%) of the sample. Among these 69 individuals, 61 (88%) had used a cigarette and 25 (36%) had used a hookah to smoke K2. In multivariate analyses, K2 use was more common in males (vs. females, adjusted Odds Ratio (aOR) = 2.0, 95% Confidence Interval (CI) = 1.2-3.5, p = 0.01) and 1st or 2nd year college students (vs. 3rd year or above, aOR = 2.4, 95% CI = 1.2-5.0, p = 0.02). Conclusions Ever use of K2 in this sample was higher than ever use of many other drugs of abuse that are commonly monitored in adolescents and young adults. Although DEA had banned five synthetic cannabinoids recently, clinicians and public health officials concerned with substance abuse in youth should be aware of and monitor the use of this drug in college students over time. PMID:21745369

Body mass index and tobacco-product use among U.S. youth: Findings from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study.

PubMed

Green, Victoria R; Silveira, Marushka L; Kimmel, Heather L; Conway, Kevin P

2018-06-01

Tobacco and obesity are leading contributors to mortality in the United States. Due to emerging changes in youth tobacco use, further examination of co-occurrence of these issues is warranted. This study examined associations between body mass index (BMI) and tobacco-product use and whether these varied by gender in a nationally representative sample of 12,416 Wave 1 (2013-2014) U.S. youth (12-17 years) from the Population Assessment of Tobacco and Health Study. Multivariable logistic regression analyses examined the odds of past 30-day tobacco-product use according to BMI. BMI was analyzed categorically using the Centers for Disease Control and Prevention (CDC) BMI-for-age weight status categories (underweight/healthy weight, overweight, and obese) and as a continuous variable. Youth classified as overweight or obese were not more likely to use any tobacco, cigarettes, e-cigarettes, any cigar, or hookah. However, youth who were obese were more likely to use smokeless tobacco (Adjusted Odds Ratio (AOR) = 1.68, 95% Confidence Interval (CI): 1.01, 2.81). There were no significant gender interactions for these associations. When BMI was analyzed continuously, a 5-unit and 10-unit increase was significantly associated with using any tobacco, cigarettes, any cigar, and smokeless tobacco. This linear association was supported by similar results for a log-transformed BMI variable. Findings suggest a continuum between weight increase and tobacco-product use among American youth. Clinicians should consider screening for tobacco use among youth who gain weight within any weight class, not just those considered overweight or obese. Copyright © 2018 Elsevier Ltd. All rights reserved.

Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014).

PubMed

Villanti, Andrea C; Johnson, Amanda L; Ambrose, Bridget K; Cummings, K Michael; Stanton, Cassandra A; Rose, Shyanika W; Feirman, Shari P; Tworek, Cindy; Glasser, Allison M; Pearson, Jennifer L; Cohn, Amy M; Conway, Kevin P; Niaura, Raymond S; Bansal-Travers, Maansi; Hyland, Andrew

2017-08-01

The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes). A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013-2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use. Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12-17 years); and young adult tobacco users (73%, aged 18-24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one's first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users. These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use. Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

Prevalence and factors associated with smoking among adolescents.

PubMed

Urrutia-Pereira, Marilyn; Oliano, Vinicius J; Aranda, Carolina S; Mallol, Javier; Solé, Dirceu

Despite anti-smoking prevention programs, many adolescents start smoking at school age. The main objectives of this study were to determine the prevalence and risk factors associated with smoking in adolescents living in Uruguaiana, RS, Brazil. A prospective study was conducted in adolescents (12-19 years), enrolled in municipal schools, who answered a self-administered questionnaire on smoking. 798 adolescents were enrolled in the study, with equal distribution between genders. The tobacco experimentation frequency (ever tried a cigarette, even one or two puffs) was 29.3%; 14.5% started smoking before 12 years of age and 13.0% reported smoking at least one cigarette/day last month. Having a smoking friend (OR: 5.67, 95% CI: 2.06-7.09), having cigarettes offered by friends (OR: 4.21, 95% CI: 2.46-5.76) and having easy access to cigarettes (OR: 3.82, 95% CI: 1.22-5.41) was identified as factors associated with smoking. Having parental guidance on smoking (OR: 0.67, 95% CI: 0.45-0.77), having no contact with cigarettes at home in the last week (OR: 0.51, 95% CI: 0.11-0.79) and knowing about the dangers of electronic cigarettes (OR: 0.88, 95% CI: 0.21-0.92) were identified as protection factors. The prevalence of smoking among adolescents in Uruguaiana is high. The implementation of measures to reduce/stop tobacco use and its new forms of consumption, such as electronic cigarettes and hookah, are urgent and imperative in schools. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Toking, Vaping, and Eating for Health or Fun: Marijuana Use Patterns in Adults, U.S., 2014.

PubMed

Schauer, Gillian L; King, Brian A; Bunnell, Rebecca E; Promoff, Gabbi; McAfee, Timothy A

2016-01-01

Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

Youth tobacco product use in the United States.

PubMed

Lee, Youn Ok; Hebert, Christine J; Nonnemaker, James M; Kim, Annice E

2015-03-01

Noncigarette tobacco products are increasingly popular among youth, especially cigarette smokers. Understanding multiple tobacco product use is necessary to assess the effects of tobacco products on population health. This study examines multiple tobacco product use and associated risk factors among US youth. Estimates of current use were calculated for cigarettes, cigars, smokeless tobacco, hookah, e-cigarettes, pipes, bidis, kreteks, snus, and dissolvable tobacco by using data from the 2012 National Youth Tobacco Survey (n = 24 658), a nationally representative sample of US middle and high school students. Associations between use patterns and demographic characteristics were examined by using multinomial logistic regression. Among youth, 14.7% currently use 1 or more tobacco products. Of these, 2.8% use cigarettes exclusively, and 4% use 1 noncigarette product exclusively; 2.7% use cigarettes with another product (dual use), and 4.3% use 3 or more products (polytobacco use). Twice as many youth use e-cigarettes alone than dual use with cigarettes. Among smokers, polytobacco use was significantly associated with male gender (adjusted relative risk ratio [aRRR] = 3.71), by using flavored products (aRRR = 6.09), nicotine dependence (aRRR = 1.91), tobacco marketing receptivity (aRRR = 2.52), and perceived prevalence of peer use of tobacco products (aRRR = 3.61, 5.73). More than twice as many youth in the United States currently use 2 or more tobacco products than cigarettes alone. Continued monitoring of tobacco use patterns is warranted, especially for e-cigarettes. Youth rates of multiple product use involving combustible products underscore needs for research assessing potential harms associated with these patterns. Copyright © 2015 by the American Academy of Pediatrics.

Tobacco Use Among Working Adults - United States, 2014-2016.

PubMed

Syamlal, Girija; King, Brian A; Mazurek, Jacek M

2017-10-27

Cigarette smoking has declined considerably among U.S. adults over several decades (1); however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of multiple tobacco products has become common among current users of noncigarette tobacco products (2,3). Differences in tobacco use have also been observed across population subgroups, including among working adults (2,4). CDC analyzed National Health Interview Survey (NHIS) data for 2014-2016 to describe the most recent prevalence estimates of current (every day or some days) tobacco product use among working U.S. adults by industry and occupation. Among working adults, 22.1% (32.7 million) currently used any form of tobacco; 15.4% used cigarettes, 5.8% used other combustible tobacco (cigars, pipes, water pipes or hookahs, very small cigars, and bidis), 3.0% used smokeless tobacco, and 3.6% used electronic cigarettes (e-cigarettes); 4.6% (6.9 million) reported current use of two or more tobacco products. By industry, any tobacco use ranged from 11.0% among education services to 34.3% among construction workers; current use of two or more tobacco products was highest among construction workers (7.1%). By occupation, any tobacco use ranged from 9.3% among life, physical, and social science workers to 37.2% among installation, maintenance, and repair workers; current use of two or more tobacco products was highest among installation, maintenance, and repair workers (10.1%). Proven interventions to prevent and reduce tobacco product use, including current use of multiple products, among working adults are important (5,6). Workplace tobacco-control interventions have been especially effective in reducing cigarette smoking prevalence (7).

Testing antismoking messages for Air Force trainees.

PubMed

Popova, Lucy; Linde, Brittany D; Bursac, Zoran; Talcott, G Wayne; Modayil, Mary V; Little, Melissa A; Ling, Pamela M; Glantz, Stanton A; Klesges, Robert C

2016-11-01

Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing antismoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing antismoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees. In a pretest-post-test experiment, 782 Airmen were randomised to view antismoking advertisements in 1 of 6 conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes, smokeless tobacco, hookah and cigarillos from pretest to post-test with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions). Antismoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions. Antismoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing antismoking advertising may be a cost-effective tool to educate young adults in the military. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Peer crowd affiliation as a segmentation tool for young adult tobacco use.

PubMed

Lisha, Nadra E; Jordan, Jeffrey W; Ling, Pamela M

2016-10-01

In California, young adult tobacco prevention is of prime importance; 63% of smokers start by the age of 18 years, and 97% start by the age of 26 years. We examined social affiliation with 'peer crowd' (eg, Hipsters) as an innovative way to identify high-risk tobacco users. Cross-sectional surveys were conducted in 2014 (N=3368) among young adult bar patrons in 3 California cities. We examined use rates of five products (cigarettes, e-cigarettes, hookah, cigars and smokeless tobacco) by five race/ethnicity categories. Peer crowd affiliation was scored based on respondents' selecting pictures of young adults representing those most and least likely to be in their friend group. Respondents were classified into categories based on the highest score; the peer crowd score was also examined as a continuous predictor. Logistic regression models with each tobacco product as the outcome tested the unique contribution of peer crowd affiliation, controlling for race/ethnicity, age, sex, sexual orientation and city. Respondents affiliating with Hip Hop and Hipster peer crowds reported significantly higher rates of tobacco use. As a categorical predictor, peer crowd was related to tobacco use, independent of associations with race/ethnicity. As a continuous predictor, Hip Hop peer crowd affiliation was also associated with tobacco use, and Young Professional affiliation was negatively associated, independent of demographic factors. Tobacco product use is not the same across racial/ethnic groups or peer crowds, and peer crowd predicts tobacco use independent of race/ethnicity. Antitobacco interventions targeting peer crowds may be an effective way to reach young adult tobacco users. NCT01686178, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

College students and use of K2: an emerging drug of abuse in young persons.

PubMed

Hu, Xingdi; Primack, Brian A; Barnett, Tracey E; Cook, Robert L

2011-07-11

K2 or "spice" has emerged as a popular legal alternative to marijuana among adolescents and young adults. However, no data has been published assessing prevalence of and associations with ever K2 use in any population. This study's aims were to examine prevalence of ever K2 use among a sample of college students, to determine characteristics of persons who use K2, and to access the association between K2 and other drug use. Ever use of K2 was reported by 69 (8%) of the sample of 852 college students. Response rate was 36%. Bivariate and multivariate analyses assessed whether sociodemographic characteristics and other drug use were associated with ever use of K2. Ever use of K2 was reported by 69 (8%) of the sample. Among these 69 individuals, 61 (88%) had used a cigarette and 25 (36%) had used a hookah to smoke K2. In multivariate analyses, K2 use was more common in males (vs. females, adjusted Odds Ratio (aOR)=2.0, 95% Confidence Interval (CI)=1.2-3.5, p=0.01) and 1st or 2nd year college students (vs. 3rd year or above, aOR=2.4, 95% CI=1.2-5.0, p=0.02). Ever use of K2 in this sample was higher than ever use of many other drugs of abuse that are commonly monitored in adolescents and young adults. Although DEA had banned five synthetic cannabinoids recently, clinicians and public health officials concerned with substance abuse in youth should be aware of and monitor the use of this drug in college students over time. © 2011 Hu et al; licensee BioMed Central Ltd.

E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students.

PubMed

Margolis, Katherine A; Donaldson, Elisabeth A; Portnoy, David B; Robinson, Joelle; Neff, Linda J; Jamal, Ahmed

2018-07-01

Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and 25.4% were curious. Respondents that perceived e-cigarettes cause a lot of harm had lower odds of both openness (OR = 0.10, 95% CI = 0.07, 0.15) and curiosity about e-cigarettes (OR = 0.10, 95% CI = 0.07, 0.13) compared to those with lower harm perception. Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use (OR = 1.22, 95% CI = 1.03, 1.44) and highly curious (OR = 1.25, 95% CI = 1.01, 1.53) compared to those not highly exposed. These findings demonstrate that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace. Published by Elsevier Inc.

Co-occurrence of tobacco product use, substance use, and mental health problems among youth: Findings from wave 1 (2013-2014) of the population assessment of tobacco and health (PATH) study.

PubMed

Conway, Kevin P; Green, Victoria R; Kasza, Karin A; Silveira, Marushka L; Borek, Nicolette; Kimmel, Heather L; Sargent, James D; Stanton, Cassandra A; Lambert, Elizabeth; Hilmi, Nahla; Reissig, Chad J; Jackson, Kia J; Tanski, Susanne E; Maklan, David; Hyland, Andrew J; Compton, Wilson M

2018-01-01

Cigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use. The current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12-17years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems. In multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR=18.9, 95% CI: 15.3-23.4). Cigarette (AOR=14.7, 95% CI: 11.8-18.2) and cigarillo (AOR=8.1, 95% CI: 6.3-10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR=1.6, 95% CI: 1.4-1.8) and externalizing (AOR=1.4, 95% CI: 1.3-1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR=3.4, 95% CI: 2.7-4.3) and have mental health (AOR=1.2, 95% CI: 1.0-1.5) and substance use (AOR=4.7, 95% CI: 3.4-6.6) problems. Regardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Marijuana use among US tobacco users: Findings from wave 1 of the population assessment of tobacco health (PATH) study.

PubMed

Strong, David R; Myers, Mark G; Pulvers, Kim; Noble, Madison; Brikmanis, Kristin; Doran, Neal

2018-05-01

With an increase in marijuana use among adults in the United States (US), understanding the potential impact of marijuana use on tobacco use and associated behavioral and health consequences, including respiratory conditions, is necessary. Survey responses from Wave 1 of the nationally representative Population Assessment of Tobacco and Health (PATH) Study were used to assess tobacco use and marijuana use among non-current tobacco users (n = 17,952) and current established tobacco-users classified as: cigarette only users (n = 8689), e-cigarette only users (n = 437), cigar only (traditional, cigarillo, or filtered) users (n = 706), hookah only users (n = 461), smokeless tobacco only users (n = 971), cigarette + e-cigarette users (n = 709), and users of multiple tobacco products (n = 2314). When compared to non-current tobacco users, each tobacco user group except smokeless only users had higher odds (odds ratios ranging from 3.86-8.07) of reporting current marijuana use. Among current tobacco users, higher levels of tobacco dependence did not explain the relationship between tobacco use and marijuana use. Additionally, concurrent marijuana use was associated with lower odds of attempts to quit tobacco (OR = 0.86, 95% CI = 0.79, 0.94, p < 0.001) and a higher probability (OR = 1.35, 95CI = 1.21, 1.51, p < 0.01) of reporting a history of respiratory disease. The association between concurrent use of tobacco and marijuana and higher tobacco dependence and lower rates of quit attempts suggests the potential for sustained tobacco use and deleterious health effects. Further, marijuana use may represent an additive risk for respiratory harm among concurrent users of tobacco and marijuana. Copyright © 2018 Elsevier B.V. All rights reserved.

The relation of self-esteem and illegal drug usage in high school students.

PubMed

Khajehdaluee, Mohammad; Zavar, Abbas; Alidoust, Mahbobeh; Pourandi, Razieh

2013-11-01

Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse. This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse. Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010 - 2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale. 53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8 + 5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P < 0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P = 0.04). There was also a significant association between the number of children in the family and self-esteem score. The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents' emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents.

Tobacco Product Use Among Adults - United States, 2013-2014.

PubMed

Hu, S Sean; Neff, Linda; Agaku, Israel T; Cox, Shanna; Day, Hannah R; Holder-Hayes, Enver; King, Brian A

2016-07-15

While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(†); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <$20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.(§).

Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013.

PubMed

Bunnell, Rebecca E; Agaku, Israel T; Arrazola, René A; Apelberg, Benjamin J; Caraballo, Ralph S; Corey, Catherine G; Coleman, Blair N; Dube, Shanta R; King, Brian A

2015-02-01

Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24-2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

E-Cigarettes and Future Cigarette Use.

PubMed

Barrington-Trimis, Jessica L; Urman, Robert; Berhane, Kiros; Unger, Jennifer B; Cruz, Tess Boley; Pentz, Mary Ann; Samet, Jonathan M; Leventhal, Adam M; McConnell, Rob

2016-07-01

There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal. The Children's Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade. Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30-11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37-10.4), including hookah, cigars, or pipes. E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use. Copyright © 2016 by the American Academy of Pediatrics.

Tobacco Use and Attachment Style in Appalachia.

PubMed

Wise, Mary Heath; Weierbach, Florence; Cao, Yan; Phillips, Ken

2017-07-01

Tobacco has been recognized as the number one cause of preventable death in America and results in almost 5.2 million years of potential life lost each year. The use of tobacco products is highly correlated with pulmonary disease, cardiovascular disease, and other forms of chronic illness in America. New tobacco products are trending in the tobacco market such as the water pipe/hookah and e-cigarettes. With e-cigarettes and other newer forms of tobacco on the rise, it is important to look at the underlying factors for using all kinds of tobacco products as a means of prevention. Certain adult attachment styles (secure, preoccupied, dismissing-avoidant, and fearful-avoidant) in emotionally meaningful relationships could be indicators for physical illness, mental illness, and even addiction. This study investigated whether or not there is a relationship between tobacco use and attachment style. Based on a university-wide survey that was sent out at a university in Appalachia with 522 participants, demographic data revealed 68.5% (n = 358) did not currently use tobacco products. Of those who did currently use tobacco products 54.5% (n = 90) were male, 84.8% (n = 140) were undergraduate students, and 66.7% (n = 110) were between the ages of 18-25. For individuals who used tobacco 23.5% (n = 38) were in the secure attachment group, 27.8% (n = 45) were in the dismissing-avoidant attachment group, 30.2% (n = 49) were in the fearful-avoidant attachment group, and 18.5% (n = 30) were in the preoccupied attachment group. Chi Square analysis demonstrated that attachment style was significantly (p < 0.001) different between tobacco users and non-users revealing that there is a possibility for prevention of smoking initiation through the development of a secure attachment style.

E-Cigarettes and Future Cigarette Use

PubMed Central

Urman, Robert; Berhane, Kiros; Unger, Jennifer B.; Cruz, Tess Boley; Pentz, Mary Ann; Samet, Jonathan M.; Leventhal, Adam M.; McConnell, Rob

2016-01-01

BACKGROUND: There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal. METHODS: The Children’s Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade. RESULTS: Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30–11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37–10.4), including hookah, cigars, or pipes. CONCLUSIONS: E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use. PMID:27296866

[Reproductive pattern and mean size of sexual maturity of female lobsters Panulirus gracilis (Decapoda: Palinuridae) in Playa Lagarto, Guanacaste, Costa Rica].

PubMed

Naranjo Madrigal, Helven

2012-12-01

The lobster P. gracilis is important as a fishery resource and also contributes to food security of fishers in coastal communities in the North Pacific of Costa Rica. Due to the importance of updating knowledge related to the reproductive pattern of this species, we analyzed 357 specimens of female lobsters caught by the fishing methods of "hookah" and lung diving, from November 2007 to October 2008 in Playa Lagarto. Furthermore, we examined the size composition by depth; monthly pattern of reproductive activity (RAI) associated with the relative increase in sea surface temperature, and also the mean size at maturity using Generalized Linear Models. Four physiological states of sexual maturity showed that females with no signs of mating or sexual maturity have a minimum mean size of 62.3mm of cephalothorax length (CL). There are characteristics of functional maturity from very small sizes ranging from 30 to 50mm CL, being the smallest berried female reported for this specie of 35.8mm CL and the highest percentage of mature females between 70 and 80mm CL. Percentages of RAI remained above 50% during the year except October and January. In addition, it observed an increase in the RAI that started from April and continued until August associated with a relative increase in temperature on March, although the correlation was not significant (r2=0.49, p>0.05). It is possible that the low mean size at maturity (70.2mm LC) for P. gracilis in this region is related to the fishing activity. It recommends the establishment of a ban in the region of at least five months (April-August) in order to protect the reproductive seasonality of the species and to promote a recruitment increase in the fishing areas.

The Relation of Self-Esteem and Illegal Drug Usage in High School Students

PubMed Central

Khajehdaluee, Mohammad; Zavar, Abbas; Alidoust, Mahbobeh; Pourandi, Razieh

2013-01-01

Background Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse. Objectives This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse. Materials and Methods Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010 - 2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale. Results 53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8 + 5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P < 0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P = 0.04). There was also a significant association between the number of children in the family and self-esteem score. Conclusions The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents’ emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents. PMID:24719686

The influence of menthol, e-cigarettes and other tobacco products on young adults' self-reported changes in past year smoking.

PubMed

Delnevo, Cristine D; Villanti, Andrea C; Wackowski, Olivia A; Gundersen, Daniel A; Giovenco, Daniel P

2016-09-01

Progression to regular smoking often occurs during young adulthood. This study examines self-reported changes in past year smoking among young adults and the potential influence of tobacco products on these trajectories. Respondents to the 2011 National Young Adult Health Survey who smoked 100 cigarettes in their lifetime (n=909) described smoking behaviour at the time of the survey and 1 year prior. Cigarette smoking trajectories were categorised as: no change, quit, decreased smoking or increased smoking. Participants were also asked about current use of menthol cigarettes and other tobacco products (ie, cigars, smokeless tobacco, hookah) and ever use of e-cigarettes. Most young adults (73.1%) reported stable cigarette smoking behaviours, while 8.2% reported having quit, 5.8% reported that they smoke on fewer days, 5% progressed from someday to daily smoking and 8% increased from not at all to current smoking. The youngest smokers (18-20) had significantly higher odds (adjusted OR (AOR) =2.6) of increasing cigarette use over the past year compared to those aged 30-34, as did blacks versus whites (AOR=2.35). Menthol cigarette use nearly doubled (AOR=1.87) the odds of increased smoking behaviour. E-cigarette and other tobacco product (OTP) use were not associated with increasing smoking but OTP use was negatively associated with remaining quit from cigarettes. Young adulthood is a critical period for smoking interventions, particularly among those most vulnerable to increasing smoking behaviours (ie, black and younger young adults). Policy efforts to restrict menthol cigarettes may reduce young adult smoking progression. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The changing tobacco landscape: What dental professionals need to know.

PubMed

Couch, Elizabeth T; Chaffee, Benjamin W; Gansky, Stuart A; Walsh, Margaret M

2016-07-01

Tobacco products in the United States and the patterns of tobacco use are changing. Although cigarette smoking prevalence has declined, dental professionals are likely to encounter substantial numbers of patients who have tried and are continuing to use new and alternative tobacco products, including cigars, water pipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. The authors reviewed conventional and new tobacco products in the United States, their adverse oral and systemic health effects, and their prevalence of use. Tobacco products other than cigarettes account for a substantial portion of tobacco use. For this reason, tobacco-use prevention and cessation counseling provided by dental health care professionals must address all tobacco products, including cigarettes, cigars, water pipes, and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. This critical review of conventional, new, and emerging tobacco products presents information that dental professionals can use in providing tobacco-related counseling to patients who use or who are at risk for using tobacco products. It is essential that dental professionals are knowledgeable about tobacco products and are able to answer patients' questions and provide them with evidence-based tobacco-related counseling. This information may prevent patients from initiating use or help reduce or cease use to avoid immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Copyright © 2016 American Dental Association. Published by Elsevier Inc

Intentions to Smoke Cigarettes Among Never-Smoking US Middle and High School Electronic Cigarette Users: National Youth Tobacco Survey, 2011–2013

PubMed Central

Agaku, Israel T.; Arrazola, René A.; Apelberg, Benjamin J.; Caraballo, Ralph S.; Corey, Catherine G.; Coleman, Blair N.; Dube, Shanta R.; King, Brian A.

2015-01-01

Introduction: Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. Methods: We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6–12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. Results: Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24–2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. Conclusion: In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes. PMID:25143298

Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo.

PubMed

Moon, Katherine A; Rule, Ana M; Magid, Hoda S; Ferguson, Jacqueline M; Susan, Jolie; Sun, Zhuolu; Torrey, Christine; Abubaker, Salahaddin; Levshin, Vladimir; Çarkoglu, Asli; Radwan, Ghada Nasr; El-Rabbat, Maha; Cohen, Joanna E; Strickland, Paul; Breysse, Patrick N; Navas-Acien, Ana

2018-03-06

Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

The Use of Fluorescence Technology versus Visual and Tactile Examination in the Detection of Oral Lesions: A Pilot Study.

PubMed

Ayoub, Hadeel M; Newcomb, Tara L; McCombs, Gayle B; Bonnie, Marshall

2015-02-01

This study compared the effectiveness of the VELscope® Vx versus visual and tactile intraoral examination in detecting oral lesions in an adult, high risk population. The pilot study compared the intra oral findings between 2 examination types. The sample was comprised of 30 participants who were addicted to either cigarettes or a dual addiction (cigarettes plus hookah). High risk population was defined as males who were current cigarette smokers or had a dual addiction. Two trained and experienced licensed dental hygienists conducted all examinations. Throughout the study, all visual and tactile intraoral examinations were conducted first by one dental hygienist first, followed by the VELscope® Vx fluorescence examinations by the second dental hygienist. All subjects received an inspection of the lips, labial and buccal mucosa, floor of the mouth, dorsal, ventral and lateral sides of the tongue, hard and soft palate, and visual inspection of the oropharynx and uvula. Both evaluations took place in 1 visit in the Dental Hygiene Research Center at Old Dominion University and external sites. All participants received oral cancer screening information, recommendations, referrals for tobacco cessation programs and brochures on the 2 types of examinations conducted. Participants were considered high risk based on demographics (current smokers and mostly males). Neither visual and tactile intraoral examination nor the VELscope® Vx examination showed positive lesions. No lesions were detected; therefore, no referrals were made. Data indicated the duration of tobacco use was significantly higher in cigarette smokers (14.1 years) than dual addiction smokers (5 years) (p>0.005). The average numbers of cigarettes smoked per day were 13.5 compared to 14.2 cigarettes for dual addiction smokers. Results from this study suggest the visual and tactile intraoral examination produced comparative results to the VELscope® Vx examination. Findings from this study support that the

Misplaced Trust: Racial Differences in Use of Tobacco Products and Trust in Sources of Tobacco Health Information.

PubMed

Alcalá, Héctor E; Sharif, Mienah Z; Morey, Brittany N

2017-10-01

Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products. Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables. There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites. The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites. Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities. © The Author

Impact of Training High School Female Students in Ahvaz, Iran in the Social Skills Required to Avoid the Use of Drugs.

PubMed

Alavijeh, Freshteh Zamani; Raisi, Zahra; Asadollahi, Abdolrahim; Irani, Reza Davasaz; Kalhori, Sharareh Rostam Niakan

2016-05-01

Gender composition and the soaring trends of drug and tobacco dependency reveal the priority of social skills training related to drug avoidance self-efficacy among female students. The aim of this study was to verify the impact training high school female students to have the social skills needed to avoid the use of drugs. This study was conducted from September 2012 to May 2013 in two high schools in Ahvaz City in southwest Iran. The participants were divided randomly into two groups of 60 students, one experimental group and one control group using the multi-stage simple sampling method. Two questionnaires, i.e. the ASES and TISS questionnaires, were completed before and after the intervention. Descriptive statistics, chi squared, paired-samples t-test, and the independent-samples t-test were used. The participants had a mean age of 14.93 years. Among the 120 participants, 90.8% indicated that they had never smoked a cigarette, and 51.7% of the participants denied having smoked a hookah. There was no significant relationship between the self-sufficiency means of drug avoidance in the two groups of girls before intervention (p ≥ 0.05). However, after intervention, a significant difference was found in test score of self-efficacy of drug avoidance between the two groups, i.e., 94.91 ± 8.3 for the control group versus 99.16 ± 3.8 for the experimental group, p < 0.05). Significant increases were observed for the pre- and post-test scores of self-efficacy of drug avoidance in the experimental group compared to the control group (99.16 ± 3.8 (p = 0.001) vs. 96.58 ± 6.98 (p > 0.05). The mean values of the pre- and post-test scores of social skill before and after intervention increased significantly only for the experimental group (97.60 ± 19.19 vs. 100.58 ± 12.37, p = 0.03). Educational intervention can significantly enhance social skills for drug avoidance self-efficacy, so it is recommended that such skills be taught in the high school curriculum.

Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014.

PubMed

Kasza, Karin A; Ambrose, Bridget K; Conway, Kevin P; Borek, Nicolette; Taylor, Kristie; Goniewicz, Maciej L; Cummings, K Michael; Sharma, Eva; Pearson, Jennifer L; Green, Victoria R; Kaufman, Annette R; Bansal-Travers, Maansi; Travers, Mark J; Kwan, Jonathan; Tworek, Cindy; Cheng, Yu-Ching; Yang, Ling; Pharris-Ciurej, Nikolas; van Bemmel, Dana M; Backinger, Cathy L; Compton, Wilson M; Hyland, Andrew J

2017-01-26

Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States. We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored. More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts. During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.).

Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014

PubMed Central

Kasza, Karin A.; Ambrose, Bridget K.; Conway, Kevin P.; Borek, Nicolette; Taylor, Kristie; Goniewicz, Maciej L.; Cummings, K. Michael; Sharma, Eva; Pearson, Jennifer L.; Green, Victoria R.; Kaufman, Annette R.; Bansal-Travers, Maansi; Travers, Mark J.; Kwan, Jonathan; Tworek, Cindy; Cheng, Yu-Ching; Yang, Ling; Pharris-Ciurej, Nikolas; van Bemmel, Dana M.; Backinger, Cathy L.; Compton, Wilson M.; Hyland, Andrew J.

2017-01-01

BACKGROUND Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States. METHODS We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored. RESULTS More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts. CONCLUSIONS During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.) PMID

Electronic cigarette use and indoor air quality in a natural setting.

PubMed

Soule, Eric K; Maloney, Sarah F; Spindle, Tory R; Rudy, Alyssa K; Hiler, Marzena M; Cobb, Caroline O

2017-01-01

Secondhand smoke (SHS) from combustible cigarettes causes numerous diseases. Policies have been developed to prevent SHS exposure from indoor cigarette use to reduce health risks to non-smokers. However, fewer policies have been implemented to deter electronic cigarette (ECIG) use indoors, and limited research has examined the impact of secondhand exposure to ECIG aerosol. Indoor air quality was measured at a 2-day ECIG event held in a large room at a hotel. Fine particulate matter (PM) was measured using 2 devices that measured concentrations of PM 2.5 μm aerodynamic diameter or smaller (PM 2.5 ). Measurements were taken before the event, over 2 days when the event was ongoing, and the day after the event. PM 2.5 measurements were also taken from the restaurant at the hotel hosting the event and a restaurant at a nearby hotel. During 6 time points when the event was ongoing, between 59 and 86 active ECIG users were present in the event room (room volume=4023 m 3 ). While the event was ongoing, median PM 2.5 concentrations in the event room increased from a baseline of 1.92-3.20 μg/m 3 to concentrations that ranged from 311.68 μg/m 3 (IQR 253.44-411.84 μg/m 3 ) to 818.88 μg/m 3 (IQR 760.64-975.04 μg/m 3 ). PM 2.5 concentrations observed at the ECIG event were higher than concentrations reported previously in hookah cafés and bars that allow cigarette smoking. This study indicates that indoor ECIG use exposes non-users to secondhand ECIG aerosol. Regulatory bodies should consider establishing policies that prohibit ECIG use anywhere combustible cigarette use is prohibited. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Adolescents’ and Young Adults’ Knowledge and Beliefs About Constituents in Novel Tobacco Products

PubMed Central

Cornacchione, Jennifer; Wagoner, Kimberly G.; Noar, Seth M.; Moracco, Kathryn E.; Teal, Randall; Wolfson, Mark; Sutfin, Erin L.

2016-01-01

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

Association between use of flavoured tobacco products and quit behaviours: findings from a cross-sectional survey of US adult tobacco users

PubMed Central

Smith, Danielle M; Bansal-Travers, Maansi; Huang, Jidong; Barker, Dianne; Hyland, Andrew J; Chaloupka, Frank

2017-01-01

Background Non-menthol characterising flavours (eg, fruit, candy) are banned in cigarettes, yet are still permitted in non-cigarette tobacco (NCT) products. This study examined associations between first use and current use of flavoured tobacco products, and current flavoured tobacco use and quit behaviours. Methods A nationally representative, telephone-based survey completed in 2012 by 1443 US adult tobacco users asked about use of 9 tobacco products: cigarettes, e-cigarettes, cigars, cigarillos, little filtered cigars, pipes, hookah, smokeless tobacco and snus. Ever users reported first use of flavoured products, while current users also reported current flavoured product use. Current users reported quit attempts made in the past year. Data were weighted to reflect the US adult tobacco user population. Logistic regression models were used to examine associations between first/current flavour use and quit behaviours. Results Over 70% of respondents reported first use of a flavoured tobacco product, while 54% reported current use of at least one flavoured product. Odds of current flavoured product use were greater among those who reported first use of a flavoured product (OR 14.82, 95% CI 9.96 to 22.06). First use of a flavoured product was associated with being a current tobacco user (OR 1.55, 95% CI 1.08 to 2.22). Compared to single product users, polytobacco users exhibited greater odds of reporting current use of flavoured products (OR 2.09, 95% CI 1.47 to 2.97). Forty-four percent of current tobacco users reported a past-year quit attempt. Adjusted analyses among current NCT users of at least one flavoured tobacco product showed reduced odds of reporting a quit attempt. Conclusions First use of a flavoured tobacco product was associated with current flavoured tobacco use and polytobacco use. Users of only flavoured NCT products exhibited reduced odds of reporting a quit attempt. Findings from this study reinforce the importance of flavoured product

Tobacco Product Use Among Adults - United States, 2015.

PubMed

Phillips, Elyse; Wang, Teresa W; Husten, Corinne G; Corey, Catherine G; Apelberg, Benjamin J; Jamal, Ahmed; Homa, David M; King, Brian A

2017-11-10

Tobacco use remains the leading cause of preventable disease and death in the United States (1). Despite declining cigarette smoking prevalence among U.S. adults, shifts in the tobacco product landscape have occurred in recent years (2,3). Previous estimates of tobacco product use among U.S. adults were obtained from the National Adult Tobacco Survey, which ended after the 2013-2014 cycle. This year, CDC and the Food and Drug Administration (FDA) assessed the most recent national estimates of tobacco product use among adults aged ≥18 years using, for the first time, data from the 2015 National Health Interview Survey (NHIS), an annual, nationally representative, in-person survey of the noninstitutionalized U.S. civilian population. The 2015 NHIS adult core questionnaire included 33,672 adults aged ≥18 years, reflecting a 55.2% response rate. Data were weighted to adjust for differences in selection probability and nonresponse, and to provide nationally representative estimates. In 2015, 20.1 % of U.S. adults currently (every day or some days) used any tobacco product, 17.6% used any combustible tobacco product, and 3.9% used ≥2 tobacco products. By product, 15.1% of adults used cigarettes; 3.5% used electronic cigarettes (e-cigarettes); 3.4% used cigars, cigarillos, or filtered little cigars; 2.3% used smokeless tobacco; and 1.2% used regular pipes, water pipes, or hookahs.* Current use of any tobacco product was higher among males; persons aged <65 years; non-Hispanic American Indian/Alaska natives (AI/AN), whites, blacks, and persons of multiple races; persons living in the Midwest; persons with a General Educational Development (GED) certificate; persons with annual household income of <$35,000; persons who were single, never married, or not living with a partner or divorced, separated, or widowed; persons who were insured through Medicaid or uninsured; persons with a disability; and persons who identified as lesbian, gay, or bisexual (LGB). Current use of

Moving toward a true depiction of tobacco behavior among Asian Indians in California: Prevalence and factors associated with cultural smokeless tobacco product use.

PubMed

Mukherjea, Arnab; Modayil, Mary V; Tong, Elisa K

2018-04-01

Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population. California Asian Indian Tobacco Use Survey data from 2004 (n = 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use. The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for ≥$100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5). The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such

Impact of Training High School Female Students in Ahvaz, Iran in the Social Skills Required to Avoid the Use of Drugs

PubMed Central

Alavijeh, Freshteh Zamani; Raisi, Zahra; Asadollahi, Abdolrahim; Irani, Reza Davasaz; Kalhori, Sharareh Rostam Niakan

2016-01-01

Introduction Gender composition and the soaring trends of drug and tobacco dependency reveal the priority of social skills training related to drug avoidance self-efficacy among female students. The aim of this study was to verify the impact training high school female students to have the social skills needed to avoid the use of drugs. Methods This study was conducted from September 2012 to May 2013 in two high schools in Ahvaz City in southwest Iran. The participants were divided randomly into two groups of 60 students, one experimental group and one control group using the multi-stage simple sampling method. Two questionnaires, i.e. the ASES and TISS questionnaires, were completed before and after the intervention. Descriptive statistics, chi squared, paired-samples t-test, and the independent-samples t-test were used. Results The participants had a mean age of 14.93 years. Among the 120 participants, 90.8% indicated that they had never smoked a cigarette, and 51.7% of the participants denied having smoked a hookah. There was no significant relationship between the self-sufficiency means of drug avoidance in the two groups of girls before intervention (p ≥ 0.05). However, after intervention, a significant difference was found in test score of self-efficacy of drug avoidance between the two groups, i.e., 94.91 ± 8.3 for the control group versus 99.16 ± 3.8 for the experimental group, p < 0.05). Significant increases were observed for the pre- and post-test scores of self-efficacy of drug avoidance in the experimental group compared to the control group (99.16 ± 3.8 (p = 0.001) vs. 96.58 ± 6.98 (p > 0.05). The mean values of the pre- and post-test scores of social skill before and after intervention increased significantly only for the experimental group (97.60 ± 19.19 vs. 100.58 ± 12.37, p = 0.03). Conclusion Educational intervention can significantly enhance social skills for drug avoidance self-efficacy, so it is recommended that such skills be taught

Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016.

PubMed

Hair, Elizabeth C; Romberg, Alexa R; Niaura, Raymond; Abrams, David B; Bennett, Morgane A; Xiao, Haijun; Rath, Jessica M; Pitzer, Lindsay; Vallone, Donna

2018-02-13

Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for

Trends in Tobacco Product Use Patterns Among U.S. Youth, 1999-2014.

PubMed

El-Toukhy, Sherine; Sabado, Melanie; Choi, Kelvin

2018-05-03

prevalent among 11- to 17-year-old tobacco users. The recent extension of FDA's regulatory jurisdiction over all tobacco products (e.g. e-cigarettes, hookah) is a step toward comprehensive tobacco control especially among youth. Public health practitioners should extend prevention and cessation efforts among youth to T-PUPs beyond exclusive cigarette smoking.

A web-based program to increase knowledge and reduce cigarette and nargila smoking among Arab university students in Israel: mixed-methods study to test acceptability.

PubMed

Essa-Hadad, Jumanah; Linn, Shai; Rafaeli, Sheizaf

2015-02-20

Among Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods. The purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel. A pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program. A total of 225 participants-response rate of 63.2% (225/356)-completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would recommend the program to their friends

State laws prohibiting sales to minors and indoor use of electronic nicotine delivery systems--United States, November 2014.

PubMed

Marynak, Kristy; Holmes, Carissa Baker; King, Brian A; Promoff, Gabbi; Bunnell, Rebecca; McAfee, Timothy

2014-12-12

Electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes) and other devices such as electronic hookahs, electronic cigars, and vape pens, are battery-powered devices capable of delivering aerosolized nicotine and additives to the user. Experimentation with and current use of e-cigarettes has risen sharply among youths and adults in the United States. Youth access to and use of ENDS is of particular concern given the potential adverse effects of nicotine on adolescent brain development. Additionally, ENDS use in public indoor areas might passively expose bystanders (e.g., children, pregnant women, and other nontobacco users) to nicotine and other potentially harmful constituents. ENDS use could have the potential to renormalize tobacco use and complicate enforcement of smoke-free policies. State governments can regulate the sales of ENDS and their use in indoor areas where nonusers might be involuntarily exposed to secondhand aerosol. To learn the current status of state laws regulating the sales and use of ENDS, CDC assessed state laws that prohibit ENDS sales to minors and laws that include ENDS use in conventional smoking prohibitions in indoor areas of private worksites, restaurants, and bars. Findings indicate that as of November 30, 2014, 40 states prohibited ENDS sales to minors, but only three states prohibited ENDS use in private worksites, restaurants, and bars. Of the 40 states that prohibited ENDS sales to minors, 21 did not prohibit ENDS use or conventional smoking in private worksites, restaurants, and bars. Three states had no statewide laws prohibiting ENDS sales to minors and no statewide laws prohibiting ENDS use or conventional smoking in private worksites, restaurants, and bars. According to the Surgeon General, ENDS have the potential for public health harm or public health benefit. The possibility of public health benefit from ENDS could arise only if 1) current smokers use these devices to switch completely

Association between use of flavoured tobacco products and quit behaviours: findings from a cross-sectional survey of US adult tobacco users.

PubMed

Smith, Danielle M; Bansal-Travers, Maansi; Huang, Jidong; Barker, Dianne; Hyland, Andrew J; Chaloupka, Frank

2016-11-01

Non-menthol characterising flavours (eg, fruit, candy) are banned in cigarettes, yet are still permitted in non-cigarette tobacco (NCT) products. This study examined associations between first use and current use of flavoured tobacco products, and current flavoured tobacco use and quit behaviours. A nationally representative, telephone-based survey completed in 2012 by 1443 US adult tobacco users asked about use of 9 tobacco products: cigarettes, e-cigarettes, cigars, cigarillos, little filtered cigars, pipes, hookah, smokeless tobacco and snus. Ever users reported first use of flavoured products, while current users also reported current flavoured product use. Current users reported quit attempts made in the past year. Data were weighted to reflect the US adult tobacco user population. Logistic regression models were used to examine associations between first/current flavour use and quit behaviours. Over 70% of respondents reported first use of a flavoured tobacco product, while 54% reported current use of at least one flavoured product. Odds of current flavoured product use were greater among those who reported first use of a flavoured product (OR 14.82, 95% CI 9.96 to 22.06). First use of a flavoured product was associated with being a current tobacco user (OR 1.55, 95% CI 1.08 to 2.22). Compared to single product users, polytobacco users exhibited greater odds of reporting current use of flavoured products (OR 2.09, 95% CI 1.47 to 2.97). Forty-four percent of current tobacco users reported a past-year quit attempt. Adjusted analyses among current NCT users of at least one flavoured tobacco product showed reduced odds of reporting a quit attempt. First use of a flavoured tobacco product was associated with current flavoured tobacco use and polytobacco use. Users of only flavoured NCT products exhibited reduced odds of reporting a quit attempt. Findings from this study reinforce the importance of flavoured product availability in the USA, which may have

Adolescents' and Young Adults' Knowledge and Beliefs About Constituents in Novel Tobacco Products.

PubMed

Wiseman, Kimberly D; Cornacchione, Jennifer; Wagoner, Kimberly G; Noar, Seth M; Moracco, Kathryn E; Teal, Randall; Wolfson, Mark; Sutfin, Erin L

2016-07-01

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. 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. 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. 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. The results of this study have implications for how the FDA and other agencies can communicate about the risks of novel

Cigar Product Modification Among High School Youth.

PubMed

Trapl, Erika S; Koopman Gonzalez, Sarah J; Cofie, Leslie; Yoder, Laura D; Frank, Jean; Sterling, Kymberle L

2018-02-07

Prevalence of cigar use has been increasing among youth. Research indicates that youth are modifying cigar products either by "freaking" (ie, removing the filter paper) or "blunting" (removing the tobacco and supplementing or replacing with marijuana), yet little is known about youth who engage in this behavior. Thus, this study examines demographic and concurrent substance use behaviors of youth who modify cigars. Data from the 2013 Cuyahoga County Youth Risk Behavior survey were examined (n = 16 855). The survey collected data on demographics, cigar product use, cigar modification behaviors, and current cigarette, hookah and marijuana use. Responses to cigar product use items were used to create a composite to classify youth in one of eight unique user categories. Univariate and bivariate statistics were calculated using SPSS complex samples procedures. Overall, 15.2% reported current cigar product use, 11.0% reported current freaking, and 18.5% reported current blunt use; taken together, 25.3% of respondents reported any current use of a cigar product. When examined by user category, of those who endorsed any cigar product use, cigars, cigarillos, and little cigars use only was most endorsed (26.3%), followed by Blunt only (25.2%) and all three (ie, cigars, cigarillos, and little cigars, freaking, and blunting; 17.4%). A substantial proportion of high school youth who report using cigar products are modifying them in some way, with nearly half freaking and nearly two-thirds blunting. Given the FDA Center for Tobacco products recent extension of its regulatory authority to include cigar products, it is imperative to understand more about the prevalence of and reasons for cigar modification behaviors. Although the FDA has recently enacted regulatory authority over cigar products, little is known about cigar product modification. This is the first study to concurrently examine two unique cigar modification behaviors, "freaking" (ie, removing the filter paper) and

A Web-Based Program to Increase Knowledge and Reduce Cigarette and Nargila Smoking Among Arab University Students in Israel: Mixed-Methods Study to Test Acceptability

PubMed Central

Linn, Shai; Rafaeli, Sheizaf

2015-01-01

Background Among Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods. Objective The purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel. Methods A pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program. Results A total of 225 participants—response rate of 63.2% (225/356)—completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would

Recent advances in oesophageal diseases.

PubMed

Al Dulaimi, David

2014-01-01

-esophageal reflux disease alongside more vigilant recording of new cases. Social class was inversely associated with the ASIR of EC regardless of gender which may be attributed to class differences in risk factor distribution particularly smoking, diet and obesity. An appreciation for the limitations of an epidemiological study is important when interpreting results which should be further evaluated in future studies. Islami F et al.Determinants of gastroesophageal reflux disease, including hookah smoking and opium use- A cross-sectional analysis of 50,000 individuals. PLoS One 2014;9(2):e89256 Gastroesophageal reflux disease (GERD) is a highly prevalent cause of gastrointestinal symptoms worldwide incurring great cost to the primary and secondary healthcare sectors. An improved understanding of the factors which influence GERD symptoms in low- to medium- income countries may inform public health initiatives. This study analysed prospective data from the Golestan cohort study, primarily established to investigate determinants of upper gastrointestinal cancers, toexplore the risk factors influencing GERD symptoms (regurgitation and/or heartburn) in 50,045 individuals aged 40-75 years in Golestan Province, Iran enrolled between 01/2004 and 06/2008.Of note, 39.12% of individuals denied ever experiencing GERD symptoms. A further 19.89% reported at least once weekly GERD symptoms with 11.83% experiencing daily symptoms. Severe symptoms, defined as disturbing daily work or sleep, were recorded by 11.33% of individuals. Separately the occurrence of daily GERD symptoms and severe symptoms were inversely associated with male gender (OR 0.36, 95% CI 0.33-0.39 both), level of formal education (p=0.01 and p=0.001 respectively), wealth score (p<0.001 both) and regular nass chewing (OR 0.86, 95% CI 0.75-0.98 and OR 0.87, 95% CI 0.76-0.99 respectively)and were positively associated with body mass index (p<0.001 both), intensity of physical activity (p=0.04 both), cigarette pack years (p<0

E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends

PubMed Central

Ferrara, Emilio; Uppu, Sree Priyanka; Cruz, Tess Boley; Unger, Jennifer B

2017-01-01

Background As e-cigarette use rapidly increases in popularity, data from online social systems (Twitter, Instagram, Google Web Search) can be used to capture and describe the social and environmental context in which individuals use, perceive, and are marketed this tobacco product. Social media data may serve as a massive focus group where people organically discuss e-cigarettes unprimed by a researcher, without instrument bias, captured in near real time and at low costs. Objective This study documents e-cigarette–related discussions on Twitter, describing themes of conversations and locations where Twitter users often discuss e-cigarettes, to identify priority areas for e-cigarette education campaigns. Additionally, this study demonstrates the importance of distinguishing between social bots and human users when attempting to understand public health–related behaviors and attitudes. Methods E-cigarette–related posts on Twitter (N=6,185,153) were collected from December 24, 2016, to April 21, 2017. Techniques drawn from network science were used to determine discussions of e-cigarettes by describing which hashtags co-occur (concept clusters) in a Twitter network. Posts and metadata were used to describe where geographically e-cigarette–related discussions in the United States occurred. Machine learning models were used to distinguish between Twitter posts reflecting attitudes and behaviors of genuine human users from those of social bots. Odds ratios were computed from 2x2 contingency tables to detect if hashtags varied by source (social bot vs human user) using the Fisher exact test to determine statistical significance. Results Clusters found in the corpus of hashtags from human users included behaviors (eg, #vaping), vaping identity (eg, #vapelife), and vaping community (eg, #vapenation). Additional clusters included products (eg, #eliquids), dual tobacco use (eg, #hookah), and polysubstance use (eg, #marijuana). Clusters found in the corpus of hashtags

Smoking in Africa: the coming epidemic.

PubMed

Taha, A; Ball, K

1982-01-01

This discussion describes the development of tobacco smoking in Africa, the increase in consumption, and how tobacco use is promoted. It also presents evidence to show that smoking-related diseases similar to those seen in Western nations may be emerging. Tobacco was first introduced into Africa in the 16th century by the Turks who brought it into Egypt. The smoking habits of today's Africans are governed by local custom and economic status. Cigarette smoking is replacing the traditional pipe (hookah), although the latter is still used, particularly in rural areas. The prevalence of smoking is higher in urban than rural areas. Traditionally, only men smoked, but the proportion of women smokers is now rising. Smoking is also increasing among African children and adolescents. Cigarette consumption was examined in the 6 African countries from which statistics were available. In all of them, it rose steeply between 1967-76 and actually doubled in Libya and Ethiopia. In Egypt domestic cigarette sales increased by 23% between 1976-78, but sales of imported cigarettes rose by 25% in 1 year alone. Consumption of imported cigarettes is rising in many African countries. Between 1965-76 the volume of tobacco imports almost doubled. Cigarette smuggling is common in some African countries and may account for about 1/3 of total cigarette consumption in the Sudan. Some African countries are expanding tobacco agriculture so that they can supply their own needs. Nigeria has increased tobacco cultivation by about 10% a year to meet local dmeands. Zaire's imports of tobacco increased by about 30% between 1969-73 but now expects to become self sufficient in tobacco production. Tanzania's tobacco output incrased 7-fold between 1962-74 and will continue to grow through the help of the International Development Association. Cigarettes are heavily promoted in Africa. The advertisements present smoking as socially desirable by showing young, happy people and by relating it to manliness and

E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends.

PubMed

Allem, Jon-Patrick; Ferrara, Emilio; Uppu, Sree Priyanka; Cruz, Tess Boley; Unger, Jennifer B

2017-12-20

As e-cigarette use rapidly increases in popularity, data from online social systems (Twitter, Instagram, Google Web Search) can be used to capture and describe the social and environmental context in which individuals use, perceive, and are marketed this tobacco product. Social media data may serve as a massive focus group where people organically discuss e-cigarettes unprimed by a researcher, without instrument bias, captured in near real time and at low costs. This study documents e-cigarette-related discussions on Twitter, describing themes of conversations and locations where Twitter users often discuss e-cigarettes, to identify priority areas for e-cigarette education campaigns. Additionally, this study demonstrates the importance of distinguishing between social bots and human users when attempting to understand public health-related behaviors and attitudes. E-cigarette-related posts on Twitter (N=6,185,153) were collected from December 24, 2016, to April 21, 2017. Techniques drawn from network science were used to determine discussions of e-cigarettes by describing which hashtags co-occur (concept clusters) in a Twitter network. Posts and metadata were used to describe where geographically e-cigarette-related discussions in the United States occurred. Machine learning models were used to distinguish between Twitter posts reflecting attitudes and behaviors of genuine human users from those of social bots. Odds ratios were computed from 2x2 contingency tables to detect if hashtags varied by source (social bot vs human user) using the Fisher exact test to determine statistical significance. Clusters found in the corpus of hashtags from human users included behaviors (eg, #vaping), vaping identity (eg, #vapelife), and vaping community (eg, #vapenation). Additional clusters included products (eg, #eliquids), dual tobacco use (eg, #hookah), and polysubstance use (eg, #marijuana). Clusters found in the corpus of hashtags from social bots included health (eg