Current Hookah Use Research Articles

Disparities in Substance Co-Use among Sexual Minority and Heterosexual Adult Hookah Smokers: Findings from Wave 4 (2016–2018) and Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study

Heavily advertised as a harmless tobacco alternative, hookah (i.e., waterpipe)-flavored tobacco smoking has contributed to the wider epidemic of smoking, especially amongst marginalized sexual minority (SM) populations. Evidence regarding the concurrent use of substances and other drugs, among SM current hookah smokers, is scarce. We utilized nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study (2016–2019) to examine patterns of the concurrent use of substances (i.e., marijuana, painkillers, sedatives, tranquilizers, cocaine, stimulants (specifically methamphetamines), and others), in SM adult hookah smokers and their heterosexual counterparts. Current hookah smoking is higher among SM adults (Wave 4: 4.22% [95% CI = 2.94–5.94] and Wave 5: 2.65% [95% CI = 1.81–3.48]) than heterosexuals (Wave 4: 1.31% [95% CI = 1.13–1.50] and Wave 5: 1.07% [95% CI = 0.89–1.25]). Among current SM hookah users, the co-use of substances, including alcohol, marijuana, and cocaine, is comparable to heterosexuals (p = ns). Adjusting for gender alone and all covariates, including age, sex, race/ethnicity, education, income, and education, no differences in concurrent substance use were observed between SM and heterosexual hookah users. While the co-use of substances is comparable between SM and heterosexual hookah smoker adults, the prevalence of current hookah use more than doubled among SM individuals than heterosexual individuals during 2018–2019. Our findings highlight the critical value of prevention efforts directed to increase education and awareness about hookah smoking use and known health effects, particularly tailored towards sexual minorities.

Vaping and Hookah Use Among Medical Trainees: A Multinational Survey Study

The increased use of e-cigarettes and hookah among young consumers represents a public health concern. This study aimed to investigate the frequency and patterns of use of e-cigarettes and hookah among medical trainees. This cross-sectional multinational online survey included medical students, residents, and fellows in Brazil (BR), the United States (US), and India (IN) between October-2020 and November-2021. Information on sociodemographics, mental health, and e-cigarettes, hookah, tobacco, marijuana, and alcohol use were collected. Generalized structural equation models were used in 2022 to explore factors associated with current vaping and current hookah use (ongoing monthly/ weekly/ daily use). People reporting previous sporadic/ frequent use or those who never used/ only tried it once were the reference group. Overall, 7,526 participants were recruited (BR =3,093, US =3,067, IN =1,366). The frequency of current vaping was 20% (BR), 11% (US), and <1% (IN) and current hookah use was 10% (BR), 6% (US), and 1% (IN). Higher family income [OR 6.35(4.42-9.12)], smoking cigarettes [(OR 5.88(4.88-7.09)] and marijuana [(OR 2.8(2.35-3.34)], and binge drinking [(OR 3.03(2.56-3.59)] were associated with current vaping. The same was true for hookah use: higher family income [OR 2.69(1.75- 4.14)], smoking cigarettes [(OR 3.20(2.53-4.06)], marijuana [(OR 4.17(3.35-4.19)], and binge drinking [(OR 2.42(1.96-2.99)]. In conclusion, e-cigarettes and hookah were frequently used by Brazilian and American trainees, sharply contrasting with data from India. Cultural aspects and public health policies may explain differences among countries. Addressing the problems of hookah and e-cigarette smoking in this population is relevant to avoid the "renormalization" of smoking.

Perceptions of electronic cigarettes among ethno-culturally diverse Latino adults in four US urban centers

ABSTRACT Objective The aim of this study was to examine perceptions including knowledge, attitudes, and beliefs about e-cigarettes among ethno-culturally diverse Latino adults living in the US, a rapidly growing minority group for which we know little about their e-cigarette perceptions. Design A total of 25 focus groups with Latinos (n = 180; ages 18–64 years) were conducted in 2014. E-cigarettes users and non-users were recruited via purposive sampling techniques. Participants completed brief questionnaires on sociodemographic factors and tobacco use. Focus group discussions were conducted in English and Spanish, audio-recorded, and transcribed. Data were analyzed using thematic analysis procedures. Results Participants were of diverse Latino backgrounds. Over one-third (35%) reported current cigarette smoking and 8% reported current e-cigarette or hookah use. Nonsmokers reported experimenting with e-cigarettes and hookah during social occasions. Participants’ perceptions towards e-cigarettes were generally formed in comparison to conventional cigarettes. Perceived benefits of using e-cigarettes included their utility as a smoking cessation aid, higher social acceptability, and lower harm compared to conventional cigarettes. Negative perceptions of e-cigarettes included lower overall satisfaction compared to conventional cigarettes and high content of toxins. Socio-cultural factors (e.g. gender roles, familismo, and simpatía) also influenced perceptions of e-cigarette of study participants. Conclusions Overall, Latino adults knew relatively little about the potential health risks associated with e-cigarette use. The limited knowledge about and misinformation of e-cigarettes among this rapidly growing minority group have important public health implications. Findings may inform culturally tailored health communication campaigns, which are much needed among underserved US Latino populations in light of low effectiveness of tobacco control and regulatory efforts.

Patterns of tobacco use and nicotine dependence among youth, United States, 2017–2018

This study examined patterns of tobacco product use and their association with nicotine dependence among U.S. youth. Combined data from the 2017–2018 National Youth Tobacco Surveys were analyzed for students that reported current (past-30-day) use of e-cigarettes, cigarettes, cigars, smokeless tobacco, or hookah (n = 6106). Analyses assessed multiple product use (≥2 tobacco products) overall and by sex, school level, race/ethnicity, current use, and frequent use (use of a product for ≥20 of the preceding 30 days). Multivariable logistic regression was used to identify correlates of nicotine dependence. During 2017–2018, 40.8% of tobacco product users reported use of multiple products. Multiple product use ranged from 47.0% among e-cigarette users to 80.7% among cigarette smokers. Among frequent users of each respective product, 80.0% of cigarette smokers, 74.9% of cigar smokers, 73.6% of smokeless tobacco users, 70.7% of hookah smokers, and 40.3% of e-cigarette users reported use of multiple products. Most youth who reported nicotine dependence (64.0%) were multiple product users. E-cigarettes were the most common single product used (36.3%) and the product most commonly used in combination with other products; e-cigarettes plus cigarettes (6.7%) was the most common product combination. Combustible product use, smokeless tobacco use, multiple product use and frequent use were associated with greater odds of nicotine dependence. Nicotine dependence among youth is especially influenced by cigarette use, smokeless tobacco use, frequent use of any tobacco product, and multiple product use. Proven tobacco control interventions in coordination with regulatory efforts can reduce youth tobacco product use.

Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students

BackgroundMost hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students.MethodsA cross-sectional survey of 2460 students (aged 18–25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns.ResultsAmong current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001.ConclusionsThe socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.

Patterns of electronic cigarette, conventional cigarette, and hookah use and related passive exposure among adolescents in Kuwait: A cross-sectional study.

INTRODUCTIONUse of tobacco products among adolescents is a major global public health concern. Given the changing landscape of tobacco product use and the lack of epidemiologic data to inform tobacco prevention and control strategies in Kuwait, this study sought to estimate the prevalence and patterns of electronic cigarette (e-cigarette), conventional cigarette, and hookah use among adolescents in Kuwait. Moreover, exposure to secondhand smoke (SHS) and secondhand aerosol (SHA) from e-cigarettes was assessed.METHODSThis cross-sectional study enrolled high school students (n=1565; 16–19 years) across Kuwait. Current (past 30-day) use of e-cigarettes, conventional cigarettes, and hookah were assessed through self-reported data. Additionally, current (past 7-day) exposure to SHS and SHA in households and public places were ascertained. Associations were evaluated using Poisson regression, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated.RESULTSOverall, 26.4% (402/1525), 25.1% (383/1525), and 20.9% (318/1525) of the study participants were current e-cigarette users, conventional cigarette smokers, and hookah smokers, respectively. Current use of any tobacco product was reported by 35.1% (535/1525) of the total study participants. The prevalence of concurrent triple use of ‘e-cigarettes, conventional cigarettes, and hookah’ was estimated to be 12.8% (195/1525). Also, among the study participants, 41.9% (619/1479) were exposed to household SHS, 32.0% (469/1465) were exposed to household SHA, and 62.2% (916/1472) were exposed to SHS and/or SHA in public places. Male adolescents were more likely than females to be current e-cigarette users (APR=5.19; 95% CI: 4.09–6.57), conventional cigarette smokers (APR=5.42; 95% CI: 4.26–6.90), and hookah smokers (APR=3.43; 95% CI: 2.72– 4.32).CONCLUSIONSA substantial proportion of adolescents in Kuwait are currently using tobacco products and being exposed to SHS/SHA. The findings emphasize the need to continue monitoring all forms of tobacco product use among adolescents and to strengthen tobacco prevention and control programs.

Transitions across tobacco use profiles among adolescents: results from the Population Assessment of Tobacco and Health (PATH) study waves 1 and 2.

To estimate progression to polytobacco use (PTU) over 1year among a sample of US youth. Prospective survey with two waves 1year apart: wave 1 (2013-14) and wave 2 (2014-15). We conducted latent transition analysis (LTA) to identify latent class transitions and examine socio-demographic predictors of transition types. United States. A total of 11, 996 people who were aged 12-17 years at wave 1. Publicly available data were used from the Population Assessment of Tobacco and Health (PATH) study, a nationally representative sample of US civilian, non-institutionalized population aged 12 years and older. Tobacco use status was assessed and classified in terms of: never use, non-current (not in the past 30 days) and current (past 30-day) use of cigarettes, cigars, e-cigarettes, hookah and smokeless tobacco. Other nicotine products were excluded because rates of use were either too low to model (e.g. pipe) or the product was not assessed in the PATH youth sample (e.g. nicotine replacement products). We identified three distinct patterns: class 1, non-use (wave 1 prevalence=86%; wave 2 prevalence=78%); class 2, ever use of cigarettes and e-cigarettes (wave 1 prevalence=11%; wave 2 prevalence =14%); and class 3, current PTU (wave 1 prevalence=4%; wave 2 prevalence=7%). Probability of progression from non-use to ever use of cigarettes and e-cigarettes was 0.06 and ever use of cigarettes and e-cigarettes to current PTU was 0.32. Non-users were more likely to transition to ever use of cigarettes and e-cigarettes if they were older (versus younger), white (versus non-white) or if their parental education level was high school or less (versus more than high school); and ever users of cigarettes and e-cigarettes to current PTU if they were older, male or white. US youth who had previously tried e-cigarettes and cigarettes at wave 1 (2013-14) had a 32% chance of transitioning to current use of two or more tobacco products within 1year.

Longitudinal Patterns of Multiple Tobacco and Nicotine Product Use Among Texas College Students: a Latent Transition Analysis.

Diverse tobacco and nicotine products have altered the terrain of tobacco use behaviors. Limited research has examined contemporary patterns of use among young adults. This study identified tobacco and nicotine product use groups and examined changes in young adults' use patterns, across a 1.5-year period. Participants were 5,482 18-29-year-old students (M age = 20.5, SD = 2.36; 63% female) from 24 Texas colleges who completed a four-wave bi-annual online survey. Latent transition analysis was used to identify groups from 10 items (ever and current use of cigarettes, cigars, smokeless tobacco, e-cigarettes, and hookah) and to examine probabilities of transitioning between groups over four waves. Five groups were identified: Non-users (30%), Poly-experimenters (26%), Hookah experimenters (18%), E-cigarette & hookah experimenters (15%), and Poly-cigarette users (11%). Few students transitioned between groups over time. Poly-cigarette users had the highest average probability of remaining stable over time (1.00), followed by E-cigarette & hookah experimenters (.97), Non-users (.94), Poly-experimenters (.93), and Hookah experimenters (.92). All groups became more stable over time except Hookah experimenters whose members were most likely to transition to Poly-cigarette users or other experimenter groups. The greatest transition was from Poly-experimenters to Poly-cigarette users with probabilities of .10, .08, and .03 for transitioning between waves one and two, two and three, and three and four, respectively. There was substantial poly-use and experimentation, which may explain little movement between groups over the 1.5-year time period and underscores the need for prevention programs targeting multiple product use among college students.

Exposure to Multimedia Tobacco Marketing and Product Use Among Youth: A Longitudinal Analysis.

Tobacco companies continue to reach youth through direct-to-consumer marketing, which has been associated with overall tobacco use. We examine how exposure to these marketing activities influences product-specific use behaviors. We analyzed data from 10 081 youth (aged 12-18 years) who participated in Waves 1 and 2 (2013-2015) of the Population Assessment of Tobacco and Health (PATH) Study. Participants reported past 6-month tobacco coupon receipt and online tobacco marketing engagement, and susceptibility to ever and current use of cigarette, e-cigarettes, cigars, smokeless tobacco, and hookah. Weighted multivariable logistic regression examined Wave 1 predictors of coupon receipt at Wave 2, and associations between coupon receipt, online engagement, and past 30-day use of different tobacco products. Youth received tobacco coupons at one (9.7%) or both waves (1.2%) and 11.1% engaged with online tobacco marketing. Coupon receipt and online marketing engagement at Wave 1 predicted Wave 2 coupon receipt among susceptible-never, ever-but-not-current, and current tobacco users (p < .05). Coupon receipt and online engagement at Wave 1 was positively associated with past 30-day use of cigarettes, e-cigarettes, cigars, smokeless tobacco, and hookah at Wave 2 (p < .05). The relationships were stronger for those who received coupons at both waves or engaged with more sources of online marketing. Tobacco direct-to-consumer marketing is reaching youth. Repeated exposure to these marketing activities within and across media is associated with use of different tobacco products. New policies and strong enforcement of existing regulations prohibiting these illegal marketing tactics are critical to protect youth from future tobacco use. Tobacco companies utilize coupons and online engagement activities to increase brand awareness, knowledge, and sales of their products. These kinds of marketing activities can be influential among youth at a time when they may develop tobacco use behaviors. Our findings suggest that tobacco companies may be targeting at-risk youth through cross-media marketing activities. The findings also indicate that exposure to these marketing activities predicts subsequent use of different tobacco products, with suggestive dose-response relationships. Increased regulations are needed to protect youth from these marketing activities.

Factors related to the use of hookah among medical students.

ABSTRACTObjectiveThis study evaluated the factors related to the use of hookah among medical students, the level of knowledge about the involved harms, and their relationship with the use and intention to stop using it.MethodsStudents of the 1st and 6th year of medical school were evaluated. A multivariate logistic regression model was used to evaluate the association between the outcome (use of hookah in the last 30 days) and demographic, subjective psychosocial data and level of knowledge about the harms of hookah use.ResultsThe experimentation rate of hookah and current use was high (59.6% and 27.7%, respectively), with no difference between the 1st and 6th year groups (p=0.70). The 6th grade students were more knowledgeable about the harm of using hookah when compared to the 1st year students (p <0.0001), and there was no association between the use of hookah in the last 30 days and the knowledge about its harms. Cigarette smoking and the use of alcoholic beverages were associated with the use of hookah in the last 30 days, with unadjusted Odds Ratio (OR) of 11.3; 95% CI 4.62-27.7; p <0.0001 and OR 8.74; 95% CI 3.78-20.2; p <0.0001; respectively.ConclusionThere is a high experimentation, current use of hookah and cigarettes among medical students. Sixth year students are more knowledgeable about the harms involved. There was no association between the use of hookah in the last 30 days and the knowledge about its harms. Smoking and the use of alcoholic beverages are independent predictors of use of hookah.

Tobacco Product Use Among Middle and High School Students - United States, 2011-2017.

Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, ≥2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2).

Trends in Hookah Use Among New York City Middle and High School Students, 2008-2014.

We examined trends in hookah use among New York City middle and high school students. We calculated prevalences, linear trends, and odds ratios of ever and current hookah use, by selected demographic variables, using 2008 through 2014 data from the New York State Youth Tobacco Survey. The prevalence of ever hookah use increased overall from 2008 through 2014 (8.9% to 13.0%, P = .01); current use was stable during this period but increased across many demographic characteristics. Our results indicate a need for efforts to educate populations with increasing prevalence of hookah use as well as policies that regulate use to reduce and denormalize hookah smoking.

Very light smoking and alternative tobacco use among college students

IntroductionConcurrent 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. MethodsParticipants 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). Results88.6% 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. ConclusionsConcurrent 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.

Dual- and Polytobacco/Nicotine Product Use Trends in a National Sample of High School Students.

The study purpose was to examine changes in patterns of ever and current dual- and polyproduct use over time and to examine demographic and modifiable risk factors including tobacco smoke exposure (TSE). A secondary analysis of the 2013 to 2015 National Youth Tobacco Survey data. Nationwide high schools were selected. A total of 31 022 high school students. Ever and current (past 30 days) tobacco/nicotine product use, home tobacco/nicotine product use, TSE and e-cigarette vapor exposure, and demographic characteristics were measured. Multivariable logistic regression and multinomial logistic regression models. Of the students, 9.4% were ever dual users and 18.6% were ever poly users. Rates of ever/current use of e-cigarettes and hookah increased from 2013 to 2015 (all Ps < .001). In 2015, participants were 4.8 times (95% confidence interval [CI], 4.5-5.2) and 4.0 times (95% CI, 3.5-4.4) more likely to report ever/current e-cigarette use and 1.61 times (95% CI, 1.5-1.7) and 1.48 times (95% CI, 1.3-1.7) more likely to report ever/current hookah use. Participants reporting TSE were 15.4 times (95% CI, 11.5-21.0) more likely to report current poly use, and those with e-cigarette exposure were 10.4 times (95% CI, 7.8-13.8) more likely to report current poly use. From 2013 to 2015, rates of ever and current use of e-cigarettes and hookah increased. Tobacco smoke and e-cigarette exposure were associated with higher rates of dual and poly use. Prevention efforts targeting these products are needed.

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

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.

Hookah use among adolescents: Differential cognitions about hookah and cigarettes

BackgroundHookah use is prevalent among adolescent and young adult populations. The study assessed how positive cognitions toward cigarettes moderate the impact of positive hookah cognitions on past 30day hookah use among a representative sample of youth. Understanding cognitions about products can contribute to effective interventions.MethodsData from the 2015 Florida Youth Tobacco Survey was used to determine cognitions and use patterns among high school students. Weighted means and proportions were used for demographic comparisons for cognitions about products. t-Tests and chi-square analysis were conducted for differences between users and non-users. Logistic regressions were conducted for the modeling of interaction between hookah and cigarette cognition.ResultsNearly one out of ten (9.6%) of adolescents reported current hookah use. Across all cognition measures, positive hookah cognitions were associated with current hookah use. Additionally, there was a pattern of hookah cognitions being more strongly associated with current hookah use among those students that did not endorse the equivalent cognition for traditional cigarettes.ConclusionsHookah cognitions were generally more associated with hookah use among youth who did not endorse positive cognitions for cigarettes compared to those that did endorse positive cognitions for cigarettes. This finding is novel given youth who feel negatively about cigarettes are more influenced by their hookah-specific cognitions. Youth who believe cigarettes pose harm may benefit from messaging about the harms of hookah. Interventions or prevention efforts that draw strong comparisons between cigarettes and hookah may be effective among youth.

Trends and Correlates of Hookah Use Among High School Students in North Carolina.

OBJECTIVES Although youth cigarette smoking has declined in the United States, use of alternative tobacco products, such as hookah, has increased. This study assesses changes in prevalence of use from 2011 to 2013, and examines factors associated with current hookah use among North Carolina high school students in 2013.METHODS Data came from the North Carolina Youth Tobacco Survey in 2011 (n = 4,791) and 2013 (n = 4,092). STATA (StataCorp LLC) logistic regression survey procedures account for the complex survey design and sampling weights.RESULTS Prevalence of reported current hookah use significantly increased from 3.6% (95% CI: 2.8-4.5) in 2011 to 6.1% (95% CI: 4.9-7.5) in 2013 while reported lifetime hookah use increased from 9.8% (95% CI: 8.0-12.0) in 2011 to 12.6% (95% CI: 11.0-14.4) in 2013. Correlates of current hookah use included having a weekly disposable income over $50 (adjusted odds ratio (AOR) = 2.05, 95% CI: 1.25-3.35), currently smoking cigarettes (AOR = 4.57, 95% CI: 1.80-11.62), and living with hookah users (AOR = 6.45, 95% CI: 3.21-12.93). Participant self-reports of "liking" or positively commenting on tobacco products on social media were associated with current hookah use (AOR = 1.83, 95% CI: 1.84-4.52). Frequent exposure to online tobacco advertisements (AOR = 1.61, 95% CI: 1.13-2.28) were also associated with current hookah use.CONCLUSIONS Comprehensive product specific communication and policy interventions are needed to educate youth about the dangers of hookah use and reduce social acceptability among youth. To decrease hookah use in North Carolina, policymakers should consider restoring funding for comprehensive tobacco prevention and control programs, and equalizing tobacco tax rates for all tobacco product types.

Trajectories of Hookah Use: Harm Perceptions from Youth to Young Adulthood.

Hookah use has increased in United States, especially among young adults. This study investigates the role of harm perceptions of hookah use over a 2-year period in a nationally representative sample of youth and young adults as they transition to young adulthood. Using a probability-based, nationally representative, longitudinal cohort of youth aged 15-21, we analyzed the 7536 participants who completed all 4 waves. Ordered logit growth models examined changes over time in hookah use, and whether that relationship varies by baseline harm perceptions. Results show that age, sex, parental education, race, and smoking status are significant predictors of hookah use. Additionally, those who perceive hookah as "less harmful" than cigarettes have the highest probability of current hookah use over time, compared to those with more accurate harm perceptions. This study helps confirm the influence of harm perceptions of hookah tobacco on hookah use among youth and young adults. Increased public education efforts aimed at youth and young adults can help shift knowledge, attitudes and beliefs regarding the health consequences of hookah use.

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

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.

Patterns, Beliefs, Norms and Perceived Harms of Hookah Smoking in North Iran

Introduction:Hookah smoking is considered as a public health threat around the globe. The aim of this study was to investigatethe hookah smoking patterns, beliefs, norms and perceived harms in Golestan province of Iran.Methods:A cross-sectional study was conducted on 395 hookah smokers using convenience sampling method in 2015. To collect data, Heinz’s hookah patternwas utilized. Ordinal regression models were used to exploring of covariates related to the odds of life time, last-30-day, and current hookah use.Results:In general, 357 (90.4%) subjects were male smokers. Most of subjects smoked hookah in café (62.2%) and with friends (75.6%). The majority of them (71.1%) did not consider themselves as a hooked person. Cigarette smoking (OR =.65, 95 % CI. 42-.98), low perceived addictiveness of hookah than cigarettes (OR =2.33, 95 % CI 1.45-3.73), Social context of hookah smoking with friends in café (OR =1.14, 95 % CI 1.08-1.2), and number of close friends who smoked hookah (OR =1.38, 95 % CI 1.18-1.61) were effective variables affected the past month use of hookah.ConclusionDevelopment, implementation and assessment of interventions particularly adapted to hookah smoking regarding increase of perceived harm of hookah than cigarette and its probable addiction focusing on close friends appeared to be beneficial.