Hookah Tobacco Research Articles

Associations Between Hookah Tobacco Smoking Knowledge and Behavior Among Southern Technical University Students in Basra, Iraq

The number of US college students using hookahs, including those who wouldn't normally use tobacco, is rising. The idea that hookah is safer than cigarettes is one factor contributing to its popularity. The study's objectives were to evaluate the degree of awareness about the negative exposures linked to hookah smoking as comparison to cigarette smoking and to identify any relationships between this knowledge and the consequences of hookah smoking. A random email sample of 400 Southern Technical University students was used to gather data on demographics, hookah smoking habits, and awareness of five exposures (such as nicotine and tar). Multivariable logistic regression models evaluated the independent relationships between knowledge and the results of hookah smoking. Out of the five questions about factual knowledge. Correct answers to any knowledge item in multivariable models did not correlate with a decreased likelihood of hookah smoking or susceptibility to smoking in the future. Despite the fact that most college students are not aware of the harmful exposures linked to hookah smoking, there is no correlation between awareness and hookah smoking behavior.

Correlates of susceptibility to waterpipe tobacco smoking in young adults.

Many US young adults are susceptible to waterpipe (i.e., hookah) tobacco smoking (WTS) initiation, but research on factors associated with WTS susceptibility is limited. We examined sociodemographic, other tobacco and substance use, and attitudes and perceptions correlates of WTS susceptibility among young adults. Baseline data from a randomized trial testing WTS risk messages was collected in US young adults aged 18 to 30 years who never used waterpipe tobacco but were susceptible to WTS (n = 294). Extent of susceptibility to WTS was defined using the average score of a valid scale with higher scores indicating higher susceptibility. Correlates were sociodemographics, other tobacco and substance use, and attitudes and perceptions. Multiple linear regression models identified correlates of greater WTS susceptibility. Participants averaged 25 (SD 3.2) years of age, 60% were male, 22% were Black non-Hispanic, 47% completed some college education, and 66% were employed. Our models consistently showed that more positive attitudes toward WTS (β = -0.08, p<0.01), lower perceived addictiveness relative to cigarettes (β = -0.09, p = 0.04), and greater perceived social acceptability of WTS (β = 0.05, p<0.01) were positively correlated with WTS susceptibility. Additionally, young adults who smoked cigarillos (β = 0.53, p<0.01), used cannabis (β = 0.14, p = 0.02), and Black non-Hispanic versus White non-Hispanic young adults (β = 0.18, p = 0.03) also had higher WTS susceptibility. Findings suggest that WTS prevention efforts require multicomponent interventions including targeting subpopulations at greater risk based on race/ethnicity and other tobacco and substance use. These interventions should consider attitudes and social acceptability of WTS as modifiable targets to maximize public health benefits.

Unsubstantiated Claims by the Hookah Tobacco Industry to Exempt Flavored Hookah Tobacco Products From Flavor Bans.

Unsubstantiated Claims by the Hookah Tobacco Industry to Exempt Flavored Hookah Tobacco Products From Flavor Bans.

Abstract 3139: Evidence Of Vascular Endothelial Dysfunction In Habitual Hookah (i.e., Waterpipe) Users: Insights For Cardiovascular Disease Risk

Introduction: Flavored hookah tobacco smoking among young adults continues to be a public health concern. While short-term exposure to flavored hookah tobacco smoking impairs vascular function, data on the long-term impact of habitual use are not clearly delineated. Research Question: Is habitual flavored hookah tobacco smoking associated with vascular endothelial dysfunction in young healthy adults? Goals: Investigate the impact of regular flavored hookah tobacco smoking on vascular endothelial function, as compared to regular cigarette smoking and never tobacco use, in young healthy adults. Methods: We assessed brachial artery flow-mediated dilation (FMD)—a well-established index of vascular endothelial function—in 22 exclusive chronic hookah smokers (25±1 years of age, 23% women; mean±SE), who reported smoking flavored hookah tobacco on average two times per week for 9±1 years, 22 exclusive cigarette smokers who reported 4±1 pack years, and 23 non-smokers. FMD and vascular endothelium-independent nitroglycerin-mediated vasodilation was assessed using high resolution ultrasound. Results: Whereas baseline brachial artery diameter was comparable between groups ( P =ns), brachial artery FMD was significantly lower in habitual hookah users and cigarette users as compared to never smokers (cigarette smokers: 5.22±0.42; hookah smokers: 6.43±0.50; non-smokers: 9.80±0.83; P &lt;0.05). Endothelium-independent dilation of the brachial artery in response to sublingual nitroglycerin did not significantly differ between groups. Conclusions: Despite claims of safety advertised by the growing hookah tobacco industry, our findings provide evidence that, as compared to non-tobacco users, young and apparently healthy adults who regularly smoke flavored hookah tobacco exhibit reduced vascular endothelial function. These results suggest that flavored hookah tobacco smoking is not without harm and has potential harmful vascular effects, associated with increased cardiovascular disease risk.

Psychometric evaluation of a new instrument to hookah tobacco smoking-related factors in the Iranian female university students based on the Extended Parallel Process Model.

The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students. This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity (P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools. During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test (P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions. Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes.

A nitrogen-doped carbon nanosheet/poly(amidoamine) dendrimer-based electrochemical sensor for nicotine in flavored hookah pipe tobacco.

Towards the nicotine addiction challenge in the smoking of hookah pipe products, we hereby present the development of an electrochemical sensor for nicotine detection. A nitrogen-doped carbon nanosheet (N-CNS)/poly(amidoamine) dendrimer (PAMAM) nanocomposite-modified electrode was prepared as a sensor for the detection of nicotine in analytical and real samples. The N-CNSs were prepared by a hydrothermal method and dropcast on a glassy carbon electrode followed by electro-deposition of the PAMAM dendrimer to form the sensor (GCE/N-CNSs/PAMAM). The N-CNSs were characterized with electron microscopy, Raman spectroscopy and FTIR. The sensor was characterized with voltammetry and electrochemical impedance spectroscopy. The N-CNS/PAMAM enhanced the electrochemical performance of the electrode towards the oxidation of nicotine. The sensor achieved a detection limit of 0.05 μM in a linear concentration range of 1.93-61.64 μM nicotine standard samples. The sensor showed good reproducibility, repeatability, and selectivity. The sensor was successful in selectively detecting nicotine in two local brands of hookah pipe tobacco with a 113-121 percent recovery. Nicotine, up to a concentration of 0.35-0.39 mg g-1, was found in the sampled hookah pipe tobacco products suggesting possible harm to human health.

Awareness of Smoking Tobacco among Dental College Students: A Questionnairebased Cross-sectional Study

Introduction: Tobacco smoking is one of the 10th leading health indicators proposed by the World Health Organisation (WHO) Healthy People 2020, with major concerns regarding increased mortality rates. Tobacco smoke contains 2.94 mg of nicotine, 802 mg of tar, 145 mg of carbon monoxide, and greater quantities of chrysene. Hookah tobacco poses a serious health threat because of the commonly held belief among college students that this tobacco product is not addictive. Assessing practices represents an important starting point in curbing the spread of tobacco use. It is crucial to understand the use, patterns, and dependence on tobacco to develop appropriate prevention and cessation strategies. Aim: To assess tobacco smoking-related knowledge, attitudes, and practices among students of dental Institutions in Lucknow city, Uttar Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted among five dental colleges in Lucknow city from July 2023 to November 2023. A total of 1050 undergraduate dental students were included in the study, and a self-structured, close-ended questionnaire was used to collect information on the knowledge, attitudes, and practices of hookah tobacco. The reliability of the questionnaire was evaluated using Cronbach’s coefficient alpha to measure internal consistency, which was found to be 0.9. Discrete (categorical) data were summarised in numbers (n) and percentages (%). Categorical groups were compared by Chi-square (χ2 ) test. Results: Out of the total 1050 students, 392 (37.3%) were aged between 18-21 years, 630 (60.0%) were aged between 22-25 years, and 28 (2.7%) were aged between 26-30 years. Furthermore, among the students, 355 (33.8%) were females and 695 (66.2%) were males. Among the total of 1050 dental students, the prevalence of hookah smoking was 59.1%. The presence or prevalence of hookah smoking was higher in males (29.4%) at 480 (45.7%) than in females 141 (13.4%), and the difference was statistically significant (χ2 =83.75, p&lt;0.001). Conclusion: The study found that the frequency of hookah smoking continues to increase with the increasing age of the participants. The study also revealed the alarming situation of a high prevalence of hookah smoking among dental college students.

A method for cancer elemental risk assessments in hookah: An example in two common types of traditional and flavored tobaccos in Iran

Aim: This study aimed to compare the elemental composition of traditional and flavored hookah tobacco, with a focus on heavy metals. Methods: We used inductively coupled plasma mass spectrometry (ICP-MS) to analyze the concentrations of 29 elements in the raw tobacco, tobacco ash, hookah water after smoking, and tobacco smoke. Results: The results showed that the traditional tobacco had significantly higher metal concentrations than the flavored tobacco in all samples. Most of the toxic metals (more than 98 %) remained in the smoke of both types of tobacco. The tobacco and hookah smoke contained high levels of harmful metals that can pose health risks to hookah users.•ICP-MS provides a comprehensive analysis of multiple elements simultaneously and it allows for precise quantification of metal concentrations in different samples.•ICP-MS requires specialized equipment and trained personnel and it may not detect elements present in extremely low concentrations.

Preliminary Findings on the Salivary Metabolome of Hookah and Cigarette Smokers.

The aim of the study was to evaluate the salivary metabolomic profile of patients who habitually smoke hookah and cigarettes. The groups consisted of 33 regular and exclusive hookah smokers, 26 regular and exclusive cigarette smokers, and 30 nonsmokers. Unstimulated whole saliva was collected for the measurement of salivary metabolites by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). The MetaboAnalyst software was used for statistical analysis and evaluation of biomarkers. 11 smoking salivary biomarkers were identified using the area under receiving-operator curver criterion and threshold of 0.9. Xylitol and octadecanol were higher in cigarette smokers compared to controls; arabitol and maltose were higher in controls compared to cigarette smokers; octadecanol and tyramine were higher in hookah smokers compared to controls; phenylalanine was higher in controls compared to hookah smokers; and fructose, isocitric acid, glucuronic acid, tryptamine, maltose, tyramine, and 3-hydroxyisolvaleric acid were higher in hookah smokers compared to cigarettes smokers. Conclusions: The evaluation of the salivary metabolome of hookah smokers, showing separation between the groups, especially between the control versus hookah groups and cigarette versus hookah groups, and it seems to demonstrate that the use of hookah tobacco is more damaging to health.

Association of non-daily hookah tobacco smoking and cardiovascular disease-related exposure biomarkers among U.S. users: The Population Assessment of Tobacco and Health Study

Hookah smoking has grown to become a global tobacco epidemic. While cigarette smoking is a well-established cardiovascular disease (CVD) risk factor, the CVD risks of hookah smoking are unknown, particularly among regular U.S. adult hookah users who are predominantly non-daily users. Herein, we examined the association between hookah smoking and biomarkers of CVD risk among regular exclusive hookah smokers (n = 75), compared to regular exclusive cigarette smokers (n = 1773), dual hookah and cigarette smokers (n = 43) and never tobacco users (n = 757), using data from a nationally representative sample of adults from the Population Assessment of Tobacco and Health Study (2013–2014). Whereas 84% of cigarette smokers reported daily use, only 8% of hookahsmokers reported daily use, with more than a third reporting monthly use. Adjusting for age and sex and as compared to exclusive cigarette smokers, exclusive hookah smokers had significantly lower geometric mean concentrations in serum sICAM-1 and urinary F2-isoprostane (p < 0.05). Although not statistically significant, a signal of increased oxidative stress was observed among hookah smokers as compared to never tobacco users (urinary F2-isoprostane). CVD-related harm biomarkers appear to be lower among hookah smokers than cigarette smokers. These findings represent patterns of hookah smoking predominantly shared among adult U.S. users who report non-daily occasional use and do not reflect solitary, daily use as is common in the Middle East. Future studies with longer exposure and longitudinal hookah use are warranted to explore the association between hookah smoking and CVD risk.

Flavored Tobacco and Nicotine Use Among California Adolescents: Preferences by Use Experience and Survey Format Effects

PurposeThis study assessed flavored tobacco use among adolescent e-cigarette, cigarette, cigar, hookah, and smokeless tobacco users; specific e-cigarette flavor preferences; risk profiles of youth that use various flavors; and the impact of survey question wording on prevalence. MethodsCross-sectional data from 4,956 California adolescent participants (aged 12–17 years) in the Teens, Nicotine, and Tobacco 2021–2022 online panel survey estimated the survey-weighted prevalence of flavored tobacco use. An embedded randomized experiment assessed survey wording effects (i.e., any vs. “usual” flavor use). Qualitative data from four contemporaneous cycles of Teens, Nicotine, and Tobacco focus groups with California adolescents (N = 63) added themes relevant to the quantitative findings. Results88.1% of current any tobacco users reported flavored tobacco use in the past 30 days. Flavor use was lowest for cigarettes (66.7%) and highest for hookah (92.8%). Fruit was the most popular e-cigarette flavor (51.6% any use; 28.8% usual use). E-cigarette users also commonly reported use of candy and cooling flavors. Sweet flavors were used most often among adolescents otherwise at low risk of tobacco use. Survey item format did not meaningfully affect overall prevalence of flavored product use but did impact reports of specific e-cigarette flavors. Focus group participants described sweet and fruity flavors as a motivating factor in their own e-cigarette use and as designed to appeal to children. DiscussionDespite local policies, flavored tobacco use remains common among California adolescents. Survey items asking about any flavor use rather than usual use provide more information without affecting the overall prevalence of flavored tobacco use.

The Effects of an Educational Intervention Based on Prevention against Tobacco Dependence (PAD) regarding Frequency of Tobacco Use among Students in Varamin City: Results of the Second Phase

Background: Tobacco use by adolescents is one of the most devastating social challenges throughout the world, threatening the health of future generations and communities in all social, cultural, health, and environmental aspects. This study aims to evaluate the effectiveness of the prevention against Tobacco dependence (PAD) interventions among students in Varamin City in 2020.&#x0D; Methods: This study utilized the findings from the initial phase of the Prevention against Tobacco Dependence (PAD) project, which was conducted using a cohort method in Varamin city (Tehran province). The study encompassed four phases and involved both male and female students. For the second phase, a sample of 780 ninth-grade students was chosen using stratified sampling, with 350 students (45%) serving as PAD-helpers. Data was collected using a modified version of a questionnaire developed by the World Health Organization (WHO).&#x0D; Results: In the students’ families, most fathers still used cigarettes (25.5%) and hookah (11.4%). In total, the prevalence of hookah, cigarette, and new tobacco product use among students was 35%, 15.9%, and 22.2%, respectively. The most important reason for smoking was curiosity (56.7%), and more than 71% of students believed that PAD project increased their knowledge about dangers of smoking. Based on t-test scores, there was a significant difference between PAD-helpers and non-PAD-helpers in terms of anti-smoking knowledge, attitude, and practice. Two variables of the level of knowledge and attitude towards smoking had a significant direct relationship with the variable of anti-smoking practice (p &lt; 0.05).&#x0D; Conclusion: This project contained effective interventions to raise the students’ knowledge and change their attitudes towards smoking, and these changes have been more evident among PAD-helpers and their anti-smoking practice.

Changes in perceived harms of tobacco and cannabis and their correlations with use: A panel study of young adults 2014–2020

PurposePerceived harm is associated with substance use. Changes in product and policy landscapes may impact perceived harms of tobacco and cannabis. This study aimed to examine changes in young adults’ perceived harms of tobacco and cannabis and their associations with use behavior during a period including both before and after legalization of cannabis. MethodsWe conducted a panel survey of California Bay Area young adults (mean age = 23.5 years old, 64.4% female) in 2014 and 2019–2020. Participants (N = 306) reported past 30-day use and perceived harms of tobacco and cannabis at both waves. Perceived harms to health of cannabis and tobacco (cigarettes, e-cigarettes, hookah, smokeless tobacco, and secondhand tobacco smoke) were measured from 1-“Not at all harmful” to 7-“Extremely harmful.” Mixed-effects logistic regressions examined associations between perceived harms and use of tobacco and cannabis, controlling for demographics. ResultsParticipants perceived lower harm for cannabis than for tobacco products. Perceived harms of e-cigarettes, hookah, and smokeless tobacco significantly increased over time; while perceived harms of cigarettes, secondhand tobacco smoke, and cannabis did not change. Increased perceived harm of e-cigarettes was associated with lower odds of any tobacco use (OR = 0.72, 95%CI = 0.56, 0.92), and increased perceived harm of cannabis was associated with lower odds of any cannabis use (OR = 0.51, 95%CI = 0.42, 0.62). ConclusionsFindings suggest that perceived harms of e-cigarettes and cannabis play important roles in driving young adult use behaviors. Risk communication efforts that increase perceptions of health harms related to e-cigarettes and cannabis may decrease use of tobacco and cannabis among young people.

Association Between Sense of Coherence and Tobacco Use Among Brazilian Adolescent Students

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13–19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p < .05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students.

Tobacco smoking among higher medical education students is a real threat today

Annotation. With the help of Google forms, a questionnaire was conducted among applicants of medical institutions of higher education regarding the prevalence, duration, and preferences of types of alternative tobacco products, namely: National Pirogov Memorial Medical University, Vinnytsya (VNMU), Lviv National Medical University named after D. Halytskyi (LNMU), Bukovyna State Medical University (BDMU), Kharkiv National Medical University (KHNMU), National Medical University named after O. O. Bogomolets (NMU), among the five medical higher education institutions of Ukraine. The purpose of the study is to identify the prevalence, duration, causes of smoking, and health threats as consequences of smoking among students of medical institutions of higher education in Ukraine. A content analysis of scientific sources of foreign scientists from many countries of the world regarding the spread of tobacco smoking among student youth in European countries was conducted based on PubMed I Google Scholar databases for the period 2008-2022. Based on the results of the questionnaire, it was determined and compared with the questionnaire of 2019. It was established that among the applicants of medical institutions of higher education I-VI courses – 69.8% (61.2% – in 2019) of students do not smoke, and 30.2% (38.8% – 2019) smoke. Out of them, 76.9% are feminine and 23.1% are masculine. The average age of starting smoking among respondents of medical institutions of higher education was 16 to 18 years old – 21.0%. They use such a bad habit to relieve stress, which accounts for 30.0% of women and 43.6% of men. Cigarettes are preferred by 40.0% of women and 20.0% of men; to cigarettes – by 25.0% of women and 23.3% of men (in 2019 – 48.6%); IQOS – 17.0% of persons of the female article and 6.7% of the persons of the male article; electronic cigarettes – 33.3% of men and 10.0% of women (in 2019 – 10.9%); hookah tobacco – 10.0% among men and 8.0% among women (21.5% in 2019). The solution to the problem of smoking among students of medical institutions of higher education can only be systematic educational measures of anti-nicotine propaganda.

Verification of radon, radium, polonium concentrations and lung cancer rates in blood of female hookah smokers

Abstract Hookah smoking has become very popular in Iraq among women and men. Hookah tobacco contains natural radioactive elements, such as radon, radium, and uranium, as well as toxic elements, such as polonium, which are released during the combustion of tobacco and are inhaled by smoking. Most reviews focus on hookah tobacco, and only a few have investigated the blood of hookah smokers. In this study, a CR-39 detector was used to measure radon, radium, and polonium concentrations and conduct risk assessments in female hookah smokers of different ages. The results show that the concentrations of radon-222, polonium-218, and polonium-214 varied between 61.62 and 384.80, 5.45–33.64 on the wall of the can, and 2.43–15.00 Bq/m3 on the surface of the detector, respectively. The effective radium-226 concentration varied between 4.52 and 56.31 Bq/kg. The absorbed effective dose varied between 1.55 and 9.71 mSv/y, which is within the recommended limit (3–10 mSv/y) by International Commission on Radiological Protection (ICRP). The average case of lung cancer 107.91 cppp, which exceeds the European Union (EU) limit (96.9–104.8 cppp). The rates of radon activity and radon exhalation from the intake of a natural radionuclide due to hookah smoking in a female’s blood were calculated and discussed. This study aimed to establish preliminary results on the risks of radioactivity concentrations and assess the dose in the blood of women who smoke hookah and assess the possibility of developing cancer.

Tobacco Use and Incidence of Adverse Oral Health Outcomes Among US Adults in the Population Assessment of Tobacco and Health Study

Evolving tobacco use patterns, including increasing electronic nicotine delivery systems (ENDS) use, warrant re-examination of the associations between tobacco use and oral health. To examine associations between tobacco product use and incidence of adverse oral health outcomes. This cohort study used nationally representative data from wave (W) 1 to W5 (2013-2019) of the Population Assessment of Tobacco and Health Study. Recruitment used a stratified address-based, area-probability household sample of the noninstitutionalized US civilian population. The W1 cohort included respondents aged 18 years and older without lifetime history of oral health outcomes at W1 or W3, depending on when the outcome was first assessed. Data analysis was performed from October 2021 to September 2022. Current (every day or someday use) established (lifetime use of at least 100 cigarettes or "fairly regular" use of other products) use of cigarettes, ENDS, cigars, pipes, hookah, snus, and smokeless tobacco, excluding snus at W1 to W4. The primary outcomes were past 12-month self-reported diagnosis of gum disease and precancerous oral lesions (W2-W5) and bone loss around teeth, bleeding after brushing or flossing, loose teeth, and 1 or more teeth removed (W4-W5). Sample sizes varied across the 6 oral health outcomes (13 149 respondents for the gum disease sample, 14 993 respondents for the precancerous oral lesions sample, 16 312 respondents for the bone loss around teeth sample, 10 286 respondents for the bleeding after brushing or flossing sample, 15 686 respondents for the loose teeth sample, and 12 061 respondents for the 1 or more teeth removed sample). Slightly more than half of adults (52%-54% across the 6 samples) were women, and the majority were of non-Hispanic White race and ethnicity. Cox proportional hazards models were developed with covariates that included time-dependent tobacco use variables mutually adjusted for each other. Cigarette smoking was positively associated with incidence of gum disease diagnosis (adjusted hazard ratio [AHR], 1.33; 95% CI, 1.11-1.60), loose teeth (AHR, 1.35; 95% CI, 1.05-1.75), and 1 or more teeth removed (AHR, 1.43; 95% CI, 1.18-1.74). Cigar smoking was positively associated with incidence of precancerous oral lesions (AHR, 2.18; 95% CI, 1.38-3.43). In addition, hookah smoking was positively associated with incidence of gum disease diagnosis (AHR, 1.78; 95% CI, 1.20-2.63), and ENDS use was positively associated with incidence of bleeding after brushing or flossing (AHR, 1.27; 95% CI, 1.04-1.54). No associations were observed between snus and smokeless tobacco excluding snus and incidence of oral health outcomes. The observed associations of combustible tobacco use with incidence of several adverse oral health outcomes and ENDS use with incidence of bleeding after brushing or flossing highlight the importance of longitudinal studies and emphasize the continued importance of tobacco cessation counseling and resources in clinical practice.

Concurrent Hookah (Waterpipe) and Substance Use among Sexual Minority Adults in the United States: Findings from the Population Assessment of Tobacco and Health Study

Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p &lt; 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.

CRITERIA FOR TOBACCO IDENTIFICATION FOR HOOKAH AND NON-TOBACCO MIXTURE FOR HEATING

Hookah tobacco is positioned as a “nicotine alternative” to traditional smoking, but the aerosol produced contains the same toxic components as cigarette smoke. Consumer properties and safety indicators of tobacco aerosol for hookah depend on the component composition of the tobacco mixture and the coal used. The main factor that has a physiological effect on the user of hookah tobacco or non-tobacco mixture for heating is the content of nicotine that passes into the aerosol. There is no single approach to the regulation of a segmental product, in addition, there are no standardized methods for generating and collecting aerosol. The smoking pattern on a laboratory smoking machine does not fully reflect the behavioral profile of a person, however, the quantitative composition of the aerosol obtained from machine testing can be used as input to determine the risk of the product. During the research, laboratory and analytical equipment was used: CERULEAN SM 405 linear smoking machine; "Expert-001-1(0.1)" ionomer, SF-16 spectrophotometer, Crystal 2000M / HP 5890 Series 11 chromatograph with FID. Experimental data have been obtained to evaluate consumer and physic-chemical parameters, including organoleptic evaluation, the content of nicotine, glycerin and propylene glycol in samples of tobacco for hookah / non-tobacco mixture for heating. The method of machine generation and collection of the solid-liquid phase of an aerosol has been standardized, which makes it possible to obtain reliable data on the quantitative content of nicotine in the produced aerosol. The content of nicotine in the samples is 0.1–1.9%, the transition of nicotine into the produced aerosol is insignificant. The microscopy method for determining the structure of the base (carrier) in combination with the determination of consumer properties (organoleptic evaluation, total content of glycerol and propylene glycol, pH and nicotine content) are tools for identifying tobacco or non-tobacco hookah products.

Exploring motivation to quit and risk appraisals of hookah tobacco smoking for self and partner among a member of single and dual smoker couples.

Negative health effects of waterpipe tobacco smoking (WTS) are likely more pronounced in dual rather than single smoker couples. Data on how smokers' perceived harms for self and partner differ between couple types and how these perceptions are associated with motivation to quit are needed. We examined these associations by surveying one member of dual smoker (i.e., both partners smoke) and single smoker (i.e., one partner smokes) couples who engages in WTS. We enrolled online adults ages 18-32 who engaged in WTS during the last month and were in a committed relationship of at least six months. Participants rated their harm to self and, when relevant, to partner, how much they were harming their partner due to their WTS, and partner's smoke exposure. Participants reported their motivation to quit. Of the 323 participants, 215 (67%) were in dual smoker couples. Participants in dual smoker couples reported lower own perceived risk, which correlated highly with perceived partner risk, than participants in single smoker couples; they also reported harming their partners more even though they downplayed how frequency of smoke exposure was harming the partner. Motivation to quit did not differ by couple type. Across couple types, motivation to quit increased with greater perceived harms. Smokers in dual compared to single smoker couples downplay their risks and perceived harms their smoking causes their partner. Interventions focused on harms to self and partner may be effective to increase motivation to quit and cessation in both couple types.