Waterpipe use among high school students in Ontario: Demographic and substance use correlates

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

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

The prevalence and trends of waterpipe tobacco smoking: A systematic review

INTRODUCTION

Waterpipe tobacco smoking is harmful to health however its prevalence estimates remain uncertain. We aimed to systematically review the medical literature on waterpipe tobacco prevalence and trends.

METHODS

We searched Medline, Embase and ISI Web of Science for 'waterpipe' and its synonyms, without using language or date restrictions. We included any measure of waterpipe tobacco smoking prevalence in jurisdictionally representative populations. We stratified findings by prevalence measure (past 30 day, ever, regular or occasional, daily, other or unspecified) and age (adults or youth).

RESULTS

We included 129 studies reporting 355 estimates for 68 countries. In general, prevalence estimates among adults were highest in the Eastern Mediterranean, and among youth were about equal between Eastern Mediterranean and European regions. Past 30 day use was highest among Lebanese youth (37.2% in 2008), ever use was highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%), regular or occasional use was highest in among Iranian university students (16.3% in 2005), and daily use was highest among Egyptian youth (10.4% in 2005). Trend data were limited but most studies reported increased use over time, ranging from 0.3-1.0% per year among youth in the US to 2.9% per year among youth in Jordan (both for past 30 day use). Results were similar for ever use trends. Turkey (2.3% in 2008 to 0.8% in 2010) and Iraq (6.3% in 2008 and 4.8% in 2012) both witnessed decreased waterpipe use.

CONCLUSION

Waterpipe tobacco smoking is most prevalent in Eastern Mediterranean and European countries, and appears higher among youth than adults. Continued surveillance will be important to assess and inform policy measures to control waterpipe tobacco use.

Overcoming Challenges in School-Wide Survey Administration

School-based surveys provide a useful method for gathering data from youth. Existing literature offers many examples of data collection through school-based surveys, and a small subset of literature describes methodological approaches or general recommendations for health promotion professionals seeking to conduct school-based data collection. Much less is available on real-life logistical challenges (e.g., minimizing disruption in the school day) and corresponding solutions. In this article, we fill that literature gap by offering practical considerations for the administration of school-based surveys. The protocol and practical considerations outlined in the article are based on a survey conducted with 11,681 students from seven large, urban public high schools in the southeast United States. We outline our protocol for implementing a school-based survey that was conducted with all students school-wide, and we describe six types of key challenges faced in conducting the survey: consent procedures, scheduling, locating students within the schools, teacher failure to administer the survey, improper administration of the survey, and minimizing disruption. For each challenge, we offer our key lessons learned and associated recommendations for successfully implementing school-based surveys, and we provide relevant tools for practitioners planning to conduct their own surveys in schools.