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

Smoking behaviors among Middle Eastern college women in the United States

Objective: to examine factors associated with cigarette and hookah smoking among Middle Eastern (ME) Arab college women. Participants: 406 adult women of ME Arabic background, currently enrolled in or recently graduated from a US college. Methods: a cross-sectional design, using an anonymous online survey of demographic characteristics, sociocultural factors, and access to health care factors. Data analysis included regression model to identify predictors of smoking behaviors. Results: Smoking rates were 21% and 19% for cigarette and hookah smoking. Cigarette smoking was higher with having liberal attitudes toward sexuality and lower among those having a healthcare provider. Hookah smoking was higher among students who are Muslim, involved in student organizations, have higher acculturation-heritage levels, and have more liberal attitudes toward women. Hookah smoking was lower among students born in the US, attending college part-time, and having higher religiosity levels. Conclusions: The study findings have several implications for interventions to address smoking behaviors among ME Arab college women through community organizations and within college campuses.

Motivators of impulsivity to smoke waterpipe tobacco among Nigerian youth who smoke waterpipe tobacco: the moderating role of social media normalisation of waterpipe tobacco

Background

Impulsivity is a formidable cause of waterpipe tobacco smoking among youth, however, it is understudied among African youth. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco, specifically among youth in Nigeria who smoke waterpipe tobacco.

Methods

Data were drawn from 695 respondents who smoke waterpipe tobacco across six Nigerian universities in the South-West zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3.

Results

Among Nigerian youth who smoke waterpipe tobacco, intention (β = 0.442, P < 0.001) was the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β = 0.302, P < 0.001). In addition, social media normalisation of waterpipe tobacco acted as a moderator that strengthened the relationship between intention and impulsivity (β = 0.287, P < 0.01), as well as, between positive evaluations and impulsivity (β = 0.186, P < 0.01) among youth.

Conclusion

Intention greatly instigates Nigerian youth’s impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educational waterpipe tobacco cessation-oriented programmes that utilise diverse constructive-based learning approaches like illustrative learning and counselling, can help to enlighten and encourage Nigerian youth on the importance of shunning the desirability to smoke waterpipe tobacco.

Exploring attitudes towards smoking behaviour and cessation among hospitalised smokers via a socio-ecological framework: A scoping review

OBJECTIVES

Cigarette smoking is a leading cause of preventable mortality and disability. Smoke-free policies in healthcare settings have been implemented as a public health measure. This scoping review aims to explore attitudes on smokers' cessation in smoke-free healthcare settings using a socio-ecological framework.

METHODS

Four databases were searched for terms: smoking cessation, patient attitudes, and smoke-free policy. Of 420 studies, 17 met full inclusion criteria.

RESULTS

The review identified four socio-ecological aspects of smoking cessation in smoke-free healthcare settings: Intrapersonal factors (health literacy, health conditions, and self-efficacy), interpersonal factors (social support, peer pressure, and social responsibility), healthcare factors (perceived mixed messages, healthcare setting, clinical, psychosocial and health promotion supports), and societal factors (restrictions on smoking in a public place and social acceptability of smoking). Smoke-free policies effectively encouraged cessation in some patients but were ineffective in those that felt a loss of autonomy. Provision of smoke breaks within smoke-free policies was considered a mixed message.

CONCLUSIONS

Holistic strategies are required to interconnect the four socio-ecological dimensions for successful smoking cessation.

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

Background

Most 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.

Methods

A 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.

Results

Among 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.

Conclusions

The 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.

Agent-based Modeling in Tobacco Regulatory Science: Exploring 'What if' in Waterpipe Smoking

Objectives

Waterpipe tobacco smoking (WTS) is an emerging public health crisis, particularly among youth and young adults. Different from the use of other tobacco products and e-cigarettes, WTS tends to be a social activity occurring among friends or persons associated with social networks. In this paper, we review a potential strategy for WTS-related research.

Methods

As a bottom-up computational model, agent-based modeling (ABM) can simulate the actions and interactions of agents, as well as the dynamic interactions between agents and their environments, to gain an understanding of the functioning of a system. ABM is particularly useful for incorporating the influence of social networks in WTS, and capturing people's space-time activity and the spatial distribution of WTS venues.

Results

Comprehensive knowledge of WTS-related behaviors at the individual level is needed to take advantage of ABM and use it to examine policies such as the interaction between WTS and cigarette smoking and the effect of flavors used in waterpipe tobacco. Longitudinal and WTS-specific surveys and laboratory experiments are particularly helpful to understand WTS basic mechanisms and elicit individual preferences, respectively.

Conclusions

We argue that the uniqueness of WTS makes ABM a promising tool to be used in WTS-related research, as well as understanding use of other tobacco products.

High-risk behaviors and demographic features: a cross-sectional study among Iranian adolescents

BACKGROUND AND OBJECTIVES

High-risk behaviors are considered to be a serious threat among adolescents. This study aimed to investigate the frequency of unhealthy and high-risk behaviors and their relationship with demographic features in adolescents living in Shiraz, Iran.

MATERIALS AND METHODS

The present descriptive, cross-sectional study was conducted on 483 students in the 10th grade of high school. The data were collected using a demographic information form and a modified adolescents high-risk behaviors questionnaire. The reliability of the questionnaire was assessed using the test-retest method. Afterwards, the data were entered into the SPSS statistical software (IBM), version 22 and were analyzed using the chi-square (χ²) test, logistic regression analysis and one-way analysis of variance (ANOVA).

RESULTS

High-risk health behaviors were significantly correlated to adolescents' gender, parents' occupations and education levels, length of residency in Shiraz and talking about important things with one's parents (p < 0.03). Gender predicted 52% of variance of bullying behaviors at school [Exp(B) = 0.502, p < 0.03, 95% confidence interval (CI) = 0.261-0.996]. In fact, most high-risk behaviors were associated with gender (p < 0.001). Indeed, bullying was mostly reported in boys, while being hopeless or sad, suicide attempts and appropriate weight loss behaviors were mostly reported among girls. Additionally, the frequency of smoking cigarettes and using hookahs was higher among girls compared to boys (23.1% for smoking cigarettes and 39.6% for using hookahs). However, no significant correlation was observed between gender and smoking cigarettes and using hookahs (p > 0.704 for smoking cigarettes and p > 0.118 for using hookahs). The most prevalent high-risk behaviors were physical fighting (51.1%), being sad or hopeless (35.2%), alcohol abuse (26.7%), overweight (14.7%) and obesity (8.1%) in both genders. Based on the results, only 26.5% of the adolescents had sufficient physical activity. Besides, the adolescents' weight scores were significantly correlated to eating green salads (p < 0.01), which was seen more among overweight adolescents.

CONCLUSION

The findings indicated that adolescents' gender and their parents' roles should be taken into consideration in designing health promotion programs, such as mental health and its related skills. This would eventually result in the prevention and reduction of unhealthy habits.

Waterpipe tobacco use in college and non-college young adults in the USA

BACKGROUND

Waterpipe tobacco smoking (WTS or 'hookah') is common among adolescents and college students in the USA. However, there has not yet been a large-scale, nationally representative study independently examining WTS among young adults who are not in college.

OBJECTIVE

This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college.

METHODS

A total of 3131 US adults ages 18-30 completed an online survey about WTS behaviour, attitudes, normative beliefs and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status.

RESULTS

Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3 and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college [adjusted odds ratio (AOR) = 2.72; 95% CI: 2.00-3.71 and AOR = 2.02; 95% CI: 1.50-2.71, respectively] and young adults in college (AOR = 3.37; 95% CI: 2.48-4.58 and AOR = 2.05; 95% CI: 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college.

CONCLUSIONS

Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college.

Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents

INTRODUCTION

Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents 'attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use.

METHODS

Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis.

RESULTS

Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one's owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents' and siblings' smoking behaviors influenced adolescent waterpipe use.

CONCLUSION

Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.

Reasons for use, potential use, or discontinued use of hookah among US young adult college students

INTRODUCTION

Given the increase in hookah use among young adults, characteristics of hookah use/users, as well as reasons for its use or discontinuation among young adults, are critical to understand.

METHODS

Data from a study of 18–25 year olds from seven Georgia colleges/universities (n=2865) were analyzed to examined: 1) differences in socio-demographics and other substance use among current (past 4 months), never, and former hookah users; 2) use characteristics among current users (e.g. device types/flavors used, quit intentions); and 3) reasons for use, potential use, and discontinued use among current, never, and former users.

RESULTS

Of the students, 56.3% were never users, 12.4% were current, and 31.3% former users. Correlates of being a current (vs never) user included being ‘other race’ (vs White), attending a historically black college/university (HBCU vs technical college), and use of other substances. Correlates of being a former (vs never) hookah user included being older (vs younger), being ‘other race’ (vs White), attending an HBCU (vs technical college), and use of other tobacco products, marijuana, or alcohol. Among current users, 73.7% reported no intention to quit; 26.2% attempted to quit in the past year. Two factors were identified regarding reasons for current use (flavors, social reasons): one factor regarding potential use among never users (related to flavors and social factors), and three factors regarding discontinued use (inconvenience, anti-tobacco attitude, social reasons).

CONCLUSIONS

Findings indicate the risk factors for hookah use and the importance of particular factors (e.g. flavors, social influences) relevant to regulation/policy.

Substance abuse behaviors among university freshmen in Iran: a latent class analysis

OBJECTIVES

Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup.

METHODS

Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students' socio-demographic characteristics on membership in each specific subgroup.

RESULTS

The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1.

CONCLUSIONS

Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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%).

CONCLUSIONS

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.

Shisha use among students in a private university in Kigali city, Rwanda: prevalence and associated factors

BACKGROUND

All over the globe shisha smoking is fast growing among different age brackets. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. In Kigali, Rwanda's capital, reports indicate that shisha use is increasing among the youths, particularly the university students. The study aimed at determining the prevalence, and establishing factors associated with shisha use among students in a university in Kigali Rwanda, which will be a significant step in stemming shisha fame among youths in Rwanda as there was no previously documented evidence-based study.

METHODS

A total of 427 students were selected for this cross-sectional study using stratified sampling method. A questionnaire was used to collect data on shisha use, knowledge about shisha, attitude towards shisha, and factors associated with use of shisha. The association between the independent variables and shisha use was assessed using chi-square p value < 0.05. Binary logistic regression was used to determine variables that were independently associated with shisha smoking.

RESULTS

Prevalence of ever smoking shisha among the university students was 26.1% and that of those that smoked in the last month (30 days) was 20.8%. About 40 % (39.9%) of the participants that had heard about shisha before demonstrated low level of knowledge, and 41.6% of these reported shisha use in the last 30 days. Logistic regression revealed that the followings were independently associated with shisha smoking: always drink alcohol (p = 0.003); drink alcohol occasionally (p = 0.045); having friend(s) who smoke shisha (p = 0.001); being aware of shisha's availability in cafes, bars and restaurants in Kigali (p = 0.022); positive attitude towards shisha smoking (p < 0.001) and participants with age < 20 years (p = 0.039).

CONCLUSIONS

There is a relative high prevalence of shisha smoking and a poor knowledge about its impact on health among these university students. Regular medical education and health promotion targeting the youths could improve knowledge and practices about shisha use. Shisha laws and regulations should be enacted, and fines imposed on individuals or group who flout them.

High-resolution Temporal Representations of Alcohol and Tobacco Behaviors from Social Media Data

Understanding tobacco- and alcohol-related behavioral patterns is critical for uncovering risk factors and potentially designing targeted social computing intervention systems. Given that we make choices multiple times per day, hourly and daily patterns are critical for better understanding behaviors. Here, we combine natural language processing, machine learning and time series analyses to assess Twitter activity specifically related to alcohol and tobacco consumption and their sub-daily, daily and weekly cycles. Twitter self-reports of alcohol and tobacco use are compared to other data streams available at similar temporal resolution. We assess if discussion of drinking by inferred underage versus legal age people or discussion of use of different types of tobacco products can be differentiated using these temporal patterns. We find that time and frequency domain representations of behaviors on social media can provide meaningful and unique insights, and we discuss the types of behaviors for which the approach may be most useful.