Devon Noonan

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

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

New tobacco trends: Waterpipe (hookah) smoking and implications for healthcare providers

Purpose: To inform healthcare providers about waterpipe smoking, a new trend in tobacco use that is gaining popularity among adolescents and young adults. Data sources: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note on Waterpipe Smoking, and pertinent publications available in the literature. Conclusions: Waterpipe smoking is a new trend in tobacco use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction. Implications for practice: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long‐lasting problem of nicotine addiction.

Utility of Biochemical Verification of Tobacco Cessation in the Department of Veterans Affairs

Research on the validity of self-report tobacco use has varied by the population studied and has yet to be examined among smokers serviced by the Department of Veterans Affairs (VA). The purpose of this study was to determine the predictors of returning a biochemical urine test and the specificity and sensitivity of self-reported tobacco use status compared to biochemical verification. This was a sub-analysis of the larger Tobacco Tactics research study, a pre-/post-non-randomized control design study to implement and evaluate a smoking cessation intervention in three large VA hospitals. Inpatient smokers completed baseline demographic, health history and tobacco use measures. Patients were sent a follow-up survey at six-months to assess tobacco use and urine cotinine levels. A total of 645 patients returned six-month surveys of which 578 also returned a urinary cotinine strip at six-months. Multivariate analysis of the predictors of return rate revealed those more likely to return biochemical verification of their smoking status were younger, more likely to be thinking about quitting smoking, have arthritis, and less likely to have heart disease. The sensitivity and specificity of self-report tobacco use were 97% (95% confidence interval=0.95-0.98) and 93% (95% confidence interval=0.84-0.98) respectively. The misclassification rate among self-reported quitters was 21%. The misclassification rate among self-reported tobacco users was 1%. The sensitivity and specificity of self-report tobacco use were high among veteran smokers, yet among self-report quitters that misclassification rate was high at 21% suggesting that validating self-report tobacco measures is warranted in future studies especially in populations that are prone to misclassification.

Risk of Smoking and Receipt of Cessation Services Among Veterans With Mental Disorders

OBJECTIVE The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. METHODS The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. RESULTS Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). CONCLUSIONS The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.

Beliefs and norms associated with smoking tobacco using a waterpipe among college students.

&NA; This web‐based, cross‐sectional survey guided by the Theory of Reasoned Action (TRA), examined behavioral beliefs and normative beliefs associated with smoking tobacco using a waterpipe in a sample of 223 undergraduate college students. Beliefs and norms associated with waterpipe smoking intention were captured using the investigator‐developed TRA Waterpipe Questionnaire. Significant behavioral beliefs that contributed to the prediction of smoking intentions included smoking tobacco with a waterpipe “will taste pleasant” and “will allow me to have a good time with my friends.” Significant norms that emerged were perceived approval of waterpipe smoking from friends and significant others. Current smoking status, both waterpipe and cigarette, also contributed to the prediction of smoking intention. The variables of the TRA represent prime targets for intervention and provide useful information that can be used to tailor waterpipe prevention messages.

Factors Associated With Perceptions of Hookah Addictiveness and Harmfulness Among Young Adults

Hookah smoking is a form of tobacco use that is growing in popularity in the United States.1 College aged students, who are known to experiment with multiple forms of tobacco, are particularly vulnerable to this tobacco trend.2 Currentstudies estimate from15 to 60% of college students and young adults have smoked hookah in their lifetime, which is similar to lifetime cigarette use in this population.1, 3-4 There is a common misconception that hookah smoking is not as dangerous as other forms of tobacco which may help explain the recent uptake of hookah, especially among young adults. However, recent research suggests that, much like cigarette smoking, hookah smoking is associated with adverse health effects including various cancers and respiratory illnesses andthat hookah smoking may be as addictive as cigarette smoking.5-6 In a recent meta-analysis looking at nicotine exposure from hookah smoking, daily hookah smokers produced cotinine levels that were similar to smoking ten cigarette a day and non-daily hookah smokers produced cotinine levels similar to smoking two cigarettes a day, suggesting that hookah smoking may lead to nicotine dependence.5 Many studies have included survey questions about perceived harmfulness of hookah use. In general, most young adultsperceive hookah smoking to be less harmfulthan other forms of tobacco.1, 3-4, 7 Fewer studies have included survey questions about perceived addictiveness of hookah smoking. Available data suggest that many college students and young adults do believe that hookah smoking is less addictive than other tobacco products.3-4, 7 Although existing studies have included survey questions capturing perceptions of hookah smoking, only one study of which we are aware has examined factors associated with perceptions of hookah smoking harmfulness (although it did not measure perceived addictiveness). In that study, the majority of adult hookah users surveyed in a west-coast cafe, believed that hookah smoking was less dangerous than regular cigarettes.8 Those of Asian descent and more frequent users of hookah were more likely to believe the hookah smoking was less harmful than cigarette smoking.8 The relationship between perceptions of hookah harm and addictiveness and demographic and tobacco use habits remains unclear in the young adult and college student population. Therefore, the purpose of the current study was to extend previous work to examine factors associated with perceived harm and perceived addictiveness of hookah smoking among young adult college attenders. This information will be useful when developingprevention programs for hookah use aimed at decreasing misconceptions and increasing the awareness of health risks surrounding this type of tobacco use with the ultimate goal ofreducing nicotine addiction in an at-risk population.

Intention to Smoke Tobacco Using a Waterpipe Among Students in a Southeastern U.S. College

OBJECTIVE Guided by the Theory of Reasoned Action, this study examined the association of behavioral beliefs, attitudes, normative beliefs, and subjective norms with waterpipe tobacco smoking intention in college students. DESIGN AND SAMPLE A cross-sectional design was used. A Web-based survey was sent to a random sample of 1,000 undergraduate students from a public institution in the southeast to recruit participants. MEASURES The Theory of Reasoned Action Waterpipe Questionnaire, a modified version of the Fishbein-Ajzen-Hanson Questionnaire, was used to capture modal constructs of the Theory of Reasoned Action related to waterpipe use. Cronbachs α coefficients for the scales of the Theory of Reasoned Action Waterpipe Questionnaire ranged from .76 to .95. RESULTS Of the sample (n=223), 13.5% currently smoked a waterpipe and 61% had ever done so. Using multiple regression, attitudes, behavioral beliefs, and subjective norms were associated with intention to smoke a waterpipe in the next 3 months and collectively explained 35% of the variance in intention. The full model, which included all the constructs of the Theory of Reasoned Action, demographic variables, and tobacco use variables, explained 83% of the variance in intention to smoke a waterpipe in the next 3 months. CONCLUSIONS This study provides valuable information that may be used to target students at risk for waterpipe smoking and serves as a starting point in developing theoretically driven interventions to prevent waterpipe smoking.

Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers

BackgroundRecent research indicates that 35 percent of blue-collar workers in the US currently smoke while only 20 percent of white-collar workers smoke. Over the last year, we have been working with heavy equipment operators, specifically the Local 324 Training Center of the International Union of Operating Engineers, to study the epidemiology of smoking, which is 29% compared to 21% among the general population. For the current study funded by the National Cancer Institute (1R21CA152247-01A1), we have developed the Tobacco Tactics website which will be compared to the state supported 1-800-QUIT-NOW telephone line. Outcome evaluation will compare those randomized to the Tobacco Tactics web-based intervention to those randomized to the 1-800-QUIT-NOW control condition on: a) 30-day and 6-month quit rates; b) cotinine levels; c) cigarettes smoked/day; d) number of quit attempts; and e) nicotine addiction. Process evaluation will compare the two groups on the: a) contacts with intervention; b) medications used; c) helpfulness of the nurse/coach; and d) willingness to recommend the intervention to others.Methods/DesignThis will be a randomized controlled trial (N = 184). Both interventions will be offered during regularly scheduled safety training at Local 324 Training Center of the International Union of Operating Engineers and both will include optional provision of over-the-counter nicotine replacement therapy and the same number of telephone contacts. However, the Tobacco Tactics website has graphics tailored to Operating Engineers, tailored cessation feedback from the website, and follow up nurse counseling offered by multimedia options including phone and/or email, and/or e-community. Primary Analysis of Aim 1 will be conducted by using logistic regression to compare smoking habits (e.g., quit rates) of those in the intervention arm to those in the control arm. Primary analyses for Aim 2 will compare process measures (e.g., medications used) between the two groups by linear, logistic, and Poisson regression.DiscussionDissemination of an efficacious work-site, web-based smoking cessation intervention has the potential to substantially impact cancer rates among this population. Based on the outcome of this smaller study, wider scale testing in conjunction with the International Environment Technology Testing Center which services Operating Engineers across North America (including US, Mexico, and Canada) will be conducted.Trial registrationNCT01124110

A pilot study of depression, stigma, and attitudes towards seeking professional psychological help among Arab adolescents

Abstract The Arab region has the largest proportion of young people in the world and many of the factors that contribute to the onset of depression. Yet, very little is known about the current situation of depression and its associated stigma in this region. The purpose of this pilot study was to obtain preliminary data examining clinically significant depressive symptoms, depression stigma, and attitudes towards seeking professional help for depression among a sample of Arab adolescents from Jordan. Cross-sectional data were collected from 88 adolescents attending public schools in Jordan using self-report questionnaires that were available in, or translated into, Arabic. Among the 88 adolescents, 22% reported scores suggesting mild depression and 19% reported scores suggesting moderate depression, while 24% reported scores suggesting severe depression. The most frequently reported depressive symptoms were changes in sleep patterns (76%), changes in appetite (63%), agitation (62%), and crying (61%). The majority (73%) had moderate depression stigma, and 43% had negative attitudes towards seeking professional help. Yet, 67% believed they would find relief in psychotherapy if they ever had a serious emotional crisis. Findings suggest that the prevalence of depressive symptoms may be high among Jordanian adolescents. Further, many of these adolescents may experience depression-related stigma that affects their attitudes and willingness to seek professional help. To determine the true scope of these issues, including the prevalence of depression among Jordanian adolescents, future research should obtain data from a nationally representative sample.

A descriptive study of waterpipe smoking among college students

Purpose: The purpose of this cross‐sectional study was to examine waterpipe smoking and beliefs about waterpipe smoking in a sample of college students from a public university in Virginia. Data sources: A web‐based survey was sent to 1000 undergraduate students recruiting them to participate in the study. Measures from the investigator‐developed Theory of Reasoned Action (TRA) Waterpipe Questionnaire were used to capture belief‐based components of the TRA related to waterpipe use. Descriptive statistics were used to examine the prevalence of waterpipe smoking and beliefs associated with waterpipe smoking. Conclusions: Of the sample (n = 223), 71% of males and 52% of females reporting ever smoking tobacco using a waterpipe and 22% of males and 5% of females reporting current waterpipe smoking. Of the sample, 28% of males and 10% of females were current cigarette smokers and 25% of males and 10% of females were current marijuana users. Common beliefs associated with waterpipe smoking are also presented. Implications for practice: Nurse practitioners working with college students need to be aware of the multiple forms of tobacco that students may engage in. They also should be aware of the common beliefs about waterpipe smoking. This information is useful when targeting and counseling patients about alternative tobacco products like waterpipe smoking.