Kymberle L. Sterling

Examining Hookah Smoking Among a Cohort of Adolescent Ever Smokers

INTRODUCTION Evidence suggests that hookah smoking is growing among adolescents, particularly among those with a history of cigarette smoking, and is an emerging public health concern. We examined hookah use and its correlates among a sample of adolescents who have ever smoked and may be considered high risk for hookah use. METHODS We examined differences between hookah users and nonusers among a cohort of 951 adolescents (75.3% of the baseline sample, mean age 17.6 years at 24 months), consisting exclusively of youth who reported ever smoking cigarettes who were participating in a longitudinal study of adolescent smoking predictors and patterns. Ever and 30-day hookah use were assessed at 24 months. RESULTS Of the 951 participants, 58.5% reported ever use and 30.2% reported smoking hookah at least 1 day in the past 30 days. Multivariate logistic regression analyses found that 30-day hookah use was associated with sex (p < .05); race (p < .001); current cigarette (p < .0001), cigar (p < .01), kretek (p < .05), and alcohol use (p < .01); and attending a hookah bar, lounge, or restaurant (p < .001). Participants who were male, White, and were concurrent users of multiple tobacco products and other substances had increased odds of 30-day hookah use. CONCLUSIONS Prevalence of hookah use is high among youth who have already tried cigarette smoking and is associated with a variety of tobacco and other substance use behaviors. Evidence-based programs may be needed to prevent initiation of or reduce Hookah smoking, as well as address cooccurring problem behaviors, to lessen the health risks associated with use among adolescents.

Examining the psychometric properties and predictive validity of a youth-specific version of the Nicotine Dependence Syndrome Scale (NDSS) among teens with varying levels of smoking ☆

Current conceptualizations of nicotine dependence suggest assessing its multidimensional structure, especially for understanding how dependence develops in teen smokers. It is unknown if a multidimensional structure holds for teens with varying levels of smoking. The psychometric properties and predictive validity of the youth-specific, multidimensional Nicotine Dependence Syndrome Scale (NDSS) was assessed among 526 teens (55.5% female; 74.3% Caucasian) who reported smoking in the past 30 days. NDSS and smoking measures were obtained at baseline and six months. Confirmatory factor analysis supported the NDSS-Total (NDSS-T, α = 0.94) and five factors for the sample: Drive (α = 0.92), Tolerance (α = 0.85), Priority (α = 0.83), Stereotypy (α = 0.73), and Continuity (α = 0.64). NDSS-T, Drive, Tolerance, and Priority were predictors of subsequent amount smoked (p < 0.01). Drive, Tolerance, and Continuity predicted subsequent cessation (p < 0.05). Though the youth-specific NDSS has good psychometric properties, tests of predictive validity for subsequent smoking and cessation behavior suggest only certain dimensions of dependence, particularly Drive and Tolerance, appear to be salient in this sample. Further studies should assess the multidimensional nature of nicotine dependence among teens with varying levels of smoking.

Factors Associated With Small Cigar Use Among College Students

OBJECTIVE To assess small cigar use among college students in the southeastern United States. METHODS Data from a 2010 online survey were analyzed to examine small cigar smoking and its sociodemographic and psychosocial correlates among 4388 college students, aged 18-30. RESULTS Small cigar users were more likely to be younger, male, black, and current cigarette, cigar, hookah, or marijuana smokers (ps < .05). They reported lower perceived harm of smoking and greater sensation seeking and perceived stress. Menthol cigarette smokers were more likely to smoke small cigars. CONCLUSIONS Small cigar use and the co-occurrence of other tobacco and substance use should be addressed among college students.

The Development and Validation of a Scale Assessing Individual Schemas Used in Classifying a Smoker: Implications for Research and Practice

INTRODUCTION Half of college students who have smoked in the past month do not consider themselves smokers. Understanding ones schema of smokers is important, as it might relate to smoking behavior. Thus, we aimed to develop a scale assessing how young adults classify smokers and establish reliability and validity of the scale. METHODS Of 24,055 students at six Southeast colleges recruited to complete an online survey, 4,840 (20.1%) responded, with complete smoking and scale development data from 3,863. RESULTS The Classifying a Smoker Scale consisted of 10 items derived from prior research. Factor analysis extracted a single factor accounting for 40.00% of score variance (eigenvalue = 5.52). Higher scores (range 10-70) indicate stricter criteria in classifying a smoker. The scale yielded a Cronbachs alpha of .91. Current smoking (past 30-day) prevalence was 22.8%. Higher Classifying a Smoker Scale scores (p = .001) were significant predictors of current smoking, controlling for sociodemographics. Higher scores were related to being nondaily versus daily smokers (p = .009), readiness to quit in the next month (p = .04), greater perceived smoking prevalence (p = .007), not identifying as smokers (p < .001), less perceived harm of smoking (p < .001), greater concern about smoking health risks (p = .01), and less favorable attitudes toward smoking restrictions (p < .001). Among current smokers, higher scores were related to greater smoking frequency (p = .02), not identifying as smokers (p < .001), and less perceived harm of smoking (p < .001), controlling for sociodemographics. CONCLUSION This scale, demonstrating good psychometric properties, highlights potential intervention targets for prevention and cessation, as it relates to smoking, risk perception, and interest in quitting.

Prevalence and harm perceptions of hookah smoking among U.S. adults, 2014–2015

This study aimed to determine the prevalence and factors associated with hookah smoking and perceptions of harm among U.S. adults. Data were pooled from the Tobacco Products and Risk Perceptions Surveys conducted separately in the summers of 2014 and 2015, among a probability sample selected from an online research panel. Descriptive, logistic regression, and multinomial logistic regression analyses were conducted. In 2014/2015, prevalence of ever and past 30-day hookah smoking among U.S. adults were 15.8% (95% C.I.: 15.0%, 16.7%) and 1.5% (95% C.I.: 1.2%, 1.8%), respectively. Adults who used other alternative tobacco products had a higher odds of hookah smoking than those who did not. Adults with some college education (AOR, 1.53) and with a college degree or more (AOR, 2.21), those identified as non-Hispanic other (AOR, 1.38) were more likely to be ever hookah smokers. Being a young adult (AOR, 2.7), college-educated (AOR, 2.3), never smoker (AOR, 2.1), and an ever hookah smoker (AOR, 2.8) were associated with lower perceptions of harm. Findings suggest that young college students are at higher risk of smoking hookah and that hookah smoking is more prevalent among individuals who use other tobacco products, such as little cigars and cigarillos, traditional cigars, and e-cigarettes, indicating a distinct group of users of alternative tobacco products. Regarding potential harm of hookah, the study highlights a knowledge gap and misperception especially among young, college-educated, and never smokers. Public health interventions should target these subpopulations to provide them with accurate information on hookah smoking.

Comparisons of three nicotine dependence scales in a multiethnic sample of young adult menthol and non-menthol smokers

BACKGROUND Few studies have compared nicotine dependence among menthol and non-menthol cigarette smokers in a multiethnic sample of young adult daily cigarette smokers. This study examines differences in nicotine dependence among menthol and non-menthol daily smokers and the associations of nicotine dependence with quitting behaviors among Native Hawaiian, Filipino, and White cigarette smokers aged 18-35. METHODS Craigslist.org, newspaper advertisements, and peer-to-peer referrals were used to recruit daily smokers (n = 186) into a lab-based study. Nicotine dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND), the Nicotine Dependence Syndrome Scale (NDSS), and the brief Wisconsin Inventory for Smoking Dependence Motives (WISDM). Multiple regression analyses were used to examine differences in nicotine dependence between menthol and non-menthol smokers and the relationship between each nicotine dependence scale with self-efficacy to quit, quit attempt in the past 12 months, and number of attempts. RESULTS Menthol smokers were more likely to report difficulty refraining from smoking in places where forbidden (p = .04) and had higher scores on social/environmental goads subscale of the WISDM (p = .0005). Two-way interaction models of the FTND and menthol status showed that menthol smokers with higher levels of dependence were more likely to have tried to quit smoking in the past 12 months (p = .02), but were less likely to have had multiple quit attempts (p = .01). CONCLUSIONS Components of the FTND and WISDM distinguish levels of dependence between menthol and non-menthol smokers. Higher FTND scores were associated with having a quit attempt, but fewer quit attempts among menthol smokers.

Perceptions of Addiction, Attempts to Quit, and Successful Quitting in Nondaily and Daily Smokers

We aimed to qualitatively examine differences in perceptions of addiction, attempts to quit, and successful quitting among nondaily versus daily college student smokers. We conducted 16 focus groups with a total of 73 college student smokers from the southeastern U.S. Focus groups were homogenous in terms of gender, smoking status (nondaily, daily), and type of school (2-year college, 4-year university). Questions centered on perceptions of addiction, their own addiction, what constitutes a quit attempt, and successful quitting. Themes that emerged among all smokers regarding conceptualization of general addiction included physiological and psychological dependence and an inability to quit smoking. In terms of their own addiction, nondaily smokers referenced their ability to quit and sense of choice to smoke as factors indicating a lack of addiction, whereas daily smokers reported dependence symptoms and their inability to control their smoking indicating addiction. Nondaily smokers discussed quit attempts in terms of making the decision to quit and avoiding situational triggers, whereas daily smokers reported taking more behavioral steps toward cessation (e.g., not buying cigarettes, reducing cigarette consumption). With regard to successful cessation, both groups identified losing the desire to smoke as a hallmark. However, nondaily smokers reported that the decision to quit might constitute successful cessation; daily smokers had more strict behavioral criteria such as abstinence for an extended period of time. The different perceptions of ones own addiction, attempting to quit smoking, and successful quitting suggest the need to improve assessments of these factors, particularly among nondaily smokers.

Attitudes about Violence and Involvement in Peer Violence among Youth: Findings from a High-Risk Community

Peer violence perpetration and victimization are the most common types of violence among youth. This study determined the associations among violent attitudes toward peers, involvement in peer violence perpetration, and experience with peer violence victimization among boys and girls in a high-risk, urban community. Analyses were based on data from the 2004 Youth Violence Survey, which was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N = 4,131) in a disadvantaged, urban, school district in the USA. Logistic regression analyses were conducted to test the associations between attitudes in support of violence and involvement in violent behaviors. Results show that among youth, attitudes supporting boys hitting boys significantly increased the odds of peer violence perpetration after controlling for potential confounders (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI] = 1.07, 1.72). However, stratified analyses for boys and girls show that attitudes supporting boys hitting boys increased the odds of peer violence perpetration for girls only after controlling for potential confounders (AOR, 1.49; 95% CI = 1.05, 2.13). The findings demonstrate that there are important differences between boys and girls in terms of their associations with violent attitudes and involvement in actual violent behaviors. However, additional research is needed to determine how attitude modifications can be incorporated into youth violence prevention programs.

Validation of Scales Measuring Attitudes, Self-Efficacy, and Intention Related to Smoking Among Middle School Students

Attitudes toward smoking, self-efficacy to avoid smoking, and smoking intention, widely cited correlates of youth smoking prevention, are often measured in large-scale youth tobacco surveys. The psychometric properties of these scales have not been well studied among middle school youth. We examined the factorial, discriminate, and convergent validity of these scales among sixth to eighth graders from a convenience sample of 22 Texas middle schools (51.2% female; 51.21% White, 32.1% Hispanic, 16.9% African American, and 8.8% Other; 67.8% nonsmokers, 21.9% experimental smokers; 3.3% former smokers; and 7.6% current smokers). Confirmatory factor analysis and invariance testing suggest that smoking attitudes, self-efficacy, and intention have evidence of construct validity in this multiethnic sample, and the scales are appropriate to assess these constructs among middle school adolescents. Additional studies are needed to establish additional evidence of validity of these constructs in other middle school samples and other subgroups (e.g. current, experimental, and former smokers).

Promotion of waterpipe tobacco use, its variants and accessories in young adult newspapers: a content analysis of message portrayal

The objective of our study was to identify waterpipe tobacco smoking advertisements and those that promoted a range of products and accessories used to smoke waterpipe tobacco. The content of these advertisements was analyzed to understand the messages portrayed about waterpipe tobacco smoking in young adult (aged 18-30) newspapers. The study methods include monitoring of six newspapers targeting young adults from four major cities in the Southeastern United States over a 6-month period. A total of 87 advertisements were found; 73.5% (64) were distinct and content analyzed. The study results showed that of the advertisements analyzed, 25% advertised waterpipe tobacco smoking, 54.7% featured waterpipe tobacco smoking and other tobacco use, 14.1% featured non-tobacco waterpipe variants (i.e. vaporizers), and 6.3% featured waterpipe apparatus accessories (e.g. charcoal, hoses). The sociability (34%) and sensuality (29.7%) of waterpipe smoking were promoted themes. Alternative to cigarette use messages (3.1%), and harm-reduction messages (17.1%) emphasized that smoking waterpipe tobacco using the featured accessory or waterpipe variant was a healthier experience than cigarette smoking. The study concluded that the messages that promoted waterpipe tobacco smoking to young adults are parallel to those used to promote cigarette use. Tobacco control professionals should continue to monitor young adult newspapers as a source of waterpipe-related advertising.