Waterpipe Tobacco Smoking among U.S. Adolescents and Young Adults

描述(由申请者提供)：使用水烟斗吸烟是一种新兴趋势，对美国公众健康构成威胁。水烟烟雾含有大量的有毒物质(如一氧化碳、焦油、尼古丁和重金属)，并与成瘾和其他不良健康后果有关。尽管有这些事实，便利性样本研究表明，在过去的一年里，20%-40%的美国大学生报告吸食水烟。此外，30%-50%的水烟吸烟者从未使用过香烟，这表明水烟烟斗将烟草输送给数百万人，否则他们可能对尼古丁很天真。更多地了解美国水烟使用者、水烟吸食机制以及水烟使用的轨迹和后果，对于制定有针对性的干预措施，防止水烟成为美国烟草流行的一种新菌株至关重要。美国大学健康协会新的全国大学健康评估(NCHA)每年对9万多人进行调查，这将是第一次包括评估水烟吸烟者基本项目的大规模调查。该项目利用这些数据来帮助我们确定在大样本美国大学生中吸食水烟的流行率及其相关性(具体目标1)。多变量模型将评估水烟斗吸烟结果与(1)年龄、性别、种族/民族、社会经济地位和其他物质使用等响应因素之间的独立关联；(2)环境变量，如学院/大学设置和地理区域。接下来，我们将使用定性评估来提供一个理论框架，描述与吸水烟斗烟草吸烟相关的因素(具体目标2)。这一构成部分将涉及：(1)对水烟网站的全国内容进行分析；(2)对吸食水烟的8个不同环境中的行为进行直接的人种学观察；(3)对水烟使用者按年龄和性别进行分层的6个深入焦点小组。这些分析将为我们的理论模型提供信息，该模型描述了与吸水烟斗吸烟相关的因素。最后，我们将对3700名年龄在15-30岁之间的人进行一项具有全国代表性的纵向研究，调查吸水烟斗吸烟的轨迹和后果(具体目标3)。这项研究的数据将使我们能够(1)从具体目标2测试概念模型；以及(2)确定水烟试验与随后的烟草使用和意图结果之间的纵向关联。总而言之，水烟斗吸烟似乎是一个日益严重的公共健康威胁，特别是在美国青少年后期和年轻人中。这个及时和创新的项目将结合对现有数据集的分析、密集的定性评估和原始的纵向数据收集，以提供关键信息，最终将有助于制定旨在减少水烟斗吸烟对公众健康威胁的干预措施。 与公共健康相关：使用水烟斗吸烟在美国是一种新兴趋势，对公众健康构成了极大的威胁。该项目利用一项大型全国性调查中新纳入的水烟吸烟问题，来确定全国大学生中水烟吸烟的普遍程度。它还将以密集的定性部分为特色，帮助我们通过现场观察和焦点小组了解为什么这种行为正在增加。最后，它将包括一项具有全国代表性的纵向数据收集，调查水烟吸烟的轨迹和后果。

DESCRIPTION (provided by applicant): Tobacco smoking using a waterpipe (a.k.a., hookah) is an emerging trend and a threat to U.S. public health. Waterpipe tobacco smoke contains large amounts of toxicants (e.g., CO, tar, nicotine, and heavy metals) and has been associated with addiction and other adverse health consequences. Despite these facts, convenience sample studies demonstrate that 20-40 percent of U.S. University students report waterpipe tobacco smoking in the past year. Moreover, 30-50 percent of waterpipe tobacco smokers have never used cigarettes, suggesting that waterpipes deliver tobacco to millions of individuals who otherwise would have been naive to nicotine. Learning more about U.S. waterpipe users, mechanisms of waterpipe smoking uptake, and the trajectory and consequences of its use will be essential for developing targeted interventions to prevent waterpipe tobacco smoking from becoming a new strain in the U.S. tobacco epidemic. The American College Health Association's new National College Health Assessment (NCHA) surveys more than 90,000 individuals annually and will be the first large scale survey to include basic items that assess waterpipe tobacco smoking. This project leverages these data to help us determine the prevalence and correlates of waterpipe tobacco smoking among a large sample of U.S. university students (Specific Aim 1). Multivariable models will assess independent associations between waterpipe smoking outcomes and (1) respondent factors such as age, gender, race/ethnicity, socioeconomic status, and other substance use; and (2) environmental variables such as college/university setting, and geographic region. Next, we will use qualitative assessments to inform a theoretical framework describing the factors related to uptake of waterpipe tobacco smoking (Specific Aim 2). This component will involve (1) a national content analysis of waterpipe tobacco Web sites; (2) direct ethnographic observation of behavior in 8 different settings where waterpipe tobacco is smoked; and (3) 6 in- depth focus groups with waterpipe tobacco users stratified by age and gender. These analyses will inform our theoretical model describing the factors related to uptake of waterpipe tobacco smoking. Finally, we will conduct a nationally-representative, longitudinal study of 3700 individuals aged 15-30 investigating the trajectories and consequences of waterpipe tobacco smoking (Specific Aim 3). Data from this study will enable us (1) to test the conceptual model from Specific Aim 2; and (2) to determine longitudinal associations between waterpipe tobacco experimentation and subsequent tobacco use and intention outcomes. In sum, waterpipe tobacco smoking appears to be a growing public health threat, particularly among U.S. late adolescents and young adults. This timely and innovative project will combine analysis of an existing data set, intensive qualitative assessments, and an original longitudinal data collection to provide crucial information that will ultimately help develop interventions aimed at reducing the public health threat posed by waterpipe tobacco smoking. PUBLIC HEALTH RELEVANCE: Tobacco smoking using a waterpipe (a.k.a., hookah) is an emerging trend in the U.S. that poses a great threat to the public health. This project leverages the new inclusion of waterpipe smoking questions in a large national survey to determine how common waterpipe tobacco smoking is among college students nationwide. It will also feature an intensive qualitative component that will help us understand through on-site observations and focus groups why this behavior is increasing. Finally, it will include a nationally-representative, longitudinal data collection investigating the trajectories and consequences of waterpipe tobacco smoking.