Op-heal120057 1..9

Hookah tobacco smoking is increasing among US college students, including those who would not otherwise use tobacco. Part of hookah’s appeal is attributed to the perception that hookah is less harmful than cigarettes. The aims of this study were to assess knowledge of harmful exposures associated with hookah smoking relative to cigarette smoking and to determine associations between this knowledge and hookah smoking outcomes. Students (N1⁄4 852) at the University of Florida were randomly sampled via e-mail to obtain information on demographics, hookah smoking behavior and knowledge of five exposures (e.g. tar and nicotine). Multivariable logistic regression models assessed independent associations between knowledge and hookah smoking outcomes. Of the five factual knowledge items asked, 475 (55.8%) of the respondents answered none correctly. In multivariable models, correct responses to any knowledge items were not associated with lower odds of hookah smoking or susceptibility to hookah smoking in the future. Although college students are largely unaware of the toxicant exposures associated with hookah smoking, there is little association between knowledge and hookah smoking behavior. Introduction A hookah (also known as a waterpipe or narghile) is an apparatus increasingly used among adolescents and young adults in the United States to smoke tobacco. Convenience and random samples of college students indicate 20–40% ever use and 5–20% current use (past 30 days’ use) of hookah to smoke tobacco [1–4]. Moreover, whereas cigarette smoking often decreases during the course of college [5], hookah use may actually increase during the same time period [6]. Hookah use is also increasing among secondary school students. Barnett et al. [7] reported that 17% of a state-wide sample of Florida adolescents had ever smoked tobacco from a hookah, with similar results among secondary school students in Arizona and California [8, 9]. Many hookah tobacco smokers perceive hookah smoking as having a low potential for harm and addictiveness [3, 4, 10, 11], yet studies suggest that it exposes the user to high levels of toxicants and carcinogens. In fact, the World Health Organization [12] reports that one hookah tobacco smoking session exposes the user to about 100 times the smoke volume of a single cigarette. Other research confirms that, compared with a single cigarette, one hookah session is associated with substantially more exposure to tar, nicotine, carbon HEALTH EDUCATION RESEARCH 2012