Consumo de tabaco de los adolescentes en Barcelona y tendencias a lo largo de 20 años

Objectives

Smoking is a preventable cause of early death and the habit starts in adolescence. The aim of this study was to describe tobacco consumption in secondary school students in 2008 and trends in the last 20 years in Barcelona.

Material and methods

We analyzed the trend in tobacco consumption by comparing data from 8 surveys carried out between 1987 and 2008 in the 8 th (2 nd year of Compulsory Secondary Education), 10th (4 th year of Compulsory Secondary Education) and 12th (2 nd year of Compulsory Secondary Education) years of secondary school. The FRESC questionnaire was used. Data on regular and daily consumption and associated factors in 2008 were gathered and compared with those corresponding to the previous studies. Percentages of annual change were calculated with Joinpoint regression and data were stratified by sex and year of education.

Results

In 2008, 6.1% of boys and 4.5% of girls in the 8 th year, 15.8% and 20.4% of those in the 10th year, respectively, and 26.1% and 33.1% of those in the 12th year, respectively, were regular smokers. A strong association was noted between regular smoking and cannabis consumption in three school years, as well as with having friends who were smokers and poor school performance. At 15-16 years old, the average annual decrease from 1996 to 2008 was 6.8% in girls and 6.1% in boys.

Conclusions

Adolescent smoking has been decreasing in the last few years in Barcelona. There is a strong association between tobacco use and cannabis consumption.     

Consumo de riesgo de alcohol y factores asociados en adolescentes de 15 a 16 años de la Cataluña Central: diferencias entre ámbito rural y urbano

Objective

To determine the prevalence of risky alcohol consumption and associated risk factors among adolescents living in Central Catalonia (Spain) during the 2011-2012 academic year, depending on their area of residence.

Method

A cross-sectional study was carried out in a sample of 1268 10th grade students (4 th grade of secondary education) in Central Catalonia.

Results

Risky alcohol consumption was higher among adolescents in rural areas than in urban areas (59.6% versus 49.8%). Associated risk factors were drunkenness in siblings and friends, having positive expectations of alcohol consumption, and buying alcohol. Not living with both parents and poorer academic achievement were associated risk factors in rural areas, while higher socioeconomic status was a risk factor in urban areas.

Conclusions

Risky alcohol consumption was much higher among adolescents living in rural areas. The main associated factor was alcohol consumption among family and friends.     

Adolescent daily smoking, negative mood-states and the role of family communication

Objective

To determine whether negative mood states constitute a risk factor for daily smoking during adolescence, and to specify the role of familial factors in the association between the two variables.

Methods

Cross-sectional study of a representative sample (second wave, Panel of Families and Childhood) of Catalan adolescents between 14 and 18 years of age. Six logistic regression models were used for girls (n = 1,442) and six for boys (n =1,100) in order to determine whether negative mood states constitute a risk factor for daily cigarette consumption, and to what extent this effect is attributable to familial factors.

Results

The prevalence of daily smoking at ages 17-18 is 3.8% for girls and 3.6 for boys. Feelings of sadness constitute a risk factor for daily cigarette consumption (odds ratio [OR] = 1.633), and communication with the father cancels out this effect. Parental pressure is a risk factor for daily smoking in both sexes (girls, OR = 2.064; boys, OR = 1.784). When parental communication is controlled for, this effect is reduced but not canceled out. Living in a reconstituted family is a risk factor for daily cigarette consumption among boys (OR = 2.988).

Conclusions

Intergenerational communication decreases the risk of daily tobacco use among adolescents independently of their mood state. Anti-smoking interventions designed in accordance with these findings may be more effective.     

Parental and retail supply of tobacco to minors: Findings from a community-based social supply intervention study

Aim

We report on findings from a quasi-experimental community trial of a complex intervention aimed at reducing social and commercial supply of cigarettes to young people.

Materials and methods

The intervention comprised a package of school, community and home-based smokefree strategies implemented over three years from 2007 to 2009 in a low-income area of Auckland, New Zealand, with another area serving as the control population. The main outcome measures were relative change in parental and retailer behaviour and in attitudes to the provision of tobacco to youth. We analysed baseline and follow-up data from questionnaires administered to parents and children living in the intervention and control areas using PASW Statistics 18.

Results

No difference was found between groups in parents’ permissiveness of smoking and in retailer compliance to the tobacco sale legislation over the course of the study, either because our intervention had no or only a limited effect, or alternatively because limitations in the study design diluted any effect.

Conclusions

Nevertheless, a key finding was that parents and retailers persisted as important sources of cigarettes for young people. Further study is required to identify effective interventions to address this issue.     

Peer Reviewed: The Influence of School Policies on Smoking Prevalence Among Students in Grades 5-9, Canada, 2004-2005

Introduction

School characteristics may account for some of the variation in smoking prevalence among schools. The purpose of this study was to investigate the relationships between characteristics of school tobacco policies and school smoking prevalence. We also examined the relationship between these characteristics and individual smoking status.

Methods

Tobacco policy data were collected from schools in 10 Canadian provinces during the 2004-2005 school year. Written tobacco policies were collected from each school to examine policy intent, and school administrators were surveyed to assess policy enforcement. Students in grades 5 through 9 completed the Youth Smoking Survey to assess smoking behaviors and attitudes. We used negative binomial regression and multilevel logistic regression to predict the influence of school policies on smoking behavior at the school and student levels.

Results

School policies that explicitly stated purpose and goals predicted lower prevalence of smoking at the school and individual levels. Policies that prohibited smoking on school grounds at all times predicted lower smoking prevalence at the school level but not at the individual level.

Conclusions

For maximum effectiveness, school smoking policies should clearly state a purpose and goals and should emphasize smoking prohibition. These policies can help reduce smoking prevalence among youths and are part of a comprehensive school approach to tobacco control.     

Attitudes of detainees and prison staff towards tobacco control policy in Switzerland: A qualitative interview study

Purpose

To explore detainees and staff's attitudes towards tobacco use, in order to assist prison administrators to develop an ethically acceptable tobacco control policy based on stakeholders’ opinion.

Design

Qualitative study based on in-depth semi-structured interviews with 31 prisoners and 27 staff prior (T1) and after the implementation (T2) of a new smoke-free regulation (2009) in a Swiss male post-trial prison consisting of 120 detainees and 120 employees.

Results

At T1, smoking was allowed in common indoor rooms and most working places. Both groups of participants expressed the need for a more uniform and stricter regulation, with general opposition towards a total smoking ban. Expressed fears and difficulties regarding a stricter regulation were increased stress on detainees and strain on staff, violence, riots, loss of control on detainees, and changes in social life. At T2, participants expressed predominantly satisfaction. They reported reduction in their own tobacco use and a better protection against second-hand smoke. However, enforcement was incomplete. The debate was felt as being concentrated on regulation only, leaving aside the subject of tobacco reduction or cessation support.

Conclusion

Besides an appropriate smoke-free regulation, further developments are necessary in order to have a comprehensive tobacco control policy in prisons.     

Efectividad de un programa multicomponente para dejar de fumar aplicado en atención primaria

Objective

To evaluate the effectiveness of a multicomponent program applied by nurses in primary care.

Method

A non-experimental pre-post study was carried out in 145 smokers from Area V of Asturias (Spain). The intervention consisted of a multicomponent group treatment program, applied for 7 weeks by primary care nurses.

Results

The mean age was 52 years. Men accounted for 39.73% of the study population. The abstinence rate at post-treatment was 51.1% (95% CI: 42.4 to 59.6). At 12 months, the abstinence rate was 41.1% (95% CI: 32.6 to 49.6). The change between the end of the intervention and follow-up at 6 and 12 months was statistically significant at both time points (p = 0.035 and p = 0.013, respectively). Among participants who had stopped smoking, there was a statistically significant decline in daily cigarette consumption. Factors that were statistically significantly associated with continued smoking at 12 months were heavier smoking before the intervention, higher scores on the Fagerström test, and a lower number of sessions attended.

Conclusions

The multicomponent treatment program was highly effective. The results suggest the desirability of specific training for health professionals to implement this type of intervention in primary care as an alternative to medical advice for smokers who need it.     

Der Rückgang des Zigarettenkonsums Jugendlicher und junger Erwachsener in Deutschland und die zunehmende Bedeutung von Wasserpfeifen,E‑Zigaretten und E‑Shishas

Background

National and international studies indicate that despite the decline in the consumption of traditional tobacco cigarettes, the consumption of other products, such as waterpipes (or hookahs), e?cigarettes or e?hookahs (a variant of e?cigarettes), may be increasing. In addition to the long-term change in smoking behaviour, this article examines how the prevalence of smoking tobacco cigarettes, waterpipes, e?cigarettes and e?hookahs in adolescents and young adults in Germany has developed between 2007 and 2016.

Methods

Data are based on representative surveys on substance use among adolescents and young adults between the ages of 12 and 25 conducted by the Federal Center for Health Education (BZgA) from 1973 to 2016. Age- and gender-specific trends of the proportion of those who describe themselves as smokers are shown. Additionally, trends of single and combined 30-day prevalence of consumption of tobacco cigarettes, waterpipes, e?cigarettes and e?hookahs are presented and tested for significance.

Results

Between 2007 and 2016, the decline in the proportion of adolescents and young adults who call themselves smokers and the decline of 30-day prevalence of consumption of tobacco cigarettes continued. At the same time, the consumption of waterpipes is rising in young adults and the consumption of e?cigarettes is rising in young men. Among adolescents, the exclusive use of waterpipes, e?cigarettes or e?hookahs was more widespread in 2016 than the exclusive consumption of tobacco cigarettes.

Discussion

In comparison to tobacco cigarettes, the consumption of waterpipes, e?cigarettes and e?hookahs is becoming increasingly important among adolescents and young adults. Thus, these products must also be considered in the planning and design of preventive measures for the prevention of smoking.

     

Cigarette smoking in Chinese adolescents: importance of controlling the amount of pocket money

Objective

To estimate the proportion of smokers that could potentially have been prevented from smoking by limiting the amount of pocket money received by Chinese adolescents.

Study design

Cross-sectional study.

Methods

Current smoking, ever smoking and the amount of pocket money were determined through self-administered questionnaires among 12,708 adolescents (aged 12–18 years) from 21 schools in Shanghai, China.

Results

Adjusted odds ratios for current smoking ranged from 2.0 [95% confidence interval (CI) 1.5–2.7] for adolescents receiving 200–399 Reminbin (RMB)/month as pocket money to 6.5 (95% CI 3.3–12.7) for those receiving ≥1000 RMB/month, compared with those receiving <200 RMB/month. The crude population-attributable risk percentage (PAR%) due to higher pocket money (≥200 RMB/month) for current smoking was 50.4% (95% CI 42.2–57.4), and adjusted PAR% was 43.3% (95% CI 30.7–53.1).

Conclusions

Approximately half of current smokers may have been prevented from smoking if pocket money was limited to <200 RMB/month among Chinese adolescents. An even larger proportion could have been prevented from smoking if pocket money was reduced further. It is recommended that future intervention programmes should target parents to reduce the amount of pocket money in China.     

Mortality attributable to smoking in Vietnamese men in 2008

Objective

Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies.

Method

We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses.

Results

When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)].

Conclusion

Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.     

Young adult former ever smokers: The role of type of smoker,quit attempts,quit aids,attitudes/beliefs,and demographics

Objective

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.

Method

Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.

Results

Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.

Conclusion

Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.     

Middle school food environments and racial/ethnic differences in sugar-sweetened beverage consumption: Findings from the Healthy Choices study

Background

Prior studies have demonstrated disproportionate clustering of fast food outlets around schools.

Purpose

The purpose of this study is to determine if racial/ethnic differences in middle school student self-reported sugar-sweetened beverage (SSB) consumption is explained by differential distributions of food outlets surrounding their schools.

Methods

Baseline (2005) data were analyzed from 18,281 middle school students in 47 Massachusetts schools participating in Healthy Choices, an obesity prevention program. Linear mixed effects models were used to examine the association of individual race/ethnicity and daily SSB consumption and the potential mediating effect of the density of food outlets (the number of fast food outlets and convenience stores in a 1500 m buffer area surrounding the school) on this association adjusting for individual and school demographics.

Results

More SSB consumption was reported by students of all racial/ethnic minority groups compared to their White peers except Asians. The density of fast food restaurants and convenience stores was not associated with individual SSB consumption (β = 0.001, p = 0.875) nor did it mediate the association of race/ethnicity and SSB consumption.

Conclusions

Racial and ethnic differences in SSB consumption among MA middle school students cannot be fully explained by the location of fast food restaurants and convenience stores.     

Questionnaire to assess behavior, knowledge and attitudes on hand hygiene among physicians

Objective

Valid and reliable instruments to measure aspects of hand hygiene are needed to determine the current situation and impact of training among health professionals. The main objective of this study was to describe the development of a questionnaire on hand hygiene among health professionals and to analyze the properties of this instrument.

Method

A questionnaire was designed and implemented between January 2010 and March 2011 at the Hospital Clínico San Cecilio (Granada, Spain). The final questionnaire consisted of 44 items that assessed provider behavior before and after contact with the patient, declarative knowledge, and attitudes to hand hygiene. The questionnaire was administered to 113 health professionals.

Results

A factor analysis was performed. Data were obtained that supported the unidimensionality of the instrument with a general convergence value that explained 39.289% of the total variance and a Cronbach's alpha of 0.784 for the established elements. Significant differences were found in hand hygiene behavior before and after contact with the patient (t = -8,991, p <0.001). Declarative knowledge and attitudes significantly predicted behavior.

Conclusions

The questionnaire shows high internal consistency, reliability, and validity and is thus a valid tool to assess behavior, knowledge and attitudes related to hand hygiene in health professionals. This instrument also detects deficiencies in basic knowledge.     

Parental and societal support for adolescent immunization through school based immunization programs

Objectives

Adolescent immunizations such as human papillomavirus vaccine have been implemented through school based immunization programs (SBIPs) in Australia. We assessed community attitudes toward immunization of adolescents though SBIPs.

Methods

A cross-sectional population survey of rural and metropolitan households in South Australia in 2011. Univariate and multiple regression analyses identified predictors of support for a SBIP.

Results

Participation rate was 57.3% with 1926 adults interviewed. Overall, 75.9% regarded school as the best place to offer adolescent immunizations, with 16.4% preferring the family physician. Parents of high school students were most supportive (88.4%) of a SBIP with 87.9% of their adolescents reported as having participated in the program. Adults 18–34 years (79.4%) were more likely to support a SBIP compared to older adults (68.7% of >55 years) [adjusted OR = 2.39, p = 0.002] and men were more supportive (80.3%) than women (71.7%) [adjusted OR = 1.54, p = 0.003]. Reasons for participation in the SBIP included convenience (39.9%), public funding for the service (32.4%), and confidence in immunization recommendations (21.0%).

Conclusions

Public support for the SBIP was very high particularly amongst parents whose adolescent/s had participated in the program.     

Influence of gender role attitudes on smoking and drinking among girls from Jujuy,Argentina

Objective

Evaluate effect of gender role attitudes on tobacco and alcohol use among Argentinean girls.

Method

Cross-sectional survey of 10th grade students attending 27 randomly selected schools in Jujuy, Argentina. Questions about tobacco and alcohol use were adapted from global youth surveys. Five items with 5-point response options of agreement–disagreement assessed attitude towards egalitarian (higher score) gender roles.

Results

2133 girls, aged 13–18 years, 71% Indigenous, 22% mixed Indigenous/European, and 7% European responded. Of these, 60% had ever smoked, 32% were current smokers, 58% ever drinkers, 27% drank in previous month, and 13% had ≥ 5 drinks on one occasion. Mean response to the gender role scale was 3.49 (95% Confidence Intervals = 3.41–3.57) out of 5 tending toward egalitarian attitudes. Logistic regression models using the gender role scale score as the main predictor and adjusting for demographic and social confounders showed that egalitarian gender role was associated with ever smoking (Odds Ratio = 1.25; 95% Confidence Intervals 1.09–1.44), ever drinking (Odds Ratio = 1.24; 95% Confidence Intervals 1.10–1.40), drinking in prior month (Odds Ratio = 1.21; 95% Confidence Intervals 1.07–1.37) and ≥ 5 drinks on one occasion (Odds Ratio = 1.15; 95% Confidence Intervals 1.00–1.33), but was not significant for current smoking.

Conclusion

Girls in Jujuy who reported more egalitarian gender role attitudes had higher odds of smoking or drinking.     

Peer Reviewed: Risk and Protective Factors for Tobacco Use Among 8th- and 10th-Grade African American Students in Virginia

Introduction

Few studies have simultaneously examined the influence of multiple domains of risk and protective factors for smoking among African Americans. This study identified individual-peer, family, school, and community risk and protective factors that predict early cigarette use among African American adolescents.

Methods

Data from 1,056 African American 8th and 10th graders who completed the 2005 Community Youth Survey in Virginia were analyzed by using logistic regression.

Results

The prevalence of smoking among the weighted sample population was 11.2%. In univariate analyses, the strongest predictors of smoking were low academic achievement, peer drug use, and early substance use (individual domain). In multivariate analyses, these factors and being in the 10th grade were significant predictors. The single protective factor in multivariate analyses was in the school domain (rewards for prosocial behavior in the school setting). When family and community variables were entered into a model in which individual-peer and school factors were controlled for, these variables were not significantly associated with smoking, and they failed to improve model fit.

Conclusion

These findings suggest that tobacco prevention programs that aim to increase school connectedness while decreasing youth risk behaviors might be useful in preventing cigarette use among African American adolescents. Given the relative importance of peer drug use in predicting smoking among African American youth, more work is needed that explores the accuracy of youths'' perceptions of their friends'' cigarette use and how family factors may moderate this risk.     

Peer Reviewed: Co-use of Alcohol and Tobacco Among Ninth-Graders in Louisiana

Introduction

The co-use of alcohol and tobacco by adolescents is a public health problem that continues well into adulthood and results in negative behavioral, social, and health consequences. The purpose of this study was to examine the co-use of alcohol and tobacco among ninth-graders in south-central Louisiana.

Methods

We created a health habits survey to collect data from 4,750 ninth-grade students, mean age 15.4 years. Cross-sectional analysis used χ ², 1-way analysis of variance, and logistic regression methods.

Results

Almost 20% of students were co-users. Students who were white, performed poorly in school, did not expect to graduate high school, and had more discretionary money to spend were more likely to be co-users. Co-users had friends who got drunk weekly and were more likely to approve of alcohol use among friends than among adults. Significant differences in attitudes toward drinking and smoking were observed between co-users and nonusers. For adolescent drinkers, including girls, hard liquor was the preferred beverage.

Conclusion

These data for high school students are applicable for prevention strategies at a critical age when harmful health behaviors can mark the start of lifelong habits. Intervention efforts will be successful only if they account for multiple levels of influence.     

Vías de exposición a plaguicidas en escolares de la Provincia de Talca,Chile

Objective

To describe pesticide concentrations in distinct environmental matrices at two time points (low and high seasons in local agricultural production) and to estimate the association between the presence of pesticide residues in matrices and the use of pesticides in the home with the sociodemographic variables of schoolchildren in the Province of Talca, Chile.

Methods

A cross-sectional study was conducted in 190 schoolchildren. Families were surveyed about their children's vegetable consumption in school and at home, the use of pesticides in the home, and other sociodemographic variables. Additionally, we measured pesticide residues in vegetables and water consumed by the schoolchildren and in the soil of 14 schools.

Results

At both time points, the vegetable matrix had the highest pesticide concentration, both in urban and rural schoolchildren. The most common pesticide residues in vegetables were chlorpyrifos, diphenylamine, pyrimethanil, and thiabendazole. In the home, pyrethroid and organophosphate pesticides were mainly used in summer. Dangerous pesticide residues such as azinphos methyl and dimethoate were found in vegetables consumed by the children in schools and households, and organochlorines were found in the soil in some schools.

Conclusions

Pesticide exposure should be limited and the health effects related to pesticide exposure should be assessed in the school population.     

Water Pipe Tobacco Smoking Among Middle and High School Students

Objectives. We examined prevalence rates of water pipe tobacco smoking among young people as a first step in assessing the health implications of this form of tobacco use.Methods. We examined water pipe use with data from the 2007 Florida Youth Tobacco Survey, which assessed tobacco-related beliefs, attitudes, and behaviors among the state''s middle and high school students.Results. Four percent of middle school students and 11% of high school students reported ever having used a water pipe. Adolescent boys were significantly more likely than adolescent girls to use water pipes, and African American adolescents were significantly less likely than adolescents from other racial/ethnic backgrounds to do so. Those who indicated ever having tried cigarettes and those who reported positive attitudes toward the social nature of cigarette use were more likely to have tried water pipes.Conclusions. Water pipe use appears to be widespread among middle and high school students. Further research is needed to assess the health risks associated with water pipe tobacco smoking as well as young people''s attitudes toward this form of tobacco use.Although the results of self-report studies indicate the apparent popularity of water pipe tobacco (also known as “hookah”) smoking among adolescents and young adults,^1–3 no population-based studies, to our knowledge, have estimated the prevalence of this form of tobacco use. Very little is known regarding water pipe tobacco smoking among adolescent groups. The few self-report studies that have examined use among adolescents have oversampled Arab American students, given the tradition of this form of tobacco use among individuals from the Middle East, Southeast Asia, and South Africa. For example, Weglicki et al.¹ compared water pipe tobacco and cigarette smoking rates among Arab Americans (representing 45% of their sample) and non-Arab Americans. The rate of water pipe use was higher among Arab Americans than among their non–Arab American counterparts (17% vs 11%).¹In addition to assessing patterns of water pipe tobacco smoking, it is important to assess the relationships between water pipe use and use of other tobacco products. Studies have shown that adolescents with a history of water pipe tobacco smoking are 4 to 16.5 times more likely than their counterparts without such a history to experiment with cigarettes.^2,4–6 Also, higher rates of water pipe use have been reported among adolescent males than among adolescent females.^2,5,6Although water pipe smoking is spreading worldwide,⁷ the overall prevalence of this practice in the United States remains unknown. However, estimates are available for certain groups, including college students. Smith et al.,⁸ in describing data collected in 2004, found that 15.3% of freshmen attending an East Coast private university had used a water pipe in the preceding 30 days. In another study, conducted in 2006 at Virginia Commonwealth University, 20.4% of students indicated water pipe use in the preceding 30 days and 48.4% reported a history of water pipe use.⁹In their study of a random sample of students enrolled at a large, urban, public university in the Northeast, Primack et al.¹⁰ found that 9.5% of students had used a water pipe in the preceding 30 days, 31% had done so in the past year, and 41% had a history of water pipe use. Of those who had used a water pipe in the past year, more than one third (35.4%) had never smoked a cigarette.¹⁰ Jackson and Aveyard¹¹ found similar results in a cross-sectional survey of college students who were customers of a water pipe cafe; most students (65%) who reported regular smoking of water pipe tobacco did not smoke cigarettes. Jackson and Aveyard also reported that rates of water pipe use increased across the college years,¹¹ a pattern opposite to that observed with cigarette smoking.¹²In addition to estimating water pipe use rates among different populations in the United States, researchers have assessed perceptions of the risks involved in this practice and the correlates of water pipe tobacco smoking. In a study of students at a private East Coast university, Smith-Simone et al.¹³ found that friends were the most likely source of influence on water pipe use in the following year; also, students reported that water pipe tobacco smoking was the most socially acceptable form of tobacco use among their peers and that their peers looked “cooler” when using water pipes than when smoking cigarettes or cigars.Eissenberg et al.,⁹ in a cross-sectional study conducted at a large public university, found that students who were current water pipe users were more likely than students with no history of water pipe use to have smoked cigarettes, cigars, or cigarillos in the preceding 30 days; to believe that water pipe use makes their peers look cool; and to believe that water pipe use is socially acceptable among their peers. They also found, in general, that water pipe users were younger, that they were less likely to be African American, that they report lower perceived harmfulness or addictiveness of water pipe use compared with cigarette use, and that they report lower perceived social acceptability of cigarette use among peers.In the earlier-mentioned study of Primack et al.,¹⁰ the authors reported that 33% of the college students in their sample believed that water pipe smoking is less harmful than cigarette smoking, and 52% believed that it is less addictive than cigarette smoking. In addition, 36% believed that water pipe smoking is “very socially acceptable.”Although individuals of college age seem to be the group most vulnerable to water pipe use, high school populations are also prone to the increasing popularity of this form of tobacco use, which is primarily social in nature. Many students reach 18 years of age, the legal age to purchase and use tobacco products, while they are still high school seniors, and with the dramatic increase in water pipe cafes (between 2000 and 2004, more than 200 new hookah cafes opened for business nationwide¹⁴), these students now have establishments available to them for water pipe use.To address gaps in the current literature on water pipe tobacco smoking among adolescents, we tested 3 hypotheses. First, older, White, male adolescents will be more likely to use water pipe tobacco than younger, non-White, female adolescents. Second, a history of having tried cigarettes will increase the likelihood of trying water pipe tobacco. Finally, adolescents who believe that cigarettes are acceptable to alleviate stress and for use in social situations will be more likely to use water pipe tobacco.We constructed models designed to assess associations between individual-level variables and water pipe tobacco smoking via hierarchical logistic regression analyses. Demographic data were included in the first model, which tested the hypothesis that water pipe tobacco smoking would be more prevalent among older, White, adolescent boys. We then added history of cigarette use in model 2 to assess our second hypothesis. Finally, in model 3, we assessed whether attitudes toward cigarette smoking with respect to social situations and stress relief would be associated with water pipe tobacco smoking, given that its relaxing and social nature is often cited as a reason for its use.