Background-Known most commonly in the U.S. as "hookah," waterpipe tobacco smoking appears to be growing among college students. Despite beliefs that waterpipe use is safer than cigarette smoking, research to date (albeit limited) has found health risks of waterpipe smoking are similar to those associated with cigarette smoking, including lung cancer, respiratory illness, and periodontal disease. The goals of this study were to estimate the prevalence of use among a large, multi-institution sample of college students and identify correlates of waterpipe use, including other health-risk behaviors (i.e., cigarette smoking, alcohol, marijuana, and other illicit drug use) and availability of commercial waterpipe tobacco smoking venues.Methods-A cross-sectional sample of 3,770 college students from eight universities in North Carolina completed a web-based survey in fall 2008.Results-Forty percent of the sample reported ever having smoked tobacco from a waterpipe, and 17% reported current (past 30-day) waterpipe tobacco smoking. Correlates associated with current waterpipe use included demographic factors (male gender, freshman class); other healthrisk behaviors (daily and nondaily cigarette smoking, alcohol use, marijuana use, other illicit drug use); perceiving waterpipe tobacco smoking as less harmful than regular cigarettes; and having a commercial waterpipe venue near campus. Conclusions-The results highlight the popularity of waterpipe tobacco smoking among college students and underscore the need for more research to assess the public health implications of this growing trend.

Background Marijuana is currently the most commonly used drug on college campuses. Marijuana use among college students is increasing, and many students begin using marijuana during college. The goal of this study was to investigate predictors of lifetime marijuana use at college entry and initiation during freshman year. Methods We used responses from the first two semesters of a longitudinal study of 3,146 students from 11 colleges in North Carolina and Virginia. Random-effects logistic regression models were constructed to identify factors that predict lifetime marijuana use at college entry and initiation during freshman year. Results Nearly 30% of students reported ever having used marijuana at college entry. Among students who had never used marijuana prior to college, 8.5% initiated use during freshman year. In multivariable logistic regression models, having at least $100 per month in spending money; attending church rarely or never; current use of cigarettes, alcohol, and hookah tobacco; lifetime use of other illicit drugs; and a higher propensity toward sensation seeking were associated with a higher likelihood of having used marijuana at least once at college entry. Hispanic ethnicity, living on campus, and current use of cigarettes and alcohol were associated with a higher likelihood of initiating marijuana use during freshman year. Conclusion These results have implications for targeting substance abuse prevention programs on college campuses.

Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our findings highlight negative product attributes reported by participants that may be useful in prevention and regulatory efforts to offset favorable marketing messages.

Background Marijuana is the most commonly used illicit drug by college students. Prior studies have established an association between marijuana use and poor academic performance in college, but research on the frequency of marijuana use over the entire college career is limited. The study objective was to examine the association of marijuana use trajectories on academic outcomes, including senior year enrollment, plans to graduate on time, and GPA. Methods Data were collected from a cohort of 3,146 students from 11 colleges in North Carolina and Virginia at six time points across the college career. Group-based trajectory models were used to characterize longitudinal marijuana use patterns during college. Associations between marijuana trajectory groups and academic outcomes were modeled using random-effects linear and logistic regressions. Results Five marijuana trajectory groups were identified: non-users (69.0%), infrequent users (16.6%), decreasing users (4.7%), increasing users (5.8%), and frequent users (3.9%). Decreasing users and frequent users were more likely to drop out of college and plan to delay graduation when compared to non-users. All marijuana user groups reported lower GPAs, on average, than non-users. Conclusion These results identify marijuana use patterns that put students at risk for poor academic performance in college. Students who use marijuana frequently at the beginning of the college career are especially at risk for lower academic achievement than non-users, suggesting that early intervention is critical.

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n=47) and susceptible nonusers (n=30). Transcripts were coded for emergent themes on participants’ perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.