Association between free tobacco product sample receipt and tobacco use in youth and adults in the PATH Study, 2014-2016.

Tobacco companies have distributed free samples of tobacco products in the past. While prior studies have found a relationship between various marketing strategies and tobacco use, no study has assessed the prevalence of free sample receipt or the relationship between receipt and subsequent tobacco use. We analyze three waves of Population Assessment of Tobacco and Health (PATH) Study data to provide the first nationally representative prevalence estimates of free tobacco product receipt among US youth and adults in 2014 to 2016. This analysis also examines the relationship between free tobacco product receipt and ever, past 30-day, and new tobacco use one year later. The prevalence of free sample receipt in the US population in 2014-2016 was 0.8% for any tobacco product but 1.6% for ENDS/e-liquid in adults, and 0.5% for any tobacco product but 1.05% for ENDS/e-liquid in youth. Free sample receipt was higher among vulnerable subgroups. Receipt of free tobacco product samples was associated with tobacco use status using cross-sectional data in youth and adults, as well as one year later in youth. Receipt of a free ENDS or e-liquid sample was associated with any tobacco and ENDS use status using cross-sectional data in youth and adults. After these data were collected, the US Food and Drug Administration broadened the ban on distributing free samples to include all tobacco products except smokeless tobacco in adult-only facilities. Our findings support limiting free samples to further prevent youth access to tobacco products.

Curiosity About and Susceptibility Toward Hookah Smoking Among Middle and High School Students.

INTRODUCTION: Hookah smoking has increased among young people. Curiosity and susceptibility may be associated with experimentation or established use. Because tobacco use behaviors are established primarily during adolescence, our objective was to examine factors that may increase the risk of future tobacco product use among youth. METHODS: We analyzed data from the 2016 National Youth Tobacco Survey, a nationally representative survey of US students. Analyses were restricted to youth who had never smoked a hookah and stratified by their ever having used other tobacco products. The prevalence of hookah curiosity and susceptibility was assessed by sociodemographic characteristics, perceptions of harmfulness and addictiveness of hookahs, and peer use of hookahs. Associations between covariates and curiosity and susceptibility were assessed by using multivariable-adjusted regression. RESULTS: Overall, 29.1% of students reported any hookah curiosity or susceptibility. Curiosity was reported by 14.6% of those who never used tobacco products and by 45.9% of those who ever used tobacco products. Hookah susceptibility was reported by 15.6% of never-users and 52.5% of ever-users. Regardless of ever having used other tobacco products, odds of curiosity and susceptibility were higher among students with perceptions of reduced hookah harmfulness and addictiveness and among those who perceived high levels of hookah use among peers. CONCLUSION: Nearly 3 in 10 youth who never smoked a hookah (6.9 million) reported hookah curiosity or susceptibility, and prevalence was highest among those who had ever used other tobacco products. These findings reinforce the importance of educating youth about the dangers of all tobacco products and dispel misperceptions about the harmfulness and addictiveness of hookah smoking. Continued surveillance of youth curiosity, susceptibility, and use of hookahs can inform public health policy and practice.

Characteristics of Hookah Tobacco Smoking Sessions and Correlates of Use Frequency Among US Adults: Findings From Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study.

Introduction: Hookah tobacco smoking has increased in the United States. However, information on hookah use frequency and other characteristics of hookah use is limited. Methods: Investigators analyzed data from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US youth and adults. Our analysis draws on baseline data from adult (ages ≥18 years) ever (N = 10 624) and past year (n = 3947) hookah users. Bivariate and regression analyses were conducted to identify associations between demographics, use characteristics, and hookah use frequency. Results: Overall, 16.4% of adults reported ever smoking tobacco from a hookah. Of those, 31.9% reported smoking hookah within the past year. Among 3947 past-year hookah tobacco smokers, 10.7% were daily/weekly users, 13.7% were monthly users, 42.1% smoked every couple of months, and 33.5% smoked about once a year. Among daily/weekly hookah users, 66% were young adults (ages 18-24 years). When comparing daily/weekly hookah users to those who smoked every couple of months, more frequent hookah use was associated with younger age, male gender, a greater number of times the hookah is refilled during a session, fewer people sharing, and hookah ownership. Conclusion: Although there were few demographic differences between daily/weekly users and less frequent hookah tobacco smokers, some notable differences in use behaviors exist among use frequency groups. Unlike other tobacco products, hookah is often smoked communally, over an extended time period. A detailed understanding of hookah user characteristics and experiences could inform hookah-specific measures, messaging, and regulations. Implications: To our knowledge, this is one of the first studies to characterize hookah use frequency, session length, and other hookah use experiences using a nationally representative sample of US adult hookah smokers. Understanding characteristics of hookah tobacco smokers, their use experiences, and patterns of hookah use frequency would be useful in assessing risks for hookah tobacco dependence at the population level. Additionally, identifying variation in use behaviors of hookah tobacco smokers could be used to inform the development of strategies to reduce and prevent hookah tobacco use, such as tobacco regulations or public education efforts, particularly among young adults.