title: Knowledge, attitudes, and normative beliefs as predictors of hookah smoking initiation: a longitudinal study of university students.
abstract: BACKGROUND
  While cross-sectional studies have shown that hookah tobacco smoking (HTS) is an increasingly popular behavior among university students, little is known about factors associated with initiation. This study sought to determine associations between knowledge, attitudes, and normative beliefs and initiation of HTS among university students.
  
  
  METHODS
  Data were from a prospective longitudinal cohort study of 569 randomly selected first- and second-year university students. Online questionnaires that were developed in accordance with our composite theoretical model were completed in September 2010 and April 2011.
  
  
  RESULTS
  About one-seventh (13%) of participants initiated HTS by follow-up. Positive attitudes and favorable normative beliefs were associated with increased adjusted odds of initiation (AOR = 4.12, 95% CI = 2.56, 6.59; and AOR = 2.01, 95% CI = 1.35, 2.99, respectively), while negative attitudes were associated with decreased adjusted odds (AOR = 0.62, 95% CI = 0.48, 0.80). Correct knowledge regarding toxicants associated with HTS was not significantly associated with initiation.
  
  
  CONCLUSIONS
  While positive attitudes and favorable normative beliefs are associated with initiation of HTS in a cohort of never-users, increased knowledge about toxins is not associated with lower initiation. It may be particularly valuable for educational interventions to attempt to alter positive attitudes and normative beliefs related to HTS.
authors: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA;
authors: Jaime E
authors: JE
authors: Sidani
authors: Ariel
authors: A
authors: Shensa
authors: Tracey E
authors: TE
authors: Barnett
authors: Robert L
authors: RL
authors: Cook
authors: Brian A
authors: BA
authors: Primack
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014495:Universities; D055815:Young Adult