title: Factors associated with smoking frequency among current waterpipe smokers in the United States: Findings from the National College Health Assessment II.
abstract: BACKGROUND
  Some waterpipe smokers exhibit nicotine dependent behaviors such as increased use over time and inability to quit, placing them at high risk of adverse health outcomes. This study examines the determinants of dependence by measuring frequency of use among current waterpipe smokers using a large national U.S.
  
  
  METHODS
  Data were drawn from four waves (Spring/Fall 2009 and Spring/Fall 2010) of the American College Health Association-National College Health Assessment datasets. The sample was restricted to students who smoked a waterpipe at least once in the past 30 days (N=19,323). Ordered logistic regression modeled the factors associated with higher frequency of waterpipe smoking.
  
  
  RESULTS
  Among current waterpipe smokers, 6% used a waterpipe daily or almost daily (20-29 days). Daily cigarette smokers were at higher odds of smoking a waterpipe at higher frequencies compared with non-smokers of cigarettes (OR=1.81; 95% CI=1.61-2.04). There was a strong association between daily cigar smoking and higher frequency of waterpipe smoking (OR=7.77; 95% CI=5.49-11.02). Similarly, students who used marijuana had higher odds of smoking a waterpipe at higher frequencies (OR=1.57; 95% CI=1.37-1.81).
  
  
  CONCLUSIONS
  Daily consumers of other addictive substances are at a higher risk of intensive waterpipe smoking and thus higher risk of waterpipe dependence. Intervention programs must incorporate methods to reduce waterpipe dependence and subsequently prevent its deleterious health effects.
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
authors.forename: M Rifat
authors.initials: MR
authors.lastname: Haider
authors.affiliation: Department of Health Outcomes and Policy, and Institute of Child Health Policy, University of Florida College of Medicine, Gainesville, FL, USA. Electronic address: rsalloum@ufl.edu.
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Islam
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Kasim S
authors.initials: KS
authors.lastname: Ortiz
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Kates
authors.affiliation: Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014495:Universities; D055815:Young Adult
keywords: College students; Dependence; Frequency; Hookah; Waterpipe