title: Behavioral associations with waterpipe tobacco smoking dependence among US young adults.
abstract: OBJECTIVE
  Waterpipe tobacco smoking (WTS) is increasingly prevalent in the United States, especially among young adults. We aimed to (1) adapt items from established dependence measures into a WTS dependence scale for US young adults (the US Waterpipe Dependence Scale), (2) determine the factor structure of the items and (3) assess associations between scale values and behavioral use characteristics known to be linked to dependence.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  United States.
  
  
  METHODS
  A total of 436 past-year waterpipe tobacco users ages 18-30 years selected at random from a national probability-based panel.
  
  
  METHODS
  Participants responded to six tobacco dependence items adapted for WTS in US populations. Behavioral use characteristics included factors such as frequency of use and age of initiation.
  
  
  RESULTS
  Principal components analysis yielded an unambiguous one-factor solution. Approximately half (52.9%) of past-year waterpipe tobacco users received a score of 0, indicating that none of the six WTS dependence items were endorsed. Approximately one-quarter (25.4%) endorsed one dependence item and 22.7% endorsed two or more items. Higher WTS dependence scores were associated significantly with all five behavioral use characteristics. For example, compared with those who endorsed no dependence items, those who endorsed two or more had an adjusted odds ratio (AOR) of 3.90 [95% confidence interval (CI) = 1.56-9.78] for having had earlier age of initiation and an AOR of 32.75 (95% CI = 9.76-109.86) for more frequent WTS sessions.
  
  
  CONCLUSIONS
  Scores on a six-item waterpipe tobacco smoking dependence scale (the US Waterpipe Dependence Scale) correlate with measures that would be expected to be related to dependence, such as amount used and age of initiation.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.|Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Sidani
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.|Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Shensa
authors.affiliation: Pinney Associates, Pittsburgh, PA, USA.
authors.forename: Saul
authors.initials: S
authors.lastname: Shiffman
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Departments of Medicine, Psychiatry, Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Pittsburgh, PA, USA.|Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA.|Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Primack
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult
keywords: Addiction; dependence; hookah; measurement; scale; tobacco; waterpipe