title: Knowledge, Beliefs, Behaviors, and Social Norms Related to Use of Alternative Tobacco Products Among Undergraduate and Graduate Nursing Students in an Urban U.S. University Setting.
abstract: OBJECTIVE
  The purpose of the study was to assess nursing students' knowledge, beliefs, behaviors, and social norms regarding use of alternative tobacco products (ATPs).
  
  
  METHODS
  This anonymous online survey was conducted with all students enrolled in a college of nursing. The survey utilized measures from several national tobacco studies to assess knowledge and beliefs about ATPs (hookahs, cigars or cigarillos, bidis, kreteks, smokeless tobacco, electronic cigarettes) compared to cigarettes, health effects of ATPs, personal use of ATPs, and social norms. Data were analyzed in SPSS 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics and frequencies were performed for basic sociodemographic data. Paired samples t tests were performed to determine differences for scaled measures.
  
  
  RESULTS
  Nursing students demonstrated very low levels of knowledge about ATPs and their health consequences, despite high rates of ATP personal use. About 76% of participants reported use of one or more ATPs once or more in their lifetimes. A greater proportion of students had used hookahs or waterpipes (39.6%) compared to cigarettes (32.7%).
  
  
  CONCLUSIONS
  Nurses' lack of knowledge about the emerging use and health threats associated with ATPs may undermine their ability to provide appropriate tobacco cessation counseling. Research is needed to identify gaps in nurses' education regarding tobacco cessation counseling and to develop new counseling approaches specific to use of ATPs.
  
  
  CONCLUSIONS
  Nurses play critical roles in counseling their patients for tobacco cessation. Further research and education about the risks presented by ATPs are critical to reducing excess tobacco-related mortality.
authors: Upsilon, Associate Professor, New, York University College of Nursing NYU Global Institute of Public Health, New York City, NY, USA.
authors: Nancy
authors: N
authors: VanDevanter
authors: Resident, University of Michigan School of Medicine, AnnArbor, MI, USA.
authors: Sherry
authors: S
authors: Zhou
authors: Alpha Chi, Assistant Professor, Boston College School of Nursing, Chestnut Hill, MA, USA.
authors: Carina
authors: C
authors: Katigbak
authors: Upsilon, Professor, New York University College of Nursing, NYU Global Institute of Public Health, New York City, NY, USA.
authors: Madeline
authors: M
authors: Naegle
authors: Associate Professor, New York University School of Medicine, NYU Global Institute of Public Health, NYU/Abu Dhabi Public Health Research Center, New York City, NY, USA.
authors: Scott
authors: S
authors: Sherman
authors: Professor, New York University School of Medicine, NYU Global Institute of Public Health, NYU/Abu Dhabi Public Health Research Center, New York City, NY, USA.
authors: Michael
authors: M
authors: Weitzman
mesh_terms: D000293:Adolescent; D000328:Adult; D004508:Education, Nursing, Baccalaureate; D004511:Education, Nursing, Graduate; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000523:psychology*; D066262:Social Norms; D013338:Students, Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014481:United States; D014495:Universities; D014505:Urban Population; D055815:Young Adult
keywords: Alternative tobacco products; nursing students; smoking cessation counseling