title: Waterpipe Tobacco Smoking and Susceptibility to Cigarette Smoking Among Young Adults in the United States, 2012-2013.
abstract: BACKGROUND
  Waterpipe tobacco smoking, also known as hookah and shisha, has surged in popularity among young people in the United States. Waterpipe is also increasingly becoming the first tobacco product that young people try. Given the limited access to and limited portability of waterpipes, waterpipe smokers who become more nicotine dependent over time may be more likely to turn to cigarettes. This study examined the relationship between waterpipe tobacco smoking and susceptibility to cigarette smoking among young adults in the United States.
  
  
  METHODS
  Using data from the 2012-2013 National Adult Tobacco Survey, a nationally representative sample of US adults, we reported rates of current waterpipe smoking and susceptibility to cigarette smoking by demographic characteristics and by use of other tobacco products among survey participants aged 18 to 24 years. Multivariable logistic regression was used to examine the relationship between current waterpipe smoking and susceptibility to cigarette smoking, defined as the lack of a firm intention not to smoke soon or within the next year.
  
  
  RESULTS
  Of 2,528 young adults who had never established cigarette smoking, 15.7% (n = 398) reported being waterpipe smokers (every day or some days [n = 97; 3.8%] or rarely [n = 301; 11.9%]); 44.2% (176/398) of waterpipe smokers reported being susceptible to cigarette smoking. Those who smoked waterpipe rarely were 2.3 times as susceptible to cigarette smoking as those who were not current waterpipe smokers (OR = 2.3; 95% CI, 1.6-3.4).
  
  
  CONCLUSIONS
  Current waterpipe smoking is associated with susceptibility to cigarette smoking among young adults in the United States. Longitudinal studies are needed to demonstrate causality between waterpipe smoking and initiation of cigarette smoking.
authors.affiliation: Department of Health Outcomes and Policy, University of Florida College of Medicine, PO Box 100177, Gainesville, FL 32610. Email: rsalloum@ufl.edu.
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
authors.affiliation: Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, and Jahangirnagar University, Dhaka, Bangladesh.
authors.forename: M Rifat
authors.initials: MR
authors.lastname: Haider
authors.affiliation: College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Barnett
authors.affiliation: College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
authors.affiliation: College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Kayla R
authors.initials: KR
authors.lastname: Getz
authors.affiliation: Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.affiliation: Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, and 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; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013689:Telephone; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult