Doctor of Philosophy (PhD)
First Advisor's Name
Dr. Wasim Maziak
First Advisor's Committee Title
Second Advisor's Name
Dr. Miguel Angel Cano
Second Advisor's Committee Title
Third Advisor's Name
Dr. Tan Li
Third Advisor's Committee Title
Fourth Advisor's Name
Dr. Matthew T. Sutherland
Fourth Advisor's Committee Title
Predictors, Waterpipe Smoking, Trajectories, Adolescents, Young Adults, Pictorial Health Warning Label
Date of Defense
In recent years waterpipe tobacco (WPT) smoking has increased among young people in the United States (US). Adequate characterization of the WPT smoking trajectories (initiation, progression, and cessation), their predictors, and examination of the effects of a pictorial health warning label (PHWL) on WPT smokers is essential to guide interventions and policies to curb WPT smoking among young people in the US. Using the Population Assessment of Tobacco and Health Study (PATH) and clinical lab data, this dissertation assessed: 1) prevalence and predictors of WPT smoking initiation and progression among adolescents and young adults; 2) magnitude and predictors of WPT cessation among young adults, and 3) the effects of PHWL on low- and high-frequency WPT smokers’ experiences, toxicant exposures, and puffing behavior.
In the first study, between 2013-2018, 4.8% of the adolescents and 18.5% of young adults initiated WPT smoking. During the same period, 10.6% of adolescent WPT smokers and 14.1% of young adult-WPT smokers progressed in WPT smoking (increase in the frequency of smoking at any subsequent wave). Predictors of WPT initiation among adolescents include lower harm perception (adjusted odds ratio (aHR)=2.89, 95% confidence interval (CI)=2.10-3.98), and other tobacco products use (aHR=3.97, 95% CI=2.73-5.78), while predictors of WPT progression include illicit drug use (aHR=4.60, 95% CI=1.99-10.67). Among young adults, predictors of WPT initiation include lower harm perception (aHR=2.77, 95% CI=2.19-3.50), and other tobacco products use (aHR=3.14, 95% CI=2.25-4.38); while predictors of WPT progression were lower harm perception (aHR=1.80, 95% CI=1.41-2.30), and alcohol use (aHR=1.61, 95% CI=1.13-2.30).
In the second study, 25.13% of the young adult WPT smokers quit smoking between waves 1-5 (2015-2019). The major predictor of WPT smoking cessation was regretting smoking (aHR= 2.33, 95% CI=1.29-4.21) whereas barriers to cessation were the lack of smoking restriction at home (aHR=0.35, 95% CI=0.18-0.70) and alcohol use (aHR=0.62, 95% CI=0.41-0.93) among young adults WPT smokers. A moderate correlation between regret smoking WPT and quit attempts (ρ=0.3, p-value
In the third study, both low- and high-frequency smoking groups showed no effect of PHWL on exposure to nicotine and other toxicants. However, there was a reduction in acute subjective experiences of smoking among high-frequency smokers compared to low-frequency smokers after smoking WPT with PHWL compared to the no-PHWL (e.g., puff liking -1.2 vs. -0.5; puff satisfaction -1.0 vs. -0.3) (p
Overall, we found a high rate of WPT smoking initiation and progression. Several modifiable risk factors including lower harm perception towards WPT and the loopholes in regulating WPT establishments were the drivers of WPT initiation, progression, and continuation. The PHWL on the WPT device showed differential effectiveness among low- and high-frequency smokers. The FDA should mandate PHWL on the WPT device and WPT establishments should not be exempted from smoke-free air legislation and not allowed indirect promotion in social media.
Previously Published In
Gautam P, Sharma E, Ebrahimi Kalan M, et al. Prevalence and predictors of waterpipe smoking initiation and progression among adolescents and young adults in waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study [published online ahead of print, 2022 Feb 23]. Nicotine Tob Res. 2022;ntac051. doi:10.1093/ntr/ntac051
Gautam, P., Kalan, M.E., Li, W. et al. The Effects of Pictorial Health Warning Label on Waterpipe (Low- and High-Frequency) Smokers’ Experiences, Toxicant Exposures, and Puffing Behavior. Int.J. Behav. Med. (2022). https://doi.org/10.1007/s12529-022-10074-w
Gautam, Prem, "Determinants of Waterpipe Smoking Trajectories and the Effects of Pictorial Health Warning Label among Young Waterpipe Smokers in the US" (2022). FIU Electronic Theses and Dissertations. 4920.
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