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OBJECTIVES Although youth cigarette smoking has declined in the United States, use of alternative tobacco products, such as hookah, has increased. This study assesses changes in prevalence of use from 2011 to 2013, and examines factors associated with current hookah use among North Carolina high school students in 2013. METHODS Data came from the North Carolina Youth Tobacco Survey in 2011 (n = 4,791) and 2013 (n = 4,092). STATA (StataCorp LLC) logistic regression survey procedures account for the complex survey design and sampling weights. RESULTS Prevalence of reported current hookah use significantly increased from 3.6% (95% CI: 2.8-4.5) in 2011 to 6.1% (95% CI: 4.9-7.5) in 2013 while reported lifetime hookah use increased from 9.8% (95% CI: 8.0-12.0) in 2011 to 12.6% (95% CI: 11.0-14.4) in 2013. Correlates of current hookah use included having a weekly disposable income over $50 (adjusted odds ratio (AOR) = 2.05, 95% CI: 1.25-3.35), currently smoking cigarettes (AOR = 4.57, 95% CI: 1.80-11.62), and living with hookah users (AOR = 6.45, 95% CI: 3.21-12.93). Participant self-reports of "liking" or positively commenting on tobacco products on social media were associated with current hookah use (AOR = 1.83, 95% CI: 1.84-4.52). Frequent exposure to online tobacco advertisements (AOR = 1.61, 95% CI: 1.13-2.28) were also associated with current hookah use. CONCLUSIONS Comprehensive product specific communication and policy interventions are needed to educate youth about the dangers of hookah use and reduce social acceptability among youth. To decrease hookah use in North Carolina, policymakers should consider restoring funding for comprehensive tobacco prevention and control programs, and equalizing tobacco tax rates for all tobacco product types., (©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Introduction: Although adolescent cigarette use continues to decline in the United States, electronic cigarette (e‑cigarette) use among adolescents has escalated rapidly. This study assessed trends and patterns of e‑cigarette use and concurrent cigarette smoking and the relationships between e-cigarette use and smoking cessation intentions and behaviors among high school students in North Carolina., Methods: Data came from high school students who completed the school-based, cross-sectional North Carolina Youth Tobacco Survey in 2011 (n = 4,791) and 2013 (n = 4,092). This study assessed changes in prevalence of e-cigarette and cigarette use from 2011 through 2013, and cessation-related factors associated with those students' current and past use of e‑cigarettes in 2013., Results: The prevalence of current e-cigarette use (use in the past 30 days) significantly increased from 1.7% (95% CI, 1.3%-2.2%) in 2011 to 7.7% (95% CI, 5.9%-10.0%) in 2013. Among dual users, current e-cigarette use was negatively associated with intention to quit cigarette smoking for good (relative risk ratio [RRR] = 0.51; 95% CI, 0.29-0.87) and with attempts to quit cigarette smoking in the past 12 months (RRR = 0.69; 95% CI, 0.49-0.97). Current e-cigarette smokers were less likely than those who only smoked cigarettes to have ever abstained from cigarette smoking for 6 months (RRR = 0.42; 95% CI, 0.21-0.82) or 1 year (RRR = 0.21; 95% CI, 0.09-0.51) and to have used any kind of aids for smoking cessation (RRR = 0.46; 95% CI, 0.29-0.74)., Conclusion: Public health practitioners and cessation clinic service providers should educate adolescents about the risks of using any nicotine-containing products, including e-cigarettes, and provide adequate tobacco cessation resources and counseling to adolescent tobacco users.

Background: Marijuana is the most commonly used illicit drug by college students. Prior studies have established an association between marijuana use and poor academic performance in college, but research on the frequency of marijuana use over the entire college career is limited. The study objective was to examine the association of marijuana use trajectories on academic outcomes, including senior year enrollment, plans to graduate on time, and GPA., Methods: Data were collected from a cohort of 3146 students from 11 colleges in North Carolina and Virginia at six time points across the college career. Group-based trajectory models were used to characterize longitudinal marijuana use patterns during college. Associations between marijuana trajectory groups and academic outcomes were modeled using random-effects linear and logistic regressions., Results: Five marijuana trajectory groups were identified: non-users (69.0%), infrequent users (16.6%), decreasing users (4.7%), increasing users (5.8%), and frequent users (3.9%). Decreasing users and frequent users were more likely to drop out of college and plan to delay graduation when compared to non-users. All marijuana user groups reported lower GPAs, on average, than non-users., Conclusion: These results identify marijuana use patterns that put students at risk for poor academic performance in college. Students who use marijuana frequently at the beginning of the college career are especially at risk for lower academic achievement than non-users, suggesting that early intervention is critical., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students., Methods: A cross-sectional web survey of 3146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010., Results: Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco., Conclusions: While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: College youth susceptible to waterpipe tobacco smoking (WTS) represent an important target to intervene upon in order to prevent their uptake of this product. This study examined the performance of a 4-item susceptibility measure to WTS to predict future waterpipe use and correlates of susceptibility., Methods: A cohort of college students from 11 university campuses in North Carolina and Virginia completed an online survey in 2012 and again in 2013 that assessed WTS susceptibility and subsequent waterpipe use. Tobacco use, marijuana use, binge drinking, and sensation seeking were also assessed., Results: Overall, 964 students who reported having never used waterpipe tobacco in 2012 completed the online surveys both years. Overall, about 27% of college youth were susceptible to WTS each year. Participants susceptible in 2012 were 2.5 times more likely to report having used waterpipe tobacco the subsequent year than non-susceptible participants after controlling for significant correlates of waterpipe use. Correlates of susceptibility were: being male, past 30 day cigarette smoking, use of other tobacco products, binge drinking and marijuana use, as well as higher sensation seeking., Conclusions: A 4-item WTS susceptibility measure predicts future WTS. This measure can be used to identify and intervene upon susceptible college youth to curb further exploration of WTS. Indeed, a nontrivial proportion of college students found susceptible go on to use waterpipe tobacco within a year., (© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: We assessed the impact of trying electronic cigarettes (e-cigarettes) on future cigarette smoking in a sample of smokers enrolled in college., Methods: In this longitudinal study, first-semester college students at 7 colleges in North Carolina and 4 in Virginia completed a baseline survey and 5 follow-up surveys between fall 2010 and fall 2013. Current cigarette smoking at wave 6 was the primary outcome. Participants (n = 271) reported current cigarette smoking at baseline and no history of e-cigarette use. We measured trying e-cigarettes at each wave, defined as use in the past 6 months., Results: By wave 5, 43.5% had tried e-cigarettes. Even after controlling for other variables associated with cigarette smoking, trying e-cigarettes was a significant predictor of cigarette smoking at wave 6 (adjusted odds ratio [AOR] = 2.48; 95% confidence interval [CI] = 1.32, 4.66), as were friends' cigarette smoking (AOR = 4.20; 95% CI = 2.22, 7.96) and lifetime use of other tobacco products (AOR = 1.63; 95% CI = 1.22, 2.17)., Conclusions: Trying e-cigarettes during college did not deter cigarette smoking and may have contributed to continued smoking.

Objective: This study assessed college student health providers' use of Motivational Interviewing (MI) with tobacco users, as well as their beliefs about the use of brief interventions to help college student tobacco users quit. MI is recommended by the United States Public Health Service to increase tobacco users' willingness to quit., Participants: Participants included 83 clinicians from health clinics at 7 different universities in North Carolina., Methods: Paper-and-pencil baseline survey from a cluster randomized trial of college student health clinicians., Results: Twenty-two percent of respondents reported always or usually using MI during the past month for tobacco-using patients not ready to make a quit attempt. Student health providers also reported information with regards to their beliefs about tobacco cessation treatment, barriers to intervening with patients, and confidence in motivating students to consider quitting., Conclusions: Results highlight the need to encourage clinicians' use of motivationally focused interventions with student tobacco users. [Table: see text].

Background: K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults., Objectives: This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college., Methods: In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights., Results: Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort's fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use., Conclusion: Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.

Background: Significant changes in the tobacco industry have led to heightened concern about co-use of cigarettes and smokeless tobacco (SLT) products., Objectives: The aim of this study was to assess whether male cigarette smokers who also used SLT products, in the first semester of their first year of college, were more or less likely than male cigarette smokers who did not use SLT products to still be smoking by the first semester of their senior year., Methods: Using a longitudinal, observational study, we followed a cohort of undergraduate students from 11 four-year universities in North Carolina and Virginia through their college career. Mixed-effects logistic regression analysis was conducted to estimate the likelihood of being a current smoker fall of senior year for male students who used both cigarettes and SLT at baseline, compared to those who only smoked cigarettes, after adjustment for potential confounders (n = 274)., Results: At baseline, 67.2% of participants were smoking cigarettes only (no SLT use) and 32.8% were dual users (cigarettes and SLT). A total of 62% were still smoking at senior year. Dual users were 30% more likely to be current smokers senior year compared to cigarette only users, although this difference was not statistically significant. Having at least one friend who smoked cigarettes and heavier cigarette smoking at baseline were significantly related to senior year smoking., Conclusions: Our findings do not support the argument that SLT use may help male college smokers discontinue their smoking habit. In fact, it may contribute to smoking persistence.

Rationale: Hookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked., Methods: In fall 2010, 3447 students from 8 colleges in N.C. completed an online survey., Results: 44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first., Conclusions: Rates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Dissolvable tobacco products (DTPs) have been introduced into test markets in the U.S. We sought to gauge the level of interest in trying these products and correlates of interest among potential consumers., Methods: A web-based survey of freshman at 11 universities in North Carolina and Virginia was conducted in fall 2010. Multivariable logistic regression analyses were used to identify correlates of students' likelihood to try DTPs if offered a free sample., Results: Weighted prevalence of likelihood to try DTPs was 3.7%. Significant correlates of likelihood to try included male gender, current cigarette smoking, current snus use, sensation seeking, lifetime illicit drug use, and perceived health risk of using DTPs. Among current smokers, current snus use, current use of chewing tobacco, and considering quitting smoking were associated with likelihood to try DTPs., Conclusions: While overall interest in trying these products was low, current users of cigarettes and snus were much more likely than others in trying a free sample. Some current smokers may consider DTPs to be an aid to smoking cessation, although the population-level impact of introducing these products is unknown., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Marijuana is currently the most commonly used drug on college campuses. Marijuana use among college students is increasing, and many students begin using marijuana during college. The goal of this study was to investigate predictors of lifetime marijuana use at college entry and initiation during freshman year., Methods: We used responses from the first two semesters of a longitudinal study of 3146 students from 11 colleges in North Carolina and Virginia. Random-effects logistic regression models were constructed to identify factors that predict lifetime marijuana use at college entry and initiation during freshman year., Results: Nearly 30% of students reported ever having used marijuana at college entry. Among students who had never used marijuana prior to college, 8.5% initiated use during freshman year. In multivariable logistic regression models, having at least $100 per month in spending money; attending church rarely or never; current use of cigarettes, alcohol, and hookah tobacco; lifetime use of other illicit drugs; and a higher propensity toward sensation seeking were associated with a higher likelihood of having used marijuana at least once at college entry. Hispanic ethnicity, living on campus, and current use of cigarettes and alcohol were associated with a higher likelihood of initiating marijuana use during freshman year., Conclusion: These results have implications for targeting substance abuse prevention programs on college campuses.

Background: Electronic cigarettes, or e-cigarettes, are battery operated devices that deliver nicotine via inhaled vapor. There is considerable controversy about the disease risk and toxicity of e-cigarettes and empirical evidence on short- and long-term health effects is minimal. Limited data on e-cigarette use and correlates exist, and to our knowledge, no prevalence rates among U.S. college students have been reported. This study aimed to estimate the prevalence of e-cigarette use and identify correlates of use among a large, multi-institution, random sample of college students., Methods: 4444 students from 8 colleges in North Carolina completed a Web-based survey in fall 2009., Results: Ever use of e-cigarettes was reported by 4.9% of students, with 1.5% reporting past month use. Correlates of ever use included male gender, Hispanic or "Other race" (compared to non-Hispanic Whites), Greek affiliation, conventional cigarette smoking and e-cigarette harm perceptions. Although e-cigarette use was more common among conventional cigarette smokers, 12% of ever e-cigarette users had never smoked a conventional cigarette. Among current cigarette smokers, e-cigarette use was negatively associated with lack of knowledge about e-cigarette harm, but was not associated with intentions to quit., Conclusions: Although e-cigarette use was more common among conventional cigarette smokers, it was not exclusive to them. E-cigarette use was not associated with intentions to quit smoking among a sub-sample of conventional cigarette smokers. Unlike older, more established cigarette smokers, e-cigarette use by college students does not appear to be motivated by the desire to quit cigarette smoking., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Use of prescription stimulants used to treat Attention Deficit/Hyperactivity Disorder (ADHD) for reasons other than prescribed, known as non-medical use, is a growing problem among undergraduates. Previous studies show that non-medical prescription stimulant (NMPS) users consume more alcohol than individuals who do not use NMPS. However, research on simultaneous use of NMPS and alcohol is limited. The objectives of this study were to: (1) determine the prevalence of simultaneous use of alcohol and NMPS; (2) examine predictors and consequences of simultaneous NMPS and alcohol use among undergraduates., Methods: In fall 2009, 4090 students from eight North Carolina universities completed a web-based survey., Results: Past year prevalence of NMPS use among this sample was 10.6% and simultaneous use of NMPS with alcohol was 4.9%. Among NMPS users, 46.4% used NMPS simultaneously with alcohol within the past year. Multivariable analysis revealed that simultaneous NMPS and alcohol use was associated with low grade point averages, use of other substances, and increased alcohol-related consequences. Simultaneous NMPS and alcohol users reported experiencing significantly more negative consequences than either past year drinkers who did not use prescription stimulants and concurrent NMPS and alcohol users (use over the past year but not at the same time)., Conclusions: Simultaneous use of NMPS and alcohol is high among NMPS users in our sample of undergraduate students. Simultaneous users are at increased risk of experiencing negative consequences. Thus, prevention and intervention efforts should include a focus on simultaneous NMPS and alcohol use., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: High-risk drinking by college students continues to pose a significant threat to public health. Despite increasing evidence of the contribution of community-level and campus-level environmental factors to high-risk drinking, there have been few rigorous tests of interventions that focus on changing these interlinked environments. The Study to Prevent Alcohol Related Consequences (SPARC) assessed the efficacy of a comprehensive intervention using a community organizing approach to implement environmental strategies in and around college campuses. The goal of SPARC was to reduce high-risk drinking and alcohol-related consequences among college students., Methods: Ten universities in North Carolina were randomized to an Intervention or Comparison condition. Each Intervention school was assigned a campus/community organizer. The organizer worked to form a campus-community coalition, which developed and implemented a strategic plan to use environmental strategies to reduce high-risk drinking and its consequences. The intervention was implemented over a period of 3 years. Primary outcome measures were assessed using a web-based survey of students. Measures of high-risk drinking included number of days alcohol was consumed, number of days of binge drinking, and greatest number of drinks consumed (all in the past 30 days); and number of days one gets drunk in a typical week. Measures of alcohol-related consequences included indices of moderate consequences due to one's own drinking, severe consequences due to one's own drinking, interpersonal consequences due to others' drinking, and community consequences due to others' drinking (all using a past 30-day time frame). Measure of alcohol-related injuries included (i) experiencing alcohol-related injuries and (ii) alcohol-related injuries caused to others., Results: We found significant decreases in the Intervention group compared with the Comparison group in severe consequences due to students' own drinking and alcohol-related injuries caused to others. In secondary analyses, higher levels of implementation of the intervention were associated with reductions in interpersonal consequences due to others' drinking and alcohol-related injuries caused to others., Conclusions: A community organizing approach promoting implementation of environmental interventions can significantly affect high-risk drinking and its consequences among college students., (Copyright © 2012 by the Research Society on Alcoholism.)

Objective: To examine gender differences in obtaining free alcohol, high-risk drinking, and consequences., Methods: Web-based surveys were administered annually (2003-2005) to random samples of undergraduates (N=10,729)., Results: Gender, race, age under 21, sorority/fraternity membership, lower disposable income, and relationship status were significant predictors of obtaining free alcohol. Frequent obtainers had greater odds of heavy episodic drinking and consequences compared to infrequent obtainers. Females were less likely to report heavy episodic drinking; however, frequently obtaining females were more likely to report heavy episodic drinking., Conclusions: Approximately 25% of undergraduates frequently obtained free alcohol. Females obtained more often, had higher odds of high-risk drinking, and experienced fewer consequences compared to males.

Objectives: To explore demographics, contextual factors, and health risk behaviors associated with nondaily smoking by college students., Methods: In fall 2005, a random sample of 4100 students completed an online survey., Results: Of those surveyed, 29% reported current smoking; of that 29%, 70% were nondaily smokers. Compared to daily smokers, nondaily smokers were younger, African American (compared to white), had mothers with higher education, belonged to Greek organizations, and attended private (vs public) schools. Nondaily smokers were less likely to have used illicit drugs., Conclusions: Nondaily and daily smokers differed on several demographic and contextual factors, but reported mostly similar health risk behaviors.

Objective: To examine use of and interest in cessation strategies among nondaily and daily college student smokers., Participants: 800 undergraduate student smokers aged 18 to 25., Methods: The authors examined nondaily versus daily smoking in relation to use of and interest in cessation strategies using an online survey., Results: Nondaily (65.8%) versus daily smokers (34.3%) were more likely to have made a quit attempt (p = .01) but less likely to have used any assistance (p < .001). Nondaily smokers were less interested in pharmacotherapy and traditional behavioral interventions; however, there was no difference in interest in technology-based interventions among nondaily versus daily smokers. Controlling for covariates, there were no significant differences in interest in traditional or technology-based behavioral interventions. Higher motivation, lower confidence, and depressive symptomatology were related to interest in each intervention. Smoking for social reasons was related to interest in technology-based interventions., Conclusions: Different intervention strategies may be appropriate for nondaily and daily smokers.

Objective: This study assessed college students' reports of tobacco screening and brief intervention by student health center providers., Participants: Participants were 3,800 students from 8 universities in North Carolina., Methods: Web-based survey of a stratified random sample of undergraduates., Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads., Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.

Introduction: The majority of college students who smoke do so on an occasional basis and generally do not define themselves as smokers. This represents a considerable challenge for public health efforts to prevent escalation of use and to promote cessation. Strengthening such efforts will require further examination of the motivations behind occasional smoking within this vulnerable group., Methods: Based within a priori identified content areas, we conducted eight focus groups of occasional smokers (N=53) at two demographically diverse colleges in the southeastern U.S., Results: Few participants self-identified as a smoker and few had immediate desire to quit. Most identified extrinsic motivations for future quitting, including college graduation and parenthood. Although participants acknowledged smoking-related health risks, they minimized them as being personally irrelevant. Participants highlighted social (i.e., alcohol and other smokers) and stress-related smoking triggers. They also described how they carefully managed the situations in which they would, and would not smoke in order to preserve their identity., Conclusions: College students who smoke occasionally appear to engage in impression management, taking effort to shape their personal image to not appear as a smoker. They use smoking mainly as a social engagement tool, but also to alleviate negative emotions. They express minimal desire to quit and believe they are immune to the health risks of smoking. Public health messages should address this common pattern of smoking among young adults differently than regular smoking patterns by highlighting the social, emotional, and health consequences of occasional smoking before nicotine dependence has fully developed., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Known most commonly in the U.S. as "hookah," waterpipe tobacco smoking appears to be growing among college students. Despite beliefs that waterpipe use is safer than cigarette smoking, research to date (albeit limited) has found health risks of waterpipe smoking are similar to those associated with cigarette smoking, including lung cancer, respiratory illness, and periodontal disease. The goals of this study were to estimate the prevalence of use among a large, multi-institution sample of college students and identify correlates of waterpipe use, including other health-risk behaviors (i.e., cigarette smoking, alcohol, marijuana, and other illicit drug use) and availability of commercial waterpipe tobacco smoking venues., Methods: A cross-sectional sample of 3770 college students from eight universities in North Carolina completed a web-based survey in fall 2008., Results: Forty percent of the sample reported ever having smoked tobacco from a waterpipe, and 17% reported current (past 30-day) waterpipe tobacco smoking. Correlates associated with current waterpipe use included demographic factors (male gender, freshman class); other health-risk behaviors (daily and nondaily cigarette smoking, alcohol use, marijuana use, other illicit drug use); perceiving waterpipe tobacco smoking as less harmful than regular cigarettes; and having a commercial waterpipe venue near campus., Conclusions: The results highlight the popularity of waterpipe tobacco smoking among college students and underscore the need for more research to assess the public health implications of this growing trend., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To explore the use of protective behaviors to reduce risks associated with alcohol consumption among adolescents during the summer preceding college enrollment., Methods: Survey data were collected in fall 2006 and 2007 that assessed demographic characteristics, drinking behaviors, and use of protective behaviors in the 3 months preceding the survey., Results: Female participants reported using 4 out of 10 protective behaviors more often than did males, and using protective behaviors was significantly related to fewer negative drinking-related consequences., Conclusions: Findings highlight potential benefits of using protective behaviors and the need to promote effective behaviors.

Introduction: Exposure to secondhand smoke (SHS) is associated with morbidity and mortality from coronary heart disease, lung cancer, respiratory infections, asthma, sudden infant death syndrome, and other illnesses. Although substantial numbers of college students smoke, little is known about their exposure to SHS. This paper provides data on self-reported exposure of college students to SHS., Methods: A Web-based survey of a random sample of undergraduate students at 10 universities (eight public and two private) in North Carolina was conducted (N = 4,223)., Results: A total of 83% of students reported any exposure in the 7 days preceding the survey. Exposure in a restaurant or bar was the most common (reported by 65% of students), followed by exposure at home or in the same room as a smoker (55%) and in a car (38%). Being a daily or nondaily smoker, binge drinking, being a fraternity or sorority member or pledge, female gender, White race, and higher parental education levels were associated with exposure in one or more contexts. Students younger than 21 years were less likely to report exposure in a bar or restaurant and more likely to report exposure in cars or at home. The overall campus smoking rate was positively associated with reported exposure in cars, at home or in someone's room, and in any location., Discussion: College administrators, other policy makers, and tobacco control advocates should take steps to reduce smoking and concomitant exposure to SHS among college students.

Objective: This study examined the association between restricting calories on intended drinking days and drunkenness frequency and alcohol-related consequences among college students., Participants: Participants included a random sample of 4,271 undergraduate college students from 10 universities., Methods: Students completed a Web-based survey regarding their high-risk drinking behaviors and calorie restriction on intended drinking days., Results: Thirty-nine percent of past 30-day drinkers reported restricting calories on days they planned to drink alcohol, of which 67% restricted because of weight concerns. Restricting calories on drinking days was associated with greater odds of getting drunk in a typical week. Women who restricted were more likely to report memory loss, being injured, being taken advantage of sexually, and having unprotected sex while drinking. Men were more likely to get into a physical fight., Conclusions: These results highlight the importance of considering weight control behaviors in the examination of high-risk college drinking.

Introduction: College smokers are often considered to be one homogenous group, those reporting smoking on at least one of the past 30 days. However, considerable heterogeneity exists among college students who report current smoking. The aim of this paper is to characterize disparate patterns of smoking among college students using latent class analysis (LCA)., Methods: The sample consisted of 1,102 past-month smokers from 10 colleges in North Carolina who completed a Web-based survey. LCA was used to create homogeneous groups of smokers with similar patterns defined by multiple indicators of smoking behavior, including quantity and frequency of smoking, smoking contexts, and weekly patterns of smoking., Results: Five subclasses of smokers were identified: "heavy smokers" (28%), moderate smokers (22%), social smokers (19%), puffers (26%), and no-context smokers (4%). Demographic characteristics that varied among these subgroups were year in school, Greek membership, and residence location. Puffers were more likely to be younger students than heavy and social smokers, suggesting a transition from experimentation to regular use over time. Social smokers and puffers were more likely to be involved in Greek organizations than were heavy and moderate smokers. Moderate and social smokers were more likely to be current drinkers and to have engaged in binge drinking in the past month than were heavy smokers. This finding suggests that, for moderate and social smokers, a strong relationship exists between alcohol and tobacco use., Discussion: The results highlight the heterogeneity of college student smokers and underscore the need for targeted interventions.

This study examined if alcohol expectancies (assessed with the Comprehensive Effects of Alcohol-Brief Form) were prospectively related to negative consequences (assessed with the Rutgers Alcohol Problem Index) and if these associations varied by gender. Data were collected from 558 first-year college students at a university in the southeastern United States as part of an intervention study conducted during their initial residence hall meetings of the fall semester of 2007. Only those students who used alcohol and completed both baseline and 3-month follow-up surveys were included in the analyses (n = 347). Mixed-model multivariate analyses indicated that higher sexuality and tension reduction expectancies were prospectively related to more alcohol consumption-related negative consequences for males but not for females. Findings suggest that intervention efforts to prevent problem drinking would benefit from being gender-specific. The study's limitations are noted.

Over 2,000 North Carolina high school students completed surveys measuring community risk and protective factors and individual health risk behaviors including dating violence perpetration and victimization. Females reported more date fighting perpetration than males (8.8% to 4.0%), as well as greater levels of date fighting victimization (7.2% and 5.0%). In multivariate models, factors associated with date fighting perpetration among females and males included riding with a drinking driver. Neighborhood organization was protective for both groups. Cigarette use, drinking and driving, and being a minority were also associated with perpetration among females, while tobacco use was associated with date fighting perpetration by males. Factors associated with victimization among both genders included riding with a drinking driver. Females were more likely to be victimized if they used marijuana, whereas males were less likely to be a victim of date fighting if they perceived their community to be "organized." Findings reflect comparable individual risk factors for date fighting across genders, with few exceptions, and warrant further investigation of the role of community assets in protecting young people from dating violence.