IntroductionWaterpipe 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.MethodsUsing 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.ResultsOf 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). ConclusionCurrent 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.

Introduction Patterns of waterpipe smoking and associated other tobacco use were assessed among U.S. young adults (aged 18–24 years). Methods A descriptive analysis of baseline data (2013–2014) from the Population Assessment of Tobacco and Health Study was conducted in 2016. Results The study included 9,119 young adults—44% ever and 11% past–30 day waterpipe smokers (12% of men and 9% of women were past–30 day smokers). Among past–30 day smokers, waterpipe smoking frequency was distributed as follows: 4% daily, 23% weekly, 36% monthly, and 37% less than monthly. The average session exceeded 30 minutes for 79% of respondents. In this age group, 29% were exclusive waterpipe smokers, 16% were dual (waterpipe/cigarette) smokers, 8% were dual (waterpipe/e-cigarette) users, 19% were waterpipe/cigarette/e-cigarette users, and 28% presented with other combinations of poly use. Conclusions Waterpipe smoking is widespread among U.S. young adults. Although waterpipe patterns are predominantly intermittent, the average smoking session provides prolonged exposure. Waterpipe smoking among young adults is primarily characterized by the use of flavored tobacco, the café culture, and poly tobacco use. Rising trends in waterpipe smoking among U.S. youth warrant a strong regulatory response to prevent future waterpipe-related morbidity and mortality.

Head and neck squamous cell carcinoma (HNSCC) is a morbid cancer with poor outcomes. Statins possess anticancer properties such as immunomodulatory and anti‐inflammatory effects. The objective of our study is to identify the association between statin use among untreated HNSCC patients and overall death, disease‐specific death and recurrence. HNSCC patients were recruited to participate in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003 to 2014. Statin use data were collected through medical record review. Participants were considered a statin user if they used a statin at or after diagnosis. Outcome data were collected through medical record review, Social Security Death Index or LexisNexis. Our analytic cohort included 1638 participants. Cox proportional hazard models were used to estimate the association between ever statin use and HNSCC outcomes. Statin use was seen in 36.0% of participants. We observed a statistically significant inverse association between ever using a statin and overall death (HR = 0.75, 95% CI = 0.63‐0.88) and HNSCC‐specific death (HR = 0.79, 95% CI = 0.63‐0.99) and a nonstatistically significant inverse association for recurrence (HR = 0.85, 95% CI = 0.70‐1.04). When investigating the association between statin use and HNSCC outcomes utilizing interaction terms between statin use and human papillomavirus (HPV), statistically significant interactions for HNSCC‐specific death and recurrence were identified (HNSCC‐specific death: HPV‐positive HR = 0.41, 95% CI = 0.21‐0.84; HPV‐negative HR = 1.04, 95% CI = 0.71‐1.51; p‐int=0.02; recurrence: HPV‐positive HR = 0.49, 95% CI = 0.29‐0.84; HPV‐negative HR = 1.03, 95% CI = 0.74‐1.43; p=int‐0.02). Statin use may be protective for adverse outcomes in HNSCC patients, particularly those with HPV‐positive disease. If true, these findings could have a meaningful impact on tertiary prevention for this cancer.

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