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Background Hookah use is prevalent among adolescent and young adult populations. The study assessed how positive cognitions toward cigarettes moderate the impact of positive hookah cognitions on past 30 day hookah use among a representative sample of youth. Understanding cognitions about products can contribute to effective interventions. Methods Data from the 2015 Florida Youth Tobacco Survey was used to determine cognitions and use patterns among high school students. Weighted means and proportions were used for demographic comparisons for cognitions about products. t -Tests and chi-square analysis were conducted for differences between users and non-users. Logistic regressions were conducted for the modeling of interaction between hookah and cigarette cognition. Results Nearly one out of ten (9.6%) of adolescents reported current hookah use. Across all cognition measures, positive hookah cognitions were associated with current hookah use. Additionally, there was a pattern of hookah cognitions being more strongly associated with current hookah use among those students that did not endorse the equivalent cognition for traditional cigarettes. Conclusions Hookah cognitions were generally more associated with hookah use among youth who did not endorse positive cognitions for cigarettes compared to those that did endorse positive cognitions for cigarettes. This finding is novel given youth who feel negatively about cigarettes are more influenced by their hookah-specific cognitions. Youth who believe cigarettes pose harm may benefit from messaging about the harms of hookah. Interventions or prevention efforts that draw strong comparisons between cigarettes and hookah may be effective among youth.

Aims In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use. Method Data collected from 511 bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption. Results Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED. Conclusions Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.