DESCRIPTION (provided by applicant): While the prevalence of cigarette smoking has been decreasing steadily over the last 40 years, the use of alternative tobacco products has risen markedly over the last decade, particularly among young adults. The aim of these three interrelated exploratory research proposals are to 1) advance our understanding of attitudes, risk perception and use of emerging tobacco and nicotine delivery products, including electronic cigarettes and hookah, among low income, minority and immigrant young adults ages 18-30 enrolled in one of the 23 colleges of the City University of New York (CUNY), 2) to assess the communication channels young adults use to seek and share information and the nature and extent of this communication about electronic cigarettes and hookah, and 3) to assess the health implications of one of these emerging products, hookah, an example of a culturally-linked method of tobacco smoking. To achieve these aims we will survey 1,500 students attending City University of New York, the largest and one of the most diverse public university systems in the U.S. (75% racial/ethnic minority). We will supplement the quantitative survey data with focus groups among water pipe tobacco smokers and electronic cigarette users, as well as among those with high intention of using these products in the next 6 months: Finally, we will assess the content of water pipe tobacco smoke and its health effects. Hookah smokers, recruited from the CUNY survey, will be monitored for cardiovascular and pulmonary effects after exposure to mainstream hookah smoke. In addition, airway epithelial cells will be collected from sputum samples separated by flow cytometry and assayed for mRNA changes in cancer-related genes. Hookah/water pipes have become the second most common form of tobacco used (after cigarettes) in some US populations and a surge in marketing for electronic cigarettes has coincided with dramatic increases in awareness and use (5 fold increase in use from 2010-2012). For both products, the alarming growth in use is highest among young adults. Yet, little is known about factors leading to initiation, patterns of use, including dual use of products, and how young adults obtain and exchange information of these products. Moreover, despite a history of industry targeting vulnerable populations, there are a lack of data on how use of nontraditional products varies by race/ethnicity and gender. This application brings together experts in environmental sciences and tobacco control, bridging the study of patterns of product use and potential toxicity. Consistent with FDA specified research goals the application represents an important step towards elucidating patterns of communication and potential public health risks posed by electronic cigarettes and Hookah that will help inform regulations related to these products.

PUBLIC HEALTH RELEVANCE: The use of alternative tobacco products in the US has been rising markedly over the last decade, dramatically outpacing the scientific evidence available on these products. This revision application focuses on two of the most common - water pipe tobacco and e-cigarettes. We will assess prevalence of water pipe and e-cigarette use in a diverse, urban young adult population, and then evaluate how people obtain and share information about these products. Finally we will evaluate the exposure to mainstream particles and gases generated by water pipe tobacco smoking, as well as the adverse health effects and elevated biomarkers of risk produced by exposure to water pipe tobacco smoke.