Brief Report
Correlates of Hookah Use and Predictors of Hookah Trial in U.S. Young Adults

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Introduction

Hookah, or waterpipe, tobacco smoking has increased among young adults (YAs) in the U.S., but few prospective studies have examined predictors of hookah use. The current study examined correlates of hookah use and predictors of hookah initiation at a 6-month follow-up in a nationally representative, prospective sample of U.S. YAs.

Methods

Data were drawn from a subset of participants aged 18–24 years at study entry from two waves of the Legacy Young Adult Cohort Study. Wave 5 was completed in July 2013 by 1,555 participants and 74% (n=1,150) completed follow-up 6 months later in January 2014. Weighted bivariate and multivariable analyses were conducted in June 2014 to estimate the prevalence and correlates of ever and past 30–day hookah use and to examine associations between baseline covariates and hookah initiation 6 months later.

Results

At baseline (Wave 5), almost 25% of the sample had ever used hookah and 4% reported past 30–day use. Alcohol, marijuana, and cigarette use were more prevalent among ever and past 30–day hookah users than among never users. Eight percent of never users at baseline reported trying hookah at the 6-month follow-up. Significant predictors of hookah trial in a multivariable model included college enrollment; alcohol, marijuana, and cigarette use; and perceptions that hookah is less harmful than cigarettes.

Conclusions

Results highlight rapid transitions in hookah use and several risk factors for initiation. Future studies should examine how these factors could be used as intervention targets to reduce tobacco use in this vulnerable age group.

Introduction

Hookah, or waterpipe, tobacco smoking recently experienced a surge in prevalence in the U.S., particularly among adolescents and young adults (YAs).1, 2, 3 Studies demonstrate high rates of hookah initiation, ranging from 13% over a 7-month period in undergraduate and graduate students4 to 23% over the course of the first year of college among female students.5 These rates of initiation and use are concerning, as a single hookah session exposes users to the equivalent of at least one to as many as 50 cigarettes, depending on the measured toxicant,6 and may place users at risk for nicotine dependence7, 8 and many of the same diseases as cigarette smokers.9, 10, 11, 12

Several risk factors and correlates of hookah use may be contributing to its rising popularity in YAs. First is the perception among YAs that hookah is less harmful13, 14, 15, 16, 17, 18, 19 and less addictive14, 15, 18, 19 than cigarettes. Second, a number of studies have documented that other health risk behaviors highly prevalent in YAs, such as alcohol and marijuana use, are correlated with hookah use.5, 20, 21, 22, 23 Finally, dual use of cigarettes and hookah is especially common in YAs.23, 24, 25 Thus, the profiles of hookah-using YAs may portend negative health consequences, propensity for nicotine dependence, and tobacco-related morbidity and mortality.

To date, few studies have examined predictors of hookah initiation using a prospective design; most have focused on hookah initiation in college-attending samples,5, 21 which may exclude a significant portion of YAs.26 This study sought to extend previous work and fill an important research gap by examining correlates of hookah use and predictors of hookah initiation in a nationally representative, prospective sample of U.S YAs.

Section snippets

Study Sample

This study used data from the Legacy Young Adult Cohort Study, a national sample of YAs aged 18–34 years drawn from an existing address-based probability sample. Online consent was collected from participants before questionnaire self-administration, and the cumulative response rate was 5.7% for Wave 5. This study was approved by the Chesapeake IRB, Inc. Details of study recruitment and methods have been published elsewhere.27 The present analysis focused on a subset of 1,555 participants aged

Results

In the weighted sample, 23% had ever used hookah and 4% had used hookah in the past 30 days (Table 1). Past 30–day users reported an average of 2.6 days of hookah use (SD=3.4) in the past month. Among those with at least some college education, ever use of hookah was significantly higher than never use or past 30–day use. Current alcohol, marijuana, and cigarette use were significantly higher in ever and past 30–day hookah users relative to never users. Past 30–day hookah users also reported

Discussion

This is the first study to examine correlates of hookah use and predictors of hookah trial using a prospective design in a national sample of YAs. Among those aged 18–24 years, almost a quarter of the sample had ever used hookah at baseline and 8% of never users reported trying hookah by 6-month follow-up. Predictors of hookah trial included college enrollment; alcohol, marijuana, and cigarette use; and perceptions that hookah is less harmful than cigarettes. These findings are consistent with

Acknowledgments

This study was funded by Legacy.

No financial disclosures were reported by the authors of this paper.

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