Age of initiation of hookah use among young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013–2017

Abstract

Objective To prospectively estimate the age of initiation of ever, past 30-day, and fairly regular hookah use among young adults (ages 18–24) overall, by sex, by race/ethnicity, and to explore the association of prior use of other tobacco products with these hookah use behaviors. Methods Secondary data analyses of the first four waves (2013–2017) of the PATH study, a nationally representative longitudinal cohort study of US young adults. Young adult never hookah users at the first wave of adult participation in PATH waves 1–3 (2013–2016) were followed-up into waves 2–4 (2014–2017) to estimate the age of initiation of three outcomes: (i) ever use, (ii) past 30-day use, and (iii) fairly regular hookah use. Weighted interval-censoring Cox proportional hazards regression models were used to examine the differences in the estimated age of initiation by sex and by race/ethnicity while controlling for the total number of other tobacco products ever used at participants’ first wave of PATH participation. In addition, to examine if prior use of other tobacco products was associated with the age of hookah initiation behaviors, six additional Cox models are reported for each hookah initiation behaviors. Results The largest increase in hookah use occurred between ages 18 and 19: 5.8% for ever use and 2.7% for past 30-day hookah use. By age 21, 10.5%, 4.7% and 1.2% reported initiation of ever, past 30-day and fairly regular hookah use, respectively. There were statistically significance differences in the age of initiation of hookah use behaviors by race/ethnicity. Conclusion Educational interventions should target young adults before the age of 21, focusing efforts specifically on males, non-Hispanic Blacks and Hispanics, to stall initiation and progression of hookah use behaviors.

The Effect of Perceptions of Hookah Harmfulness and Addictiveness on the Age of Initiation of Hookah Use among Population Assessment of Tobacco and Health (PATH) Youth

“…Our results are consistent with prior studies examining the associations between perceptions of harmfulness and addictiveness of hookah and hookah initiation. Prior studies of hookah use have warned that the low perceptions of harmfulness and addictiveness among youth may lead to subsequent hookah initiation [16,17,27]. Our results extend these findings by examining these risk perceptions regarding the ages of hookah initiation outcomes.…”

“…For the few participants who refused to answer these questions, PATH imputed their values at wave 1 using the household information [23]. Following prior studies [1,4,[24][25][26][27][28][29][30][31], we combined race and ethnicity into four categories: Non-Hispanic White, Hispanic, Non-Hispanic Black, and Non-Hispanic Other (Asian, multi-race, and other races).…”

Longitudinal Transition Patterns of Tobacco Use Among Youth and Young Adults Never Tobacco Product Users: Findings From the Population Assessment of Tobacco and Health Study, 2014-2019

“…Tobacco use remains high among youth and young adults despite recent efforts to curb tobacco initiation in the context of the evolving tobacco product landscape [1][2][3][4][5][6][7] . A recent report of the 2021 National Youth Tobacco Survey (NYTS) indicated that 19.4%, 8.1% and 2.8% of middle and high school students, had ever used e-cigarettes, cigarettes, and hookah, respectively 1 .…”

“…Understanding longitudinal patterns of tobacco use behaviors is central to curbing tobacco initiation, as this information can identify windows of opportunity in which to intervene to prevent or reduce progression in the severity or intensity of tobacco use [2][3][4][5][6][7] . This is particularly important among never users of a particular TP who may be susceptible to initiation of a particular TP and later on progress to regular TP use.…”

Age of Onset of Susceptibility to Different Tobacco Products Among Non-Susceptible US Young Adults: Findings from the Population Assessment of Tobacco and Health Study Waves 2-4 (2014-2017)

“…Additionally, while Non-Hispanic Black youth exhibited decreased risk of an earlier age of onset of susceptibility to cigarettes compared with Non-Hispanic White youth, 48 there were no differences in the age of susceptibility onset between Non-Hispanic Black and Non-Hispanic White young adults. Hispanic youth were also found to show increased risk of an earlier age of onset of susceptibility to hookah compared with Non-Hispanic White youth, 56 while the findings among young adults reported no difference between these two groups. Finally, there were no differences in the age of onset of susceptibility to cigarillos/filtered cigars among youth, 50 while the current study reports increased risk among Non-Hispanic Black young adults.…”