Risk Factors Associated With Hookah Use

Abstract

Background: Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement. Method: An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/ hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent). Result: Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05). Conclusions: Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.

Prevalence and harm perceptions of hookah smoking among U.S. adults, 2014–2015

“…Consistent with the literature (Barnett, Smith, et al, 2013; Cavazos-Rehg, et al, 2015; Salloum, et al, 2015), the results of the current study show that ever hookah smoking is more common among young, educated, non-heterosexual, and other, non-Hispanic, adults. The popularity of hookah smoking among young and college-educated adults is emphasized by the strategic placement of hookah establishments in close proximity to college campuses (Kates, et al, 2016), exposure to online and social media advertisement (Krauss, et al, 2015; Primack, et al, 2012), and the use of flavors attractive to young people (Akl, et al, 2015).…”

“…Similar to findings from 2013 (Cavazos-Rehg, et al, 2015), we estimated that about 16% of U.S. adults have tried hookah, even once in their life in 2014–2015. The prevalence of ever hookah smoking in the current study was higher than that rates in reported in NATS in 2012–2013 (12.3%) (Agaku, et al, 2014) in 2009–2010 (9.8%) (Salloum, et al, 2015) and that estimated using the Social Climate Survey of Tobacco Control in 2010 (8.8%) (McMillen, et al, 2012).…”

“…Non-heterosexual adults are known to have higher risk of smoking cigarettes and trying alternative tobacco products, such as e-cigarettes (Weaver, et al, 2016). The result that non-Hispanic, other, and Hispanic adults were more likely to smoke hookah than non-Hispanic White adults was expected (Agaku, et al, 2014; Barnett, Smith, et al, 2013; Cavazos-Rehg, et al, 2015). These findings highlight the profiles of individuals who are at risk of hookah smoking, and therefore, for whom it would be useful to target tailored interventions.…”

“…Males, young adults aged 18–24 years, those who self-identify as non-Hispanic other (American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and multiple race individuals), those who have college education, and current smokers are more likely to smoke hookah (Cavazos-Rehg, Krauss, Kim, & Emery, 2015; Haddad, El-Shahawy, Ghadban, Barnett, & Johnson, 2015; Villanti, Cobb, Cohn, Williams, & Rath, 2015). Hookah relies on charcoal combustion to heat a moist sweetened flavored tobacco to generate an aerosol that travels through the water-filled hookah body, then passes through a hose to be inhaled by the hookah smoker via a mouthpiece (Soule, et al, 2015).…”

Emerging adulthood themes and hookah use among college students in Southern California

“…Emerging adults have a higher risk for hookah use, relative to younger and older age groups (Cavazos-Rehg, Krauss, Kim, & Emery, 2015; Grekin & Ayna, 2012; Smith et al, 2011). In the U.S., recent research demonstrated that 25% of emerging adults reported lifetime hookah use (Villanti, Cobb, Cohn, Williams, & Rath, 2015), and demonstrated that 10% of college students reported past 30-day use (Jarrett, Blosnich, Tworek, & Horn, 2012).…”