Examining hookah use among U.S. college students

Hookah smoking has become a popular form of tobacco use among college students. However, there is limited research exploring the risk factors associated with hookah use among this population. This study examined two risk factors, harm perceptions and beliefs about government evaluation of hookah, associated with current use of hookah among 18-24 year old college students, and looked at differences between current hookah users and non-users on cigarette smoking status, various demographic characteristics, and the two risk factors (harm perceptions and beliefs). Participants were 5,028 university students aged 18-24 (M age = 20.5 years; 59.6% female) from seven public universities within a larger university system. Students completed an online survey, which assessed their knowledge, beliefs, and behaviors related to hookah use. In this sample, 10.8% of participants reported current or past 30-day hookah use. There were differences between current hookah users and non-users on cigarette smoking status, gender, race/ethnicity, harm perceptions, as well as beliefs about government evaluation of hookah. Cigarette smokers, males, non-Hispanic White students, students reporting lower harm perceptions regarding hookah use, and those who believed the government evaluates hookah for safety were significantly more likely than their peers to be current hookah users. Results from a logistic regression analysis indicated that after controlling for cigarette smoking status, gender, and race/ethnicity, harm perceptions of hookah use, but not beliefs about government safety evaluation of hookah, was associated with an increased likelihood of current hookah use. Cigarette smoking was the strongest correlate of current hookah use; current cigarette smokers were seven times more likely than non-smokers to have used hookah in the past 30 days. Findings point to the necessity of educating college students, particularly cigarette smokers, about the dangers of hookah use. Additionally, tobacco prevention and cessation programs should be implemented in order to reduce initiation and continued use, and it is important to educate college student smokers about the dangers of dual use of this product with cigarettes.