While cigarette smoking has become less prevalent among college-aged young adults, alternative tobacco use has increased. Waterpipe smoking (also known as hookah) is a common tobacco product with particularly high rates on college campuses. Waterpipe smoking is often perceived as less harmful than cigarettes; however evidence shows it poses the same risks as other tobacco products. Although it is common, waterpipe smoking use patterns have not been well studied. The Population Assessment of Tobacco and Health (PATH) study is a national study on tobacco use that provides an opportunity to understand these patterns. This study used baseline data from PATH to examine waterpipe smoking patterns among young adults (aged 18-24), in addition to their use of other tobacco products. The study included data on 9,116 young adults (18-24 years) that answered questions related to past use of waterpipe, cigarettes, and e-cigarettes. Participants were also asked about patterns of use in relation to age of initiation, smoking frequency, average length of a smoking session, usual place of smoking, ownership of smoking devices, and use of flavored tobacco. Among the individuals surveyed, 44.2% reported ever smoking a waterpipe and 10.7% reported past 30 day use. For participants that reported past-30 day waterpipe use, the average age at initiation was 17.4 years. Of these users, 37.5% reported less than monthly use, 36.2% reported monthly, 22.9% reported weekly, and 3.4% reported daily smoking. Daily smokers were more likely to be black than white, whereas weekly smokers were more likely to be Hispanic/Latino than white. Average length of smoking sessions were reported as less than 30 minutes (20.8%), 30 to 60 minutes (45.7%), 1 to 2 hours (26.5%), and greater than 2 hours (2.6%). Participants reported their usual place to smoke was at home or a friend’s house (35%), at a hookah bar/café (22.7%), or both in homes and at bars/cafes (42.1%). Flavored tobacco was used during the first time of smoking for 92.9% of participants, and 38.4% owned a waterpipe. About 30% of participants did not use other tobacco products in the past 30 days. Cigarette use (15.6%), e-cigarette use (5.9%), both cigarette and e-cigarette use (9%), and other poly tobacco use (40.3%) were reported by participants.
Take away: The results of this study confirm that waterpipe smoking is common among this age group and smokers typically spend greater than 30 minutes per session, exposing them to greater health risks. About half of past 30 day users had not smoked cigarettes prior to waterpipe use, indicating that waterpipe smoking may be a gateway to cigarette smoking. The health consequences associated with waterpipe and other tobacco use create a need for regulation. Understanding these patterns is crucial to informing effective control strategies.