Prior research has documented that hookah or waterpipe smoking can be more harmful than cigarette smoking; however, young adults perceive using hookah as less harmful than using other types of tobacco. A recent study investigated whether past-month hookah use predicted subsequent initiation of (1) other combustible tobacco products (i.e., cigarettes, cigars) and (2) electronic nicotine delivery systems (ENDS) among a sample of U.S. college students during a 2.5-year study period. Data from Waves 1 – 6 of the Marketing and Promotions Across Colleges in Texas (Project M-PACT) were used, for which participants reported their tobacco use behaviors and potential covariates every six months. At baseline, participants (n = 5,482) included college students aged 18 to 29 years old at two- and four-year universities in Texas. At Wave 6, 4,384 participants remained, a retention rate of 80%; the overall participation rate for eligible college students was 40%. The authors used two samples in the current study: (1) Participants who reported never using other combustible tobacco products at Wave 1 (n = 2,355) and (2) those who reported never using ENDS at Wave 1 (n = 2,590). Survey measures included lifetime number of cigarettes smoked, lifetime cigar/cigarillo use, lifetime ENDS use, and past-30-day hookah use at each wave. Covariates included in the analyses were sex, race/ethnicity, age at Wave 1, and college attended at Wave 1, past-month use of other combustible tobacco products (for the first sample) and past-month use of ENDS (for the second sample), and risk behaviors (sensation seeking and impulsivity). The authors analyzed the data using Chi-square tests and t-tests to examine differences in demographic characteristics, tobacco use, and risk behaviors by initiation status for other tobacco products and ENDS. Two separate discrete-time survival analyses were used to model the associations between past-30-day hookah use at the previous wave and subsequent initiation of (1) other combustible tobacco products and (2) ENDS. Results indicated that by Wave 6, a significantly higher proportion of past month hookah and ENDS users initiated other combustible tobacco product use than non-users (p < 0.001) and participants who began using other combustible tobacco products scored significantly higher on both sensation seeking and impulsivity than their peers who did not initiate use (p < 0.001). Similarly, participants who reported initiating ENDS use at Wave 6 reported significantly higher levels of sensation seeking and impulsivity (p < 0.001) and a higher proportion of past-month hookah users initiated ENDS use compared to non-users. Controlling for covariates, results of the discrete-time survival analyses indicated that past-month hookah use at the previous wave was associated with significantly higher odds of initiating other combustible tobacco product use (adjusted odds ratio [AOR] = 3.27, 95% confidence interval [CI]: 2.37, 4.51), as well as ENDS initiation (AOR = 2.60, CI: 2.04, 3.76).
Take away: Results of this longitudinal study indicated past-month hookah use was associated with over three times greater odds of initiating other combustible tobacco product use and over two times greater odds of electronic nicotine delivery system (ENDS) use, compared to abstaining from hookah.
Case, K.R., Creamer, M.R., Cooper, M.R., Loukas, A. & Perry, C.L. (2018). Hookah use as a predictor of other tobacco product use: A longitudinal analysis of Texas college students. Addictive Behaviors [published online ahead of print June 26, 2018] doi: 10.1016/j.addbeh.2018.06.028