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Hookah use, positive attitudes toward hookah common among college and non-college young adults

A new study examined hookah use (also called waterpipe tobacco smoking) among a nationally representative sample of young adults and compared results between participants who were enrolled in college or graduate school and participants who were not. Participants (n = 3,131) were recruited from KnowledgePanel ®, an online, non-volunteer access panel. Inclusion criteria were being 18 to 30 years old and living in the U.S. Participants reported their lifetime and past-30-day hookah use, as well as positive attitudes (i.e., hookah use is fun, romantic, or relaxing) and negative attitudes (i.e., hookah use is harmful or addictive). Participants’ normative beliefs about hookah use were assessed by having them rate how socially acceptable they believed hookah use was among their peers and estimate the proportion of their peers who had ever used hookah. After stratifying responses by student status, the authors used Rao-Scott Chi-square tests to examine relationships among sociodemographic characteristics and current hookah use. Logistic regression was then used to assess the independent association between each attitude, normative belief, and current hookah use, controlling for socio-demographic characteristics and stratifying by student status. Results indicated the sample was overwhelmingly heterosexual (92%), and majority non-Hispanic White (57%). The average participant age was 24 years old and 52% were female. Nearly 60% of the sample reported they were not enrolled in college or graduate school. Among the non-student group, 29% (95% CI: 26–33%) reported lifetime hookah use and 3% (95% CI: 2–5%) reported current use, compared to 35% (95% CI: 31–38%) and 7% (95% CI: 6–9%) of students, respectively. Both prevalence rates were significantly different between groups (both ps < 0.001). Results also indicated each of the individual positive attitude items were positively associated with current hookah use for both groups, as were having overall positive attitudes toward hookah use (Adjusted odds ratios [AORs] = 3.37 and 2.72). Having an overall negative attitude toward this hookah use was protective for both groups (AORs = 0.82 and 0.76). Believing a greater percentage of peers use hookah and accept hookah use were both associated with current hookah use (AORs = 2.02 and 2.05); however, the magnitude of these associations did not vary between students and non-students. Results of multivariable analyses indicated, for college students, identifying as bisexual was associated with more than three times the odds of current hookah use compared to students who identified as heterosexual (AOD = 3.28).

Take away: In this nationally representative sample, college students were more likely to report lifetime and past-month hookah use than non-students; however, nearly a third of non-students reported lifetime use. Positive attitudes toward hookah use were associated with increased odds of current hookah use for both groups.

Sidani, J.E., Shensa, A., Yabes, J., Fertman, C. & Primack, B.A. (2018). Waterpipe tobacco use in college and non-college young adults in the USA. Family Practice [published online ahead of print May 8, 2018] doi: 10.1093/fampra/cmy037

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