Exploring the hookah phenomenon: Prevalence and correlates of waterpipe tobacco use among college students

Known commonly in the US as “hookah,” waterpipe tobacco (WT) use appears to be popular among college students. In fact, the number of WT cafés has grown rapidly over the past several years, especially in college towns. However, little is known about the prevalence and correlates of this behavior. In fall 2008, 3770 students from 8 colleges in North Carolina completed a web-survey as part of a randomized group trial of an intervention to prevent high-risk drinking on college campuses. About 40% reported ever smoking tobacco from a waterpipe, whereas 47% reported ever smoking a cigarette. About 17% reported current (past 30-day) WT use, while 25% reported current cigarette smoking. Prevalence of current WT use varied by school (6%-30%). Multivariable logistic regression modeling for current WT use was performed, accounting for within-school clustering. Results revealed that having a WT café in the surrounding community was associated with current WT use (AOR=1.72; 95%CI=1.14,2.61). Current WT smoking was associated with daily and nondaily cigarette smoking (AOR=2.78; 95%CI=1.86,4.15; AOR=2.67; 95%CI=1.99,3.57, respectively). However, about a quarter of WT users had never tried a cigarette, suggesting that WT may have been their first tobacco product. Marijuana use (AOR=4.63; 95%CI=3.64,5.89), illicit drug use (AOR=2.81; 95%CI=1.95,4.06), and current drinking (AOR=2.26, 95%CI=1.58,3.23) were also associated with current WT use. WT smoking is a common form of tobacco use among college students. Considerable overlap between WT and cigarette and marijuana smoking highlights the need for further research to assess whether WT use is a gateway to cigarettes and/or marijuana.