Prevalence of hookah use among a representative sample of college students

The prevalence of hookah smoking is increasing in the United States, particularly among both adolescents and young adults. Hookah cafes are especially increasing in college towns. Using an intercept approach, we surveyed students of a large, public University in the south. The intercept approach yielded a high response rate (51.7%) and a more representative sample of students than traditional phone or web-based surveys, with 45.7% participation among males and 46.1% non-white. Of the sample, 10.9% report current (defined as past 30 days) hookah use, approaching the current cigarette use rate of 11.7%. More students, however, have tried hookah (45.4%) than cigarettes (40.3%) or any other form of tobacco. Of those reporting current hookah use, the majority (67.9%) also own their own hookah pipe; with more than one-third (35.9%) reporting combining other substances with the shisha tobacco. As evidence of the social nature of smoking among college students, nearly 22% did not try tobacco products until after age 18. Clearly, college students are experimenting with tobacco products, and hookah provides a perceived less harmful way to use tobacco, which could potentially lead to openness toward other tobacco products. As hookah cafes become an easily accessed bar atmosphere for those under 21, efforts need to increase in both educating users regarding harm and enforcing existing policy such as the clean indoor air act to slow the opportunity for use.