Hooked on hookah? Examining hookah use in high school students in Texas

Objectives: This study aims to examine the prevalence of hookah use among high school students in Texas and explore associated factors.

Methods: Data were analyzed from the 2010 Texas Youth Tobacco Survey which was a self-reported, paper-and-pencil, cross-sectional survey of a representative sample of 6,407 secondary students in grades 7 through 12 in Texas. Descriptive analyses and multinomial logistic regression models were applied.

Results: Among secondary school students in Texas, 6.6% are current (past 30-day) users of tobacco in a hookah or water pipe. An overwhelming majority (90%) of current hookah users said they had tried cigarette smoking in the past and 86% reported concurrent use of other tobacco such as cigarettes and chewing tobacco.

Multivariate analysis indicates that predictors of current hookah use include grade level, race, concurrently using other tobacco products, perceiving that smoking makes you relax, perceiving that smoking makes you look cool, believing that cigarettes are not dangerous, having close friends who smoke cigarettes, exposure to tobacco education at school, exposure to tobacco advertising and tobacco promotional products. Notably, anti-smoking messages did not have any effect on hookah use.

Conclusions: Comparable data from prior years indicate that hookah use is on the rise, even as overall tobacco use falls. This study helps understand hookah use in this adolescent population and has implications for tobacco prevention policies, such as a need to incorporate questions about hookah use in tobacco surveillance systems and a need to target education & prevention activities.