Hookah and Cigarette Use Among Young Adult Bar Patrons

Background: Smoking tobacco using a hookah (or waterpipe) is popular among young adults. Despite data demonstrating potential health risks, many users perceive smoking hookah is distinct from, and less harmful than, smoking cigarettes. It is unknown whether anti-tobacco messages developed for cigarettes will be effective for hookah. Methods: Cross-sectional randomized time-location survey samples of young adults (aged 18-29) attending bars in San Diego (N=1,403), Oklahoma City (N=1,355), Tulsa (N=1,210), Albuquerque (N=1,013), and Las Cruces (N=893) collected in 2010 and 2011. Multinomial logistic regression was used to analyze the associations between tobacco use factors and patterns of hookah and cigarette use. Results: There were differences between respondents who only used hookah (OH) and those who used both hookah and cigarettes (HC) by sex (OH= 50% male, HC=63.3% male), college status (OH=66.1% in college, HC=52.6% in college), and tobacco related attitudes (OH=32% strongly agreed second hand smoke is dangerous, HC=20.8% strongly agreed) respectively. Having strong anti-industry attitudes did not have a strong negative effect on hookah use as they do on cigarette use. Unlike for cigarettes, strong anti-industry attitudes were positively associated with only using hookah (only hookah Coef=.89, p<.0001 relative to only cigarette). Discussion: Anti-tobacco industry messages have a powerful negative effect on cigarette smoking, but they may not be effective for hookah use, perhaps because hookah is viewed as a different product, or because it is perceived as disconnected from the tobacco industry. These differences should be addressed when developing strategies to discourage hookah use among young adults.