Exploring a factor model for hookah smoking attitudes & beliefs in college students

Background: Hookah use continues to be a growing trend among US college students. Potential risks associated with hookah smoking are largely unrecognized by this population although it carries negative health effects. This study was designed to investigate the factor structure of the hookah smoking outcome expectation questionnaire. The instrument was administered to college students to determine positive and negative attitudes and beliefs regarding such behavior.

Methods: An online survey of 573 Florida college students was conducted in 2014. Hookah use attitudes and beliefs were measured through an 87-item, 6-point Likert scale questionnaire. Descriptive analysis and exploratory factor analysis (EFA) were used to evaluate important constructs underlying the questionnaire. Construct validity and scale reliability statistics were generated to review principal relationships. Exploratory factor analysis was done with Maximum Likelihood extraction and oblique rotation.

Results: EFA findings suggested a 5-factor structure be retained. The five factors: behavioral deterrents, peer appeal, physical deterrents, knowledge, and enticement met the eigenvalue >1 criteria and were confirmed via scree plot. The proposed solution explained 40% of the variance and provided strong fit to the data. Each factor contained an adequate number of items and had good internal consistency (Cronbach’s alpha = 0.958).

Conclusions: The presence of enticement and peer appeal effects for hookah use in collegiate smoking practices may explain current rising prevalence. The resulting factors can be used to assess differences between hookah users and non-users to evaluate the value placed on the positive vs deterring factors. The findings can help guide interventions and inform policies and future research.