Examining Hookah as an Introduction to Nicotine Products among College Students

ABSTRACT

Background: Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. Objectives: This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Methods: Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. Results: Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. Conclusions: The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.

KEYWORDS:

• Hookah
• tobacco initiation
• nicotine
• young adults

Declaration of interest

Other than Dr. Mahoney, the other co-authors have no financial interest in this study and no conflicts of interests to disclose. Dr. Mahoney has previously served as a consultant to Pfizer regarding Chantix® and the topic of smoking cessation, has received peer-reviewed research funding from Pfizer's Global Research Award for Nicotine Dependence (GRAND), has conducted smoking cessation clinical trials, and has served as a paid expert witness in litigation against the tobacco industry; he also currently serves as the Medical Director for the NYS Smokers Quitline.

Ethics approval

The ethics approval is via SUNY University at Buffalo Social and Behavioral Sciences IRB (SBSIRB), IRB #IRB00003128.

Additional information

Funding

Author JAK's time was supported through Health Resources and Services Administration (HRSA) award #T32HP30035 to the University at Buffalo Primary Care Research Institute (PI: Kahn). Author MLS's time was funded through award #P50-CA-179546, University of Pennsylvania Tobacco Centers of Regulatory Science (TCORS).