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Hookah Tobacco Smoking Among U.S. College Students

Primack, Brian (2011) Hookah Tobacco Smoking Among U.S. College Students. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Although cigarette smoking is decreasing in the U.S., hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposures. While HTS is popular among various socio-demographic groups, it is most common among university students. Therefore, three interrelated studies were conducted to better understand this health behavior and inform future interventions to reduce it.

Cross-sectional data from over 100,000 students in 152 U.S. universities participating in the National College Health Assessment during 2008-2009 were analyzed. These data demonstrated that 30.5% and 8.4% of the sample reported HTS ever and in the past 30 days, respectively, making HTS the second most common source of tobacco. Fully adjusted multivariable models accounting for clustering of individuals within institutions showed that HTS was most strongly associated with younger age, male gender, white race, fraternity/sorority membership, and non-religious institutions in large cities in the western United States.

The sample was then partitioned using two-step cluster analysis according to current use of HTS, cigarettes, cigars, marijuana, and alcohol. A 6-cluster solution was found, and in one cluster all members had used HTS in the past 30 days. Three individual factors (gender, undergraduate status, and fraternity/sorority membership)—but no institutional factors—were significantly associated with cluster membership.

Finally, municipal, county, and state legal texts from the largest 100 cities in the U.S. were examined in order to characterize each city’s policies related to HTS. Although 73 of the 100 largest cities in the U.S. have laws that disallow cigarette smoking in bars, HTS may be allowed due to exemptions in 69 of these 73 cities. Multinomial logistic regression was used to demonstrate that, compared with cities without clean air legislation, the cities in which HTS may be exempted had denser and more politically liberal populations.

These findings suggest that, after cigarettes, HTS is now the most common form of tobacco use among university students. Because hookah use affects groups with a wide variety of individual and institutional characteristics, and because the current policy environment is permissive, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Primack, Brianbprimack@pitt.eduBPRIMACK
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFine, Michaelfinemj@upmc.eduMJF1
Thesis AdvisorSwitzer, Galenswitzerge@upmc.eduGSWITZER
Committee MemberBarnett,
Committee MemberDonohue, Juliejdonohue@pitt.eduJDONOHUE
Committee MemberKim, Kevinkhkim@pitt.eduKHKIM
Date: 20 December 2011
Date Type: Publication
Defense Date: 23 September 2011
Approval Date: 20 December 2011
Submission Date: 9 November 2011
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 74
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Clinical and Translational Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: hookah; tobacco; waterpipe; water-pipe; smoking; college; university; policy; shisha; cluster analysis
Date Deposited: 20 Dec 2011 19:36
Last Modified: 19 Dec 2016 14:34


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