Waterpipe smoking among U.S. university students

Abstract

Introduction: While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics.

Methods: We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever.

Results: Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States.

Conclusions: After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.

Figure 1.

Percentage of students using different types of tobacco in the past 30 days (current use) and ever (ever use). For both periods, waterpipe smoking was the second most common type of tobacco use. We conducted two-sample tests of proportions comparing each pair of behaviors (e.g., current waterpipe smoking vs. current cigarette smoking, current waterpipe smoking vs. current cigar smoking, ever waterpipe smoking vs. ever cigarette smoking, etc.). Each of these tests indicated that the proportions were significantly different at the level p < .001.

Figure 2.

Area-proportional Venn diagrams showing overlap in types of tobacco use in the past 30 days (current use) and ever (ever use). Numbers are shown for the 104,434 students who provided data for the three major types of tobacco use (cigarette, waterpipe, and cigar). Data for smokeless tobacco use are not shown.