Longitudinal pathways of exclusive and polytobacco hookah use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016)

Abstract

Objective: The goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older).

Design: Data were drawn from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results: Young adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes.

Conclusions: Hookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.

Keywords: non-cigarette tobacco products; prevention; surveillance and monitoring.

Figure 1:

Cross-sectional weighted percent of ever, P12M, P30D and daily P30D hookah use among youth, young adults and adults 25+ in W1, W2 and W3 of the Population Assessment of Tobacco and Health (PATH) Study. Abbreviations: P12M = past 12-month; P30D = past 30-day; W1 = Wave 1; W2 = Wave 2; W3 = Wave 3 W1/W2/W3 ever hookah use unweighted Ns: youth (ages 12–17) = 1,005/799/597; young adults (ages 18–24) = 5,061/4,370/4,144; adults 25+ (ages 25 and older) = 5,561/5,430/5,776W1/W2/W3 P12M hookah use unweighted Ns: youth = 815/584/344; young adults = 3,665/2,726/2,357; adults 25+ = 1,899/1,341/1,427W1/W2/W3 P30D hookah use unweighted Ns: youth = 226/153/72; young adults = 1,261/1,244/867; adults 25+ = 459/530/473W1/W2/W3 Daily P30D hookah use unweighted Ns: youth = 14/15/7; young adults = 61/37/28; adults 25+ = 29/27/16 X-axis shows four categories of hookah use (ever, P12M, P30D, and daily P30D). Y-axis shows weighted percentages of W1, W2, and W3 users. Sample analyzed includes all W1, W2, and W3 respondents at each wave. All respondents with data at one wave are included in the sample for that wave’s estimate and do not need to have complete data at all three waves. The PATH Study cross-sectional (W1) or single-wave weights (W2 and W3) were used to calculate estimates at each wave. Ever hookah use is defined as having ever used a Hookah, even once or twice in lifetime. P12M hookah use is defined as any hookah use within the past 12 months. P30D hookah use is defined as any hookah use within the past 30 days. Daily P30D hookah use is defined as use of hookah on all 30 of the past 30 days. All use definitions refer to any use that includes exclusive or polytobacco use of hookah. a denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W1 and W2 b denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W1 and W3 c denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between W2 and W3 The logit-transformation method was used to calculate the 95% confidence intervals. † Estimate should be interpreted with caution because it has low statistical precision. It is based on a denominator sample size of less than 50, or the coefficient of variation of the estimate or its complement is larger than 30%. Analyses were run on the W1, W2, and W3 Public Use Files (https://doi.org/10.3886/ICPSR36498.v8).

Figure 2:

Patterns of W1-W2-W3 persistent any P12M hookah use, discontinued any P12M hookah use and reuptake of any P12M hookah use among W1 any P12M hookah users. Abbreviations: W1 = Wave 1; W2 = Wave 2; W3 = Wave 3; P12M = past 12-month; CI = confidence interval Wave 1 any P12M hookah use weighted percentages (95% CI) out of total U.S. population: youth (ages 12–17) = 5.9% (5.3–6.5); young adults (ages 18–24) = 35.2% (33.0–37.5); adults 25+ (ages 25 and older) = 4.2% (3.9–4.5) Analysis included W1 youth, young adults, and adults 25+ P12M Hookah users with data at all three waves. Respondent age was calculated based on age at W1. W3 longitudinal (all-waves) weights were used to calculate estimates. These rates vary slightly from those reported in Figure 1 or Supplemental Table 1 because this analytic sample in Figure 2 includes only those with data at each of the three waves to examine weighted longitudinal use and non-use pathways. Any P12M hookah use was defined as any hookah use within the past 12 months. Respondent could be missing data on other P12M tobacco product use and still be categorized into the following three groups:1) Persistent any P12M hookah use: Defined as exclusive or hookah polytobacco use at W2 and W3.2) Discontinued any P12M hookah use: Defined as any non-hookah use or no tobacco use at either W2 and W3 or just W3.3) Reuptake of any P12M hookah use: Defined as discontinued hookah use at W2 and any hookah use at W3. a denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between youth and young adults b denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between youth and adults 25+ c denotes significant difference at p<0.0167 (Bonferroni corrected for three comparisons) between young adults and adults 25+ The logit-transformation method was used to calculate the 95% CIs. Analyses were run on the W1, W2, and W3 Public Use Files (https://doi.org/10.3886/ICPSR36498.v8).