Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun:117:106838.
doi: 10.1016/j.addbeh.2021.106838. Epub 2021 Jan 21.

Prospective estimation of the age of initiation of hookah use among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study waves 1-4 (2013-2017)

Adriana Pérez  1 , Arnold E Kuk  2 , Meagan A Bluestein  3 , Melissa B Harrell  4 , Cheryl L Perry  5 , Baojiang Chen  6
Affiliations

Prospective estimation of the age of initiation of hookah use among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study waves 1-4 (2013-2017)

Adriana Pérez et al. Addict Behav. 2021 Jun.

Abstract

Objective: This study reports the prospectively estimated age of initiation of susceptibility to, ever, past 30-day, and fairly regular hookah use.

Design: Secondary data analyses of the first four waves (2013-2017) of the PATH study, a nationally representative longitudinal cohort study of US youth (ages 12-17).

Methods: Youth who were never hookah users at their first wave of participation were identified (n = 16,678; N = 31,136,834). Four outcomes were analyzed, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) fairly regular hookah use. The age of hookah initiation of each outcome was estimated. Weighted interval censoring survival analyses and Cox regression models were conducted to estimate the age of initiation of each hookah use outcome, and to estimate differences in age of initiation by sex and by race, respectively.

Results: Around 11% of youth were classified as susceptible to hookah use by 13 years of age, 8% reported initiating ever hookah use by age 17, almost 10% reported initiating past 30-day hookah use by age 19, and 3% reported initiating fairly regular hookah use by age 20. Females and Hispanics were at higher risk of becoming susceptible to and ever hookah use at earlier ages compared to males and Non-Hispanic White youth.

Conclusion: Education, communication campaigns, and proven culturally targeted tobacco interventions that reach youth at ages before they first become susceptible or start using hookah use are needed to prevent the onset of hookah use among vulnerable youth.

Keywords: Adolescents; Narghile; Shisha; Water pipe tobacco.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: The authors have no conflicts of interest to disclose except Dr. Harrell is a consultant in litigation involving the vaping industry.

Figures

Figure 1.
Figure 1.
Estimated hazard function of the age of initiation of hookah use overall: Panel (a) shows susceptibility to hookah use, panel (b) shows ever hookah use, panel (c) shows past 30-day hookah use, and panel (d) shows fairly regular hookah use
Figure 2.
Figure 2.
Estimated hazard function of the age of initiation of hookah use by sex: Panel (a) shows susceptibility to hookah use and panel (b) shows ever hookah use
Figure 3.
Figure 3.
Estimated hazard function of the age of initiation of hookah use by race/ethnicity: Panel (a) shows susceptibility to hookah use, panel (b) shows ever hookah use, and panel (c) shows past 30‐day hookah use
See this image and copyright information in PMC

References

    1. Aljarrah K, Ababneh ZQ, & Al-Delaimy WK (2009). Perceptions of hookah smoking harmfulness: Predictors and characteristics among current hookah users. Tobacco Induced Diseases, 5(1), 16. doi: 10.1186/1617-9625-5-16 - DOI - PMC - PubMed
    1. Amrock SM, Gordon T, Zelikoff JT, & Weitzman M (2014). Hookah use among adolescents in the United States: Results of a national survey. Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco, 16(2), 231–237. doi: 10.1093/ntr/ntt160 - DOI - PubMed
    1. Ansari H (2014). Hookah use among youth and young adults: A public health challenge. Health Scope, 3(3), e20632. doi: 10.17795/jhealthscope-20632 - DOI
    1. Arrazola RA, Neff LJ, Kennedy SM, Holder-Hayes E, & Jones CD (2014). Tobacco use among middle and high school students--United States, 2013. Morbidity and Mortality Weekly Report, 63(45), 1021–1026. - PMC - PubMed
    1. Barnett TE, Curbow BA, Weitz JR, Johnson TM, & Smith-Simone SY (2009). Water pipe tobacco smoking among middle and high school students. American Journal of Public Health, 99(11), 2014–2019. doi: 10.2105/ajph.2008.151225 - DOI - PMC - PubMed

Publication types