Transitions in hookah (Waterpipe) smoking by U.S. sexual minority adults between 2013 and 2015: the population assessment of tobacco and health study wave 1 and wave 2

Abstract

Background: Tobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts.

Methods: We analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013-2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014-2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2.

Results: Ever and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p < 0.0001). Among SM adults who reported hookah use at Wave 1, 46% quit hookah use at Wave 2; 39% continued hookah use and did not transition to other products while 36% of heterosexual adults quit hookah use at Wave 2 and 36% continued hookah use and did not transition to other products. Compared with heterosexuals, SM adults reported higher use of hookah plus e-products (Wave 2 usage increased by 65 and 83%, respectively).

Conclusions: Compared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have implications for stronger efforts to increase awareness of the harmful effects of hookah as well as vaping, specifically tailored among SM communities.

Keywords: Hookah; Sexual minority; Tobacco; Vaping; Waterpipe.

Fig. 1

Hookah Smoking Transitions from Wave 1 (2013) to Wave 2 (2014) of the PATH Study. Transitions among current hookah only use reported at Wave 1 were categorized into 4 categories: a No transition in hookah use (i.e., hookah use at Wave 2 as used at Wave 1); b Continued hookah and transitioned to other tobacco product(s) (i.e., hookah plus other tobacco product(s) use at Wave 2); c Quit hookah and transitioned to other tobacco product(s) (i.e., no hookah use but other tobacco product(s) use at Wave 2); and d Quit all tobacco use (i.e., no use of hookah or any tobacco product at Wave 2). Estimates were weighted to represent the U.S. adult population

Fig. 2

Transitions in Hookah Use and Co-use of Tobacco, Alternative Tobacco Products and E-Products among SM Adult Current Hookah Smokers, arranged according to Single, Dual and Poly Use, Waves 1 and 2 (2013–2014). E-products include e-cigarettes, and e-hookah and e-pipe (Wave 2 only); smokeless tobacco include snus, moist snuff, dip, spit, chewing tobacco or dissolvable tobacco; and other combustibles include traditional cigars, filtered cigars, cigarillos, pipe tobacco. Single use was defined as those who reported hookah only use; dual use was defined as those who concurrently use hookah plus one other product category; and poly use was defined as those who concurrently used hookah plus 2 or more other product categories

Fig. 3

Transitions in Hookah Use and Co-use of Tobacco, Alternative Tobacco Products and E-Products among Heterosexual Adult Current Hookah Smokers, arranged according to Single, Dual and Poly Use, Waves 1 and 2 (2013–2014). E-products include e-cigarettes, e-hookah and e-pipe (Wave 2 only); smokeless tobacco include snus, moist snuff, dip, spit, chewing tobacco or dissolvable tobacco; and other combustibles include traditional cigars, filtered cigars, cigarillos, pipe tobacco. Single use was defined as those who reported hookah only use; dual use was defined as those who concurrently use hookah plus one other product category; and poly use was defined as those who concurrently used hookah plus 2 or more other product categories

Fig. 4

Transitions in Hookah Use and Co-use of E-Products and Alternative Tobacco Products among SM vs. Heterosexual Adult Current Hookah Smokers, Waves 1 and 2 (2013–2014). E-products include e-cigarettes, and e-hookah and e-pipe (Wave 2 only); and alternative tobacco products include cigarettes, smokeless tobacco (i.e., snus, moist snuff, dip, spit, chewing tobacco or dissolvable tobacco) and other combustibles (i.e., traditional cigars, filtered cigars, cigarillos, pipe tobacco)