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. 2022 Apr 21;19(9):5034.
doi: 10.3390/ijerph19095034.

The Effect of Perceptions of Hookah Harmfulness and Addictiveness on the Age of Initiation of Hookah Use among Population Assessment of Tobacco and Health (PATH) Youth

Arnold E Kuk  1 , Meagan A Bluestein  1 , Baojiang Chen  1   2 , Melissa Harrell  1   3 , Charles E Spells  1 , Folefac Atem  4 , Adriana Pérez  1   2
Affiliations

The Effect of Perceptions of Hookah Harmfulness and Addictiveness on the Age of Initiation of Hookah Use among Population Assessment of Tobacco and Health (PATH) Youth

Arnold E Kuk et al. Int J Environ Res Public Health. .

Abstract

Despite the negative health consequence of hookah, hookah risk perceptions are misguided among youth. Secondary data analysis of 12-17-year-old never hookah users at their first wave of PATH participation (2013-2019) was performed. The effect of perceptions of hookah harmfulness and addictiveness on the age of initiation ever, past 30-day, and fairly regular hookah use were estimated using interval-censored Cox proportional hazards models. The distribution of the age of initiation of hookah outcomes by perception levels of harmfulness and addictiveness are reported as cumulative incidence and 95% CI. Youth who perceived hookah to be neither harmful nor addictive were 173% more likely to initiate ever, 166% more likely to first report past 30-day use, and 142% more likely to first report fairly regular hookah use at earlier ages compared to youth who considered hookah to be both harmful and addictive. By age 18, 25.5% of youth who perceived hookah as neither harmful nor addictive were estimated to initiate ever hookah use while 9.3% of youth who perceived hookah as harmful and addictive were estimated to initiate ever hookah use. These findings indicate the need to provide prevention and education campaigns to change perceptions of the harmfulness and addictiveness of hookah to delay the age of initiation of hookah use.

Keywords: Cox regression; interval censoring; narghile; shisha; survival analysis; time to event; tobacco risk perception; waterpipe.

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Conflict of interest statement

The authors declare no conflict of interest except Harrell, who is a consultant in litigation involving the vaping industry.

Figures

Figure 1
Figure 1
Hazard functions (cumulative incidence in percentage) of the age of initiation of (A) ever use, (B) past 30-day use, and (C) fairly regular use of hookah by perception levels.
Figure 1
Figure 1
Hazard functions (cumulative incidence in percentage) of the age of initiation of (A) ever use, (B) past 30-day use, and (C) fairly regular use of hookah by perception levels.
See this image and copyright information in PMC

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