Abstract
To prospectively estimate the age of initiation of ever, past 30-day, and fairly regular hookah use among young adults (ages 18-24) overall, by sex, by race/ethnicity, and to explore the association of prior use of other tobacco products with these hookah use behaviors. Secondary data analyses of the first four waves (2013-2017) of the PATH study, a nationally representative longitudinal cohort study of US young adults. Young adult never hookah users at the first wave of adult participation in PATH waves 1-3 (2013-2016) were followed-up into waves 2-4 (2014-2017) to estimate the age of initiation of three outcomes: (i) ever use, (ii) past 30-day use, and (iii) fairly regular hookah use. Weighted interval-censoring Cox proportional hazards regression models were used to examine the differences in the estimated age of initiation by sex and by race/ethnicity while controlling for the total number of other tobacco products ever used at participants' first wave of PATH participation. In addition, to examine if prior use of other tobacco products was associated with the age of hookah initiation behaviors, six additional Cox models are reported for each hookah initiation behaviors. The largest increase in hookah use occurred between ages 18 and 19: 5.8% for ever use and 2.7% for past 30-day hookah use. By age 21, 10.5%, 4.7% and 1.2% reported initiation of ever, past 30-day and fairly regular hookah use, respectively. There were statistically significance differences in the age of initiation of hookah use behaviors by race/ethnicity. Educational interventions should target young adults before the age of 21, focusing efforts specifically on males, non-Hispanic Blacks and Hispanics, to stall initiation and progression of hookah use behaviors.
Highlights
The popularity of hookah use can be contributed to many factors, such as misperceptions that it is less harmful and not as addictive as cigarettes [1,2,3]
Researchers can apply for access to the restricted-use datasets from the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan
Please reference the Virtual Data Enclave (VDE) Guide to learn about the application process, about using the VDE, and how to request disclosure review of VDE output located here: https://www.icpsr.umich.edu/web/pages/ NAHDAP/vde/index.html
Summary
The popularity of hookah use can be contributed to many factors, such as misperceptions that it is less harmful and not as addictive as cigarettes [1,2,3]. Studies suggest that hookah use exposes users to chemicals inducing nicotine dependence [2,3,5,6] and results in higher risk of oral health deterioration, gastro-esophageal reflux disease, low birth weight, cancers, cardiovascular diseases, and pulmonary diseases [2]. Hookah use has caught the attention of researchers and health professionals because of its rising popularity among young adults and the health risks associated with its use [2,4,13,14]. A different study found that among 18–24 year old never hookah users in 2013–2014, 14.1% initiated ever use, 6.1% initiated past 30-day use, and 0.2% initiated frequent hookah use (i.e. use on at least 20 days in the past 30-days) one year later [18]
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