Waterpipe tobacco smoking trends among middle and high school students in the United States from 2011 to 2017

Abstract

BackgroundWaterpipe smoking has increased in popularity globally. Despite evidence regarding the harmful effects of waterpipe smoking, there is a common belief that it is less harmful than traditional cigarettes. Little is known about trends in waterpipe use in the U.S. This study examined national trends in waterpipe smoking among middle and high school students. MethodsWe used the 2011–2017 National Youth Tobacco Survey data (n = 140195). For trend analyses, logistic regression was used for the prevalence of waterpipe ever use and current use. Joinpoint regression analysis was performed to identify where significant changes in trend occurred. Additionally, we examined the correlates of waterpipe smoking. ResultsOverall prevalence of adolescent waterpipe ever and current use increased significantly from 7.6% and 2.8% in 2011 to 14.6% and 6.4% in 2014, then decreased significantly to 7.7% and 2.5% in 2017. This trend was consistent in most subgroups including male, female, Hispanic, White, middle school, and high school students. Joinpoint occurred in 2015 for Black adolescents. For example, current waterpipe use increased significantly from 1.4% in 2011 to 4.1% in 2015, declining to 2.5% in 2017. Multivariable analysis showed that cigarette smoking, e-cigarette use, curiosity about waterpipes, and tobacco smoke exposure at home were associated with ever and current waterpipe tobacco use among all participants as well as male and female subgroups. ConclusionsFindings indicate a decreasing trend of ever and current waterpipe tobacco use, which began in 2014 or 2015 for all groups included in the analyses.