Hashish Use Research Articles

Substance abuse among university students in Egypt: prevalence and correlates.

Drug abuse is a global challenge with harmful effects on health, wealth and wellbeing of nations. University students report more habitual use of marijuana, cocaine, hallucinogens and illicit drugs than noncollege students report. To identify the prevalence of tobacco use, alcohol and drug abuse and to identify some factors associated with drug abuse. A cross-sectional study recruiting 2552 students from all faculties hosted by Kafr El-Sheikh University during the academic year 2018-2019. Data were collected using a structured self-administered questionnaire. The prevalence of current drug abuse was 8.9% for cigarette smoking, followed by tranquilizers (4.3%), hashish (3.6%), alcohol (2.7%), bhang (1.4%) and tramadol (1.0%). Men reported significantly greater use of cigarettes, alcohol, tramadol, hashish and bhang than women. Students of practical colleges were found to smoke cigarettes and abuse hashish significantly more than their peers in other colleges. Risk factors associated with drug abuse were mainly related to gender and college type. There is a need to design and implement programmes to raise awareness and provide supportive services for prevention and management of drug abuse among university students tailored according to their needs.

Cannabis Consumption, Purchasing and Sources among Young Canadians: The Cannabis Purchase and Consumption Tool (CPCT)

Background: Despite its extensive use, there is a paucity of research on consumption and purchasing patterns of cannabis, especially by modes of delivery. Objective: To assess the self-reported use and frequency of use of 12 different cannabis modes of delivery, their associated purchase sources, self-reported price, average consumption amount, and knowledge of THC and CBD levels. Methods: The Cannabis Purchase and Consumption Tool, an online survey, sampled Canadians 16-30 years old (N = 868) in October 2017. Final sample included participants reporting use of any mode of cannabis within the past 30-days (N = 185). Results: The most common modes of delivery were dried herb that was either smoked or vaporized, and cannabis edibles. Use of hashish, hash oil and other concentrates followed, while liquids, tinctures, topical ointments, and fresh flower/leaf were used less frequently. Average dried herb consumption was 17.8 g/month, 17.4 g/month, and 9.4 g/month among licensed medical, non-licensed medical, and non-medical cannabis users, respectively. At last time of purchase, participants paid an average of $17.97/gram for dried herb. 31.5% of current users reported knowing THC and 13.2% CBD levels of their cannabis. Conclusions: Youth and young adults report a wide diversity of cannabis products and modes of administration. Traditional measures that rely primarily on frequency of use may be inadequate to assess the rapidly evolving cannabis market, particularly given policy changes, including legalization of non-medical cannabis.

The Association between Sociocultural Factors and Substance Use among Haramaya University Students.

All the associated risk factors were not equally responsible for influencing individuals either in alcohol use, khat use, tobacco, or cannabis use. This study attempted to examine sociocultural factors influencing university students in substance use by comparing one with another. A cross-sectional study was carried out. The study used a quantitative approach to collect data from 384 students. Compared with their involvement in khat use, female students were positively influenced in cigarette and hashish use (Adjusted Odds Ratio, AOR = 1.102, 95% CI: 1.056, 1.149) and alcohol use (AOR = 1.066, 95% CI: 1.021, 1.113). The involvement of students in alcohol use (AOR = 0.884, 95% CI: 0.838, 0.932) and cigarettes and hashish use (AOR = 0.909, 95% CI: 0.866, 0.953) were negatively associated with stress related to their academic activities. The involvement of students in alcohol use (AOR = 0.942, 95% CI: 0.906, 0.979) was negatively associated with parental influences; involved in alcohol use (AOR = 0.445, 95% CI: 0.210, 0.941) was negatively associated with the thoughts of considering substances as an energizer. The involvement of students in alcohol use (AOR = 4.980, 95% CI: 1.614, 15.368) was positively associated with peer influences. It was, thus, suggested that the management of Haramaya University should work on creating awareness of the negative consequences of substance use. Concerned professionals, including sociologists, psychologists, and health workers, should work on raising students’ awareness as it was possible to undertake their studies without substance use. Moreover, the university management is strongly recommended to expand recreational centers within the campus. Lastly, Haramaya woreda administration should restrict the availability and accessibility of these substances around the campus.

Poor sleep quality and associated factors among prisoners of the Diredawa correctional facility in eastern Ethiopia

BackgroundImpaired sleep quality affects judgment, psychomotor skills, memory, decision-making, concentration, and attention. It might also contribute to the development of new physical health problems, as well as exacerbating already existing physical problems. Despite this, there is a scarcity of research done in Africa including Ethiopia that addressed this issue. So this study assessed the quality of sleep and related factors among prisoners of the Diredawa correctional facility, Diredawa, eastern Ethiopia.MethodsA cross-sectional study was done using a simple random sampling technique to recruit 421 participants from May 21 to June 21; 2017. A semi-structured questionnaire, Pittsburgh Sleeps Quality Index (PSFIG), Patient Health Questionnaire-9 (PQ-9), and Sleep Hygiene Index (SHI) were used to assess participants’ socio-demographic data, sleep quality, depression, and sleep hygiene, respectively. The collected data were entered into EPA-data 3.1 and analyzed by using SPAS-20. Descriptive and analytical statistics were used. Bivariate and multivariable logistic regression with odds ratio and 95% CI were employed. The statistical significance was declared at p value < 0.05.ResultsA total of 421 out of 423 prisoners were interviewed, resulting in a response rate of 99.5%. The prevalence of poor sleep quality was 227 (53.9%) with 95% CI (49.2, 58.7). Having co-morbidity of depression (adjusted odds ratio; OAR = 3.47, 95% CI 1.38,8.76), lifetime use of cigarette (OAR = 2.16, 95% CI 1.21,5.58), marijuana and hashish (OAR = 5.02, 95% CI 1.63,15.46), current use of coffee (OAR = 2.75, CI 1.37, 7.05), poor sleep hygiene (OAR = 3.19, CI 1.32,7.69), committing assault crime (OAR = 4.12, CI 1.29,10.63) and crime of rape (OAR = 5.57, CI (1.45, 13.89) were the associated factors for poor sleep quality in this study.ConclusionMore than half of the participants (53.9%) have poor sleep quality. Depression, lifetime use of cigarettes, using cannabis and hashish, current use of coffee, poor sleep hygiene, and crime types were the associated factors that should be taken into consideration and evaluated early to minimize poor sleep quality.

Refractory ARDS with diffuse centrilobular nodules: did the patient smoke a tree?

A 22-year-old man with no relevant medical history except hashish use (10 joints a day) was admitted to the intensive care unit in December 2018 for refractory acute respiratory distress...

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence.

As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls.

ObjectivesWe investigated whether differences in cognitive performance between people living with HIV (PLWH) and comparable HIV‐negative people were mediated or moderated by depressive symptoms and lifestyle factors.MethodsA cross‐sectional study of 637 ‘older’ PLWH aged ≥ 50 years, 340 ‘younger’ PLWH aged < 50 years and 276 demographically matched HIV‐negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z‐scores [mean = 0; standard deviation (SD) = 1] and averaged to obtain a global Z‐score. Depressive symptoms were evaluated via the Patient Health Questionnaire (PHQ‐9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education.ResultsAfter adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV‐negative controls (P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms (P < 0.001) and use of hashish (P = 0.01) were associated with lower cognitive function; alcohol consumption (P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV‐negative controls was no longer significant (P = 0.08), while that between younger PLWH and older HIV‐negative controls remained significant (P = 0.01).ConclusionsPoorer cognitive performances in PLWH compared with HIV‐negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH.

Up the Ladder of Concern: Youth and Young Adult Cannabis Use

This paper aims to review patterns of cannabis (i.e., marijuana and hashish) use among high-risk Israeli youth and young adults based on research conducted by the Ben-Gurion University, Regional Alcohol and Drug Abuse Research Center. A total of 1074 Israeli youth (67.0% male, 33.0% female) were studied from 2004 to 2016. The youth and young adults included those placed in residential programs for learning and/or behavior problems (youth villages) and were school dropouts referred to a 90-day treatment facility for drug abuse. Country of origin, determined by mother’s birthplace, revealed 42.4% of the youth was of Israeli origin and 57.6% from other countries—mostly the former Soviet Union and Ethiopia. About “village” youth, no gender or religious status (secular/non-secular) differences were found for lifetime and last month cannabis use. Immigrant origin youth, than those with Israeli status, reported more lifetime and last month use as well as cannabis availability. Youth from families with low socio-economics status reported a higher rate of last month cannabis use than those with better economic conditions. Among school dropouts, no gender or religious status differences were found for lifetime and last month cannabis use and availability. For all study youth, binary logistic regression results indicated six factors significantly predicted last month cannabis use: male gender, age, last month binge drinking, illicit drug selling, reduced relations with friends, and cannabis availability. In terms of policy and service provision, high-risk youth (e.g., those in residential programs, whether for learning and/or behavior problems) should be priority for drug prevention efforts.

New product trial, use of edibles, and unexpected highs among marijuana and hashish users in Colorado

ObjectiveThis study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs. MethodsWe conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs. ResultsIn the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p<0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p<0.05). ConclusionPeople who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.

Illicit Substance Use in US Adults With Chronic Low Back Pain.

A population-based cross-sectional survey. The aim of this study was to compare the prevalence of illicit drug use among US adults with and without chronic low back pain (cLBP). Although addictive medications, such as opioids and benzodiazepines, are frequently prescribed to patients with cLBP, little is known about illicit drug use among Americans with cLBP. We used data from the back pain survey, administered to a representative sample of US adults aged 20 to 69 years (N = 5103) during the 2009 to 2010 cycle of the National Health and Nutrition Examination Survey (NHANES). Participants with pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold for at least 3 months were classified as having cLBP (N = 700). The drug use questionnaire was self-administered in a private setting, and included data on lifetime and current use of marijuana or hashish, cocaine, heroin, and methamphetamine. Chi-square tests, one-way analysis of variance, and logistic regression, adjusted for age, gender, race, and level of education, were used for comparisons. About 46.5% of US adults with cLBP used marijuana versus 42% of those without cLBP [Adjusted odds ratio (aOR) 1.36, 95% confidence interval (95% CI) 1.06-1.74]. About 22% versus 14% used cocaine (aOR 1.80, 95% CI 1.45-2.24), 9% versus 5% used methamphetamine (aOR 2.03, 95% CI 1.30-3.16), and 5% versus 2% used heroin (aOR 2.43, 95% CI 1.44-4.11). Subjects with cLBP who reported lifetime illicit drug use were more likely to have an active prescription for opioid analgesics than those without illicit drug use history: 22.5% versus 15.3%, P = 0.018. cLBP in community-based US adults was associated with higher odds of using marijuana, cocaine, heroin, and methamphetamine. Prescription opioid analgesic use was more common in cLBP sufferers with a history of illicit drug use. 2.

Hashish traffickers, hashish consumers, and colonial knowledge in Mandatory Palestine

ABSTRACTI examine the extent to which the rise in the early 1900s of international efforts to stamp out or regulate the flow and (ab)use of hashish affected the (under)world of hashish traffickers and hashish consumers in Mandatory Palestine. A crucial phase in the global fight against cannabis, the Mandatory period serves as an excellent arena for exploring the local reverberations triggered by the reversal of the course of ‘the psychoactive revolution’, a revolution that has made drugs pervasive in human societies from the seventeenth to the nineteenth centuries. I begin by examining how hashish traffickers responded to these new conditions of control and prohibition, showing that their persistence in maintaining the illicit trade presented the authorities with unforeseen challenges. I then provide a vista into Mandatory Palestine's consuming subjects and the kinds of colonial knowledge about cannabis which helped to raise critical, racial-cum-cultural, awareness of these people, as well as to deter Jews from consuming the forbidden substance. As opposed to other regions of the British Empire (most notably India and Egypt), the history of cannabis in Palestine has not been told before. By drawing on previously untapped archival, press and literary sources, this article seeks to rectify this lacuna.

National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran

BackgroundFor a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. MethodsWe implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. ResultsThe most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. ConclusionIt seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed.

Antoine Isaac Silvestre de Sacy and the Myth of the Hachichins: Orientalizing hashish in nineteenth-century France

AbstractBuilding on recent historical scholarship on drugs and European empires, this study shows how early French conceptions of hashish use emerged from a popular imperial imaginary developing ac...

Antoine Isaac Silvestre de Sacy and the Myth of the Hachichins: Orientalizing hashish in nineteenth-century France

Building on recent historical scholarship on drugs and European empires, this study shows how early French conceptions of hashish use emerged from a popular imperial imaginary developing across Europe and the West during the eighteenth and nineteenth centuries that routinely envisaged drugs as stereotypical markers of Oriental barbarism. The first section examines the discursive process through which the mythic connection between hashish and Islamic assassins, first established by French linguist Antoine-Isaac Silvestre de Sacy in 1809, became a fait prouvé in France during the first half of the nineteenth century. The analysis shows that Sacy based his studies of the Islamic assassins on Orientalized fantasies rather than facts and thus inaccurately portrayed hashish as an evil intoxicant used by certain Muslims to transform disciples into blindly obedient and bloodthirsty murderers. Ignorant of, or indifferent to, the inaccuracies in Sacy’s contentions, scholars and scientists working in a range of academic disciplines routinely referenced Sacy’s myth when discussing hashish, Muslims, and the Islamic world. With their repeated, mostly uncritical citations of Sacy’s work, French and European scholars steadily transformed the myth of the Hashish-eating Muslim assassins into common knowledge requiring, by the middle of the nineteenth century, no citation or reference to prove its veracity.

Prevalence and correlates of hashish use in a national sample of high school seniors in the United States

Background: Cannabis (marijuana) use and acceptance towards use are increasing in the US, and state-level policies are becoming more liberal. A wealth of research has been conducted to examine risk factors for use; however, studies rarely differentiate between different forms of marijuana. Objective: We sought to determine prevalence of use and delineate who is at risk for use of hashish, a more potent form of marijuana. Methods: We examined data from a nationally representative sample of high school seniors in the Monitoring the Future study (2007–2011; weighted n = 10 597). We determined how sociodemographic factors and reasons for marijuana use correlated with recent (12 month) hashish use. Results: Prevalence of recent hashish use was 6.5% and it was used by 18.3% of recent marijuana users. Hashish and other marijuana use tended to share many of the same correlates; however, associations were often stronger for hashish use. Females were consistently at low risk for use and users of other drugs were consistently at high risk for use. Black students tended to be at low risk for hashish use. Low risk of identifying as Hispanic or religious and high risk of higher personal income or going out more evenings per week for fun disappeared when controlling for other drug use. Using marijuana because the student felt he/she was “hooked” nearly doubled the odds for hashish use. Conclusions: This was the first national study to examine prevalence and correlates of hashish use. These findings can inform prevention in a time of increasing popularity of marijuana use.

Daily tobacco smoking, heavy alcohol use, and hashish use among adolescents in southern Sweden: A population-based multilevel study

IntroductionThe aim of this study was to investigate school contextual effects on daily tobacco smoking, heavy alcohol use and hashish use among adolescents, using multilevel analyses adjusting for individual-level factors. MethodsThe 2012 public health survey among adolescents in Skåne includes pupils in ninth grade in primary school (predominantly 15–16years old) and second grade in secondary school (gymnasium) (predominantly 17–18years old). Multilevel logistic regressions were performed. ResultsThe prevalence of all three behaviors was higher in the second grade in the gymnasium. Several sociodemographic, psychosocial and parental factors were associated with these behaviors. In the ninth grade, variance partition coefficients (VPCs) for tobacco smoking decreased from 10.2% in the empty model to 1.9% in the fully adjusted model, for heavy alcohol use from 6.5% to 6.3%, while VPCs for hashish increased from 9.9% to 11.0%. In the second grade, VPCs for daily tobacco smoking decreased from 13.6% in the empty model to 6.5% in the fully adjusted model, VPCs for heavy alcohol use decreased from 4.6% to 1.7%, and VPCs for hashish use increased from 7.3% to 8.3%. ConclusionsDaily tobacco smoking (in both grades) and heavy alcohol use in the second grade in the gymnasium may be preventable by actions directed against individual-level protective factors including social capital, social support and peer/parent behavior and attitude, while interventions directed at school contexts may be more important for alcohol use in the ninth grade and hashish use in both grades.

Enucleation of Eye Using Finger Following Cannabis Consumption:a Case Report

Background Enucleation is a topic discussed in psychiatry which is a self-injury matter. Enucleation is observed as psychotic disorder due to substance abuse. In people with mental disorders who also have substance use leading to hallucinations and delusions, unusual eye evacuation were reported. In most cases, enucleation was done using sharp tools. Case Report This report describes a man suffering from psychosis after consuming hashish and has attempted to evacuate his eyes with his finger. Discussion Given the increasing prevalence of hashish use by young people, and false beliefs about the use of hashish in order to withdraw other substances, preventive methods and education for young and vulnerable people are suggested.

Consumption of Cocaine Once – Trigger of Psychosis in a Consumer Hashish – Clinical Case

Introduction The consumption of cannabinoids has increased exponentially in the young. The cannabis-induced psychotic disorder is a rare condition, with transient paranoid ideation being the most common manifestation. Symptoms of anxiety are the most common adverse reaction associated with the moderate use of smoked cannabis. Cocaine use, in turn, is related to the appearance of delusions and hallucinations in up to 50% of its customers, depending on the dosage, duration and personal sensitivity to the substance. Clinical Case 23 years old single male, jobless, without relevant personal history, who presented in for a psychiatry consultation because of auditory, visual, tactile, somatic and kinesthetic hallucinations, as well as delusional paranoid ideation, influence and self-referencing. Regular consumer of hashish since 15 years and with previous single cocaine use at 21 years old. After the treatment with Risperidone (2mg id); Aripiprazole (15 mg id) e Lorazepam (2,5 mg id in SOS), almost complete regression of hallucinatory symptoms and raving. However, the patient continued with regular use of cannabis as a form of social integration, without stoping the psychotropic medication. Conclusions Regular hashish use can induce long-term psychotic states. However, the question that arises is whether the single cocaine may have had a synergistic effect and / or ”triggering“ of psychosis in a patient already hash consumer, since there is reference to the start of hallucinatory symptoms and delusional after consumption of that. However, in this context, it is also difficult to excluded of paranoid schizophrenia since the patient as not completely abandoned the use of hash.

Perceived Discrimination and Its Associations With Mental Health and Substance Use Among Asian American and Pacific Islander Undergraduate and Graduate Students

Objectives: Racial discrimination experiences can negatively affect health. This study examined perceived discrimination and its relationship with mental health and substance use among Asian American and Pacific Islander (API) undergraduate and graduate students. Participants: A total of 113 API students aged 18–35 completed the study during February–June, 2011. Methods: The authors conducted a cross-sectional, anonymous survey online. Dependent variables included mental health (depressive, anxiety, and somatic symptoms) and substance use (alcohol problems, use of tobacco, marijuana or hashish, and other illegal drugs). Results: Students’ perceived discrimination were significantly, positively associated with depressive, anxiety, and somatic symptoms, but not with substance use. Ethnic identity moderated the relationship between perceived discrimination and somatic symptoms, but not depressive or anxiety symptoms. Conclusions: These findings suggested the negative effect of racial discrimination on API students’ mental health. The buffering effect of ethnic identity may increase resilience in these students when they face racial discrimination.

What are young adults smoking in their hookahs? A latent class analysis of substances smoked

RationaleHookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked. MethodsIn fall 2010, 3447 students from 8 colleges in N.C. completed an online survey. Results44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first. ConclusionsRates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances.