Rapid Communication

Annals of Behavioral Medicine

, Volume 36, Issue 1, pp 81-86

First online:

Prevalence of and Associations with Waterpipe Tobacco Smoking among U.S. University Students

  • Brian A. PrimackAffiliated withDivision of General Internal Medicine, Department of Medicine, University of Pittsburgh School of MedicineCenter for Research on Health CareDivision of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Email author 
  • , Jaime SidaniAffiliated withUniversity of Pittsburgh Student Health Service
  • , Aaron A. AgarwalAffiliated withCenter for Research on Health Care
  • , William G. ShadelAffiliated withRAND Corporation
  • , Eric C. DonnyAffiliated withDepartment of Psychology, University of Pittsburgh
  • , Thomas E. EissenbergAffiliated withVirginia Commonwealth University

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Although waterpipe tobacco smoking seems to be increasing on U.S. university campuses, these data have come from convenience samples.


We aimed to determine the prevalence of and associations with waterpipe tobacco smoking among a random sample of students.


We surveyed a random sample of graduate and undergraduate students at a large, urban university. We used multivariate modeling to determine independent associations between belief-related predictors and waterpipe tobacco smoking.


Of the 647 respondents, waterpipe smoking was reported in 40.5%, over the past year in 30.6%, and over the past 30 days in 9.5%. Over half of the sample (52.1%) perceived that tobacco smoking from a waterpipe was less addictive than cigarette smoking. In fully adjusted multivariate models, 1-year waterpipe smoking was associated with low perceived harm (OR = 2.54, 95% CI = 1.68, 3.83), low perceived addictiveness (OR = 4.64, 95% CI = 3.03, 7.10), perception of high social acceptability (OR = 20.00, 95% CI = 6.03, 66.30), and high perception of popularity (OR = 4.72, 95% CI = 2.85, 7.82).


In this sample, lifetime waterpipe use was as common as lifetime cigarette use. Perception of harm, perception of addictiveness, social acceptability, and popularity were all strongly related to waterpipe smoking.


Waterpipe Hookah Narghile Shisha Tobacco Smoking