Annals of Behavioral Medicine

, Volume 36, Issue 1, pp 81–86 | Cite as

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

  • Brian A. PrimackEmail author
  • Jaime Sidani
  • Aaron A. Agarwal
  • William G. Shadel
  • Eric C. Donny
  • Thomas E. Eissenberg
Rapid Communication



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 



Dr. Primack is supported by a Physician Faculty Scholar Award from the Robert Wood Johnson Foundation, a career development award from the National Cancer Institute (K07-CA114315), and a grant from the Maurice Falk Foundation. Dr. Eissenberg’s research is supported by R01-CA103827, R01-DA11082, and R01-TW005962.


  1. 1.
    Shihadeh A. Investigation of the mainstream smoke aerosol of the argileh water pipe. Food and Chem Toxicol. 2003; 41: 143–152.CrossRefGoogle Scholar
  2. 2.
    Shihadeh A, Azar S, Antonius C, Haddad A. Towards a topographical model of narghile water-pipe cafe smoking. Biochem Pharmacol Behav. 2004; 791: 75–82.CrossRefGoogle Scholar
  3. 3.
    Djordjevic MV, Stellman SD, Zang E. Doses of nicotine and lung carcinogens delivered to cigarette smokers. J Nat Cancer Institute. 2000; 92: 106–111.CrossRefGoogle Scholar
  4. 4.
    Shihadeh A, Saleh R. Polycyclic aromatic hydrocacrbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol. 2005; 43: 655–661.PubMedCrossRefGoogle Scholar
  5. 5.
    Shafagoj YA, Mohammed FI, Hadidi KA. Hubble-bubble (water pipe) smoking: Levels of nicotine and cotinine in plasma, saliva and urine. Int J Clin Pharmacol Ther. 2002; 40: 249–255.PubMedGoogle Scholar
  6. 6.
    Chaouachi K. The medical consequences of narghile (hookah, shisha) use in the world. Rev Epidemiol Sante Publique. 2007; 553: 165–170. Mar.PubMedGoogle Scholar
  7. 7.
    Bedwani R, Renganathan E, El-Kwhsky F, et al. Epidemiology of bladder cancer in Alexandria, Egypt: Tobacco smoking. Int J Cancer. 1997; 73: 64–67.PubMedCrossRefGoogle Scholar
  8. 8.
    Maziak W, Ward WD, Eissenberg T. Factors related to frequency of narghile (waterpipe) use: The first insights on tobacco dependence in narghile users. Drug Alcohol Depend. 2004; 76: 101–106.PubMedCrossRefGoogle Scholar
  9. 9.
    Ward KD, Eissenberg T, Rastam S, et al. The tobacco epidemic in Syria. Tob Control. 2006; 15: 24–29.CrossRefGoogle Scholar
  10. 10.
    Jabbour S, El-Roueiheb Z, Sibai AM. Narghile (water-pipe) smoking and incident coronary heart disease: A case-control study. Ann Epidemiol. 2003; 13: 570.CrossRefGoogle Scholar
  11. 11.
    Hookah cafes on the rise. Smokeshop Magazine; 2004.Google Scholar
  12. 12.
    Lewin T. Collegians smoking hookahs...filled with tobacco. The New York Times. April 19, 2006.Google Scholar
  13. 13.
    Primack BA, Aronson JD, Agarwal AA. An old custom, a new threat to tobacco control. Am J Public Health. 2006; 968: 1339. Aug.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith SY, Curbow B, Stillman FA. Harm perception of nicotine products in college freshmen. Nicotine Tob Res. 2007; 9: 977–982.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith-Simone SY, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: Knowledge, attitudes, beliefs, and behavior in two U.S. samples. Nicotine Tob Res.. 2008; 10: 393–398.PubMedCrossRefGoogle Scholar
  16. 16.
    Maziak W, Eissenberg T, Rastam S, et al. Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria. Ann Epidemiol. 2004; 149: 646–654. Oct.PubMedCrossRefGoogle Scholar
  17. 17.
    Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.Google Scholar
  18. 18.
    American College Health Association. National College Health Assessment 2004: ACHA-NCHA 2004. Baltimore, MD: American College Health Association; 2004.Google Scholar
  19. 19.
    Ward KD, Eissenberg T, Gray J, Srinivas V, Wilson N, Maziak W. Characteristics of American waterpipe users: A preliminary report. Nicotine Tob Res.. 2007; 9: 1339–1346.PubMedCrossRefGoogle Scholar
  20. 20.
    Maziak W, Eissenberg T, Ward KD. Patterns of waterpipe use and dependence: Implications for intervention development. Pharmacol Biochem Behav. 2005; 801: 173–179. Jan.PubMedCrossRefGoogle Scholar
  21. 21.
    Primack BA, Switzer GE, Dalton MA. Improving measurement of normative beliefs involving smoking among adolescents. Arch Pediatr Adolesc Med. 2007; 1615: 434–439. May.PubMedCrossRefGoogle Scholar
  22. 22.
    Morrell HER, Cohen LM, Bacchi D, West J. Predictors of smoking and smokeless tobacco use in college students: A preliminary study using Web-based survey methodology. J Am Coll Health. 2005; 542: 108–115.PubMedCrossRefGoogle Scholar
  23. 23.
    Sax LJ, Gilmartin SK, Bryant AN. Assessing response rates and nonresponse bias in web and paper surveys. Res High Educ. 2003; 444: 409–431.CrossRefGoogle Scholar
  24. 24.
    White AM, Jamieson-Drake DW, Swartzwelder HS. Prevalence and correlates of alcohol-induced blackouts among college students: Results of an E-mail survey. J Am Coll Health. 2002; 513: 117–131.PubMedCrossRefGoogle Scholar
  25. 25.
    Pealer LN, Weiler RM, Pigg RM, Miller D, Dorman SM. The feasibility of a web-based surveillance system to collect health risk behavior data from college students. Health Educ Behav. 2001; 285: 547–559.PubMedCrossRefGoogle Scholar
  26. 26.
    Porter SR, Whitcomb ME. Non-response in student surveys: The role of demographics, engagement, and personality. Res High Educ. 2005; 462: 127–152.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2008

Authors and Affiliations

  • Brian A. Primack
    • 1
    • 2
    • 3
    Email author
  • Jaime Sidani
    • 4
  • Aaron A. Agarwal
    • 2
  • William G. Shadel
    • 5
  • Eric C. Donny
    • 6
  • Thomas E. Eissenberg
    • 7
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Center for Research on Health CarePittsburghUSA
  3. 3.Division of Adolescent Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.University of Pittsburgh Student Health ServicePittsburghUSA
  5. 5.RAND CorporationPittsburghUSA
  6. 6.Department of PsychologyUniversity of PittsburghPittsburghUSA
  7. 7.Virginia Commonwealth UniversityRichmondUSA

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