Journal of Community Health

, Volume 43, Issue 5, pp 1012–1018 | Cite as

Policy Implications and Research Recommendations: A Review of Hookah Use Among US College Students

  • Bradley FevrierEmail author
  • Rebecca A. Vidourek
  • Pauline Privitera


The rate of Hookah use among college students during the last decade is about 30%. Although college students perceive hookah use as a safer alternative to conventional cigarettes, hookah use increases the risk of disease and nicotine dependence, and therefore remains an area of concern. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. This review attempts to assess empirical literature relating to hookah use while focusing on the consequences for regulatory policy. PubMed (including MEDLINE 2010–2017), PsycINFO, EBSCO, Scopus (Elsevier) databases were examined to pinpoint articles published in English. The following terms were used in the searches: Hookah or Waterpipe or nargile or “arghile” or “shisha” or “hubble bubble” or “alternative tobacco product” or “flavored tobacco”. Hookah use may initiate smoking among tobacconaïve college students. College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior. In addition, few public health messages target college-age adults with anti-hookah messages. A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of “safety” which inadvertently may imply a suggestion of no need for safety measures. Hence, a research agenda that would inform about health policy actions has been proposed.


Hookah Shisha Waterpipe Co-occurring substance use Marijuana Hookah and other drug use 


Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.


  1. 1.
    Allem, J. P., & Unger, J. B. (2016). Emerging adulthood themes and hookah use among college students in Southern California. Addictive Behaviors, 61, 16–19.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Amrock, S. M., Gordon, T., Zelikoff, J. T., & Weitzman, M. (2013). Hookah use among adolescents in the United States: Results of a national survey. Nicotine & Tobacco Research, 16(2), 231–237.CrossRefGoogle Scholar
  3. 3.
    Berg, C. J., Stratton, E., Schauer, G. L., Lewis, M., Wang, Y., Windle, M., & Kegler, M. (2015). Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: Marijuana, hookah, and electronic cigarettes win. Substance Use & Misuse, 50(1), 79–89.CrossRefGoogle Scholar
  4. 4.
    Blazer, D. G., & Wu, L.T., (2012). Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States. Aging & Mental Health, 16(3), 296–304.CrossRefGoogle Scholar
  5. 5.
    Cobb, C. O., Khader, Y., Nasim, A., & Eissenberg, T. (2012). A multiyear survey of waterpipe and cigarette smoking on a US university campus. Journal of American College Health, 60(7), 521–527.CrossRefPubMedGoogle Scholar
  6. 6.
    Conway, K. P., Green, V. R., Kasza, K. A., Silveira, M. L., Borek, N., Kimmel, H. L., … Reissig, C. J. (2017). Co-occurrence of tobacco product use, substance use, and mental health problems among adults: Findings from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Drug and Alcohol Dependence, 177, 104–111CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Fielder, R. L., Carey, K. B., & Carey, M. P. (2012). Prevalence, frequency, and initiation of hookah tobacco smoking among first-year female college students: A one-year longitudinal study. Addictive Behaviors, 37(2), 221–224.CrossRefPubMedGoogle Scholar
  8. 8.
    Gathuru, I. M., Tarter, R. E., & Klein-Fedyshin, M. (2015). Review of hookah tobacco smoking among college students: Policy implications and research recommendations. The American Journal of Drug & Alcohol Abuse, 41(4), 272–280.CrossRefGoogle Scholar
  9. 9.
    Gilreath, T. D., Leventhal, A., Barrington-Trimis, J. L., Unger, J. B., Cruz, T. B., Berhane, K. … Pentz, M. A. (2015). Patterns of alternative tobacco product use: Emergence of hookah and E-cigarettes as preferred products amongst youth. Journal of Adolescent Health, 58, 181–185CrossRefPubMedGoogle Scholar
  10. 10.
    Goodwin, R. D., Grinberg, A., Shapiro, J., Keith, D., McNeil, M. P., Taha, F., … Hart, C. L. (2014). Hookah use among college students: Prevalence, drug use, and mental health. Drug & Alcohol Dependence, 141, 16–20.CrossRefGoogle Scholar
  11. 11.
    Grekin, E. R., & Ayna, D. (2012). Waterpipe smoking among college students in the United States: A review of the literature. Journal of American College Health, 60(3), 244–249.CrossRefPubMedGoogle Scholar
  12. 12.
    Grigsby, T. J., Forster, M., Soto, D. W., & Unger, J. B. (2017). Changes in the strength of peer influence and cultural factors on substance use initiation between late adolescence and emerging adulthood in a Hispanic sample. Journal of Ethnicity in Substance Abuse, 16(2), 137–154.CrossRefPubMedGoogle Scholar
  13. 13.
    Gwon, S. H., Yan, G., Huang, G., & Kulbok, P. A. (2017). The influence of tobacco retailers on adolescent smoking: Prevention and policy implications. International Nursing Review. Scholar
  14. 14.
    Heinz, A. J., Giedgowd, G. E., Crane, N. A., Veilleux, J. C., Conrad, M., Braun, A. R., … Kassel, J. D. (2013). A comprehensive examination of hookah smoking in college students: Use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use. Addictive Behaviors, 38(11), 2751–2760.CrossRefPubMedGoogle Scholar
  15. 15.
    Jamal, A. (2016). Current cigarette smoking among adults—United States, 2005 2015. MMWR. Morbidity and Mortality Weekly Report, 65, 1205–1211CrossRefPubMedGoogle Scholar
  16. 16.
    Jarrett, T., Blosnich, J., Tworek, C., & Horn, K. (2012). Hookah use among US college students: Results from the National College Health Assessment II. Nicotine & Tobacco Research, 14, 1145–1153.CrossRefGoogle Scholar
  17. 17.
    Jiang, N., Ho, S. Y., Wang, M. P., Leung, L. T., & Lam, T. H. (2017). The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents. Addictive Behaviors, 64, 123–128.CrossRefPubMedGoogle Scholar
  18. 18.
    Kuiper, N. M., Gammon, D., Loomis, B., Falvey, K., Wang, T. W., King, B. A., & Rogers, T. (2017). Trends in sales of flavored and menthol tobacco products in the United States during 2011–2015. Nicotine & Tobacco Research. Scholar
  19. 19.
    MacLean, R. R., Pincus, A. L., Smyth, J. M., Geier, C. F., & Wilson, S. J. (2017). Extending the balloon analogue risk task to assess naturalistic risk taking via a mobile platform. Journal of Psychopathology & Behavioral Assessment, 40, 1–10.Google Scholar
  20. 20.
    Mays, D., Arrazola, R. A., Tworek, C., Rolle, I. V., Neff, L. J., & Portnoy, D. B. (2016). Openness to using non-cigarette tobacco products among US young adults. American Journal of Preventive Medicine, 50(4), 528–534.CrossRefPubMedGoogle Scholar
  21. 21.
    Maziak, W., Taleb, Z. B., Jawad, M., Afifi, R., Nakkash, R., Akl, E. A., … Sherman, S. (2016). Consensus statement on assessment of waterpipe smoking in epidemiological studies. Tobacco Control, 26, 338–343.CrossRefPubMedGoogle Scholar
  22. 22.
    Noonan, D. (2013). A descriptive study of waterpipe smoking among college students. Journal of the American Association of Nurse Practitioners, 25(1), 11–15.CrossRefPubMedGoogle Scholar
  23. 23.
    Perkins, K. A., Kunkle, N., & Karelitz, J. L. (2017). Threshold dose for behavioral discrimination of cigarette nicotine content in menthol vs. non-menthol smokers. Psychopharmacology, 234(8), 1255–1265.CrossRefPubMedGoogle Scholar
  24. 24.
    Primack, B. A., Shensa, A., Kim, K. H., Carroll, M. V., Hoban, M. T., Leino, E. V., et al. (2013). Waterpipe smoking among U.S. university students. Nicotine & Tobacco Research, 15, 29–35.CrossRefGoogle Scholar
  25. 25.
    Primack, B. A., Sidani, J., Agarwal, A. A., Shadel, W. G., Donny, E. C., & Eissenberg, T. E. (2008). Prevalence of and associations with waterpipe tobacco smoking among US university students. Annals of Behavioral Medicine, 36(1), 81–86.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Raad, D., Gaddam, S., Schunemann, H. J., Irani, J., Jaoude, P. A., Honeine, R., & Akl, E. A. (2011). Effects of water-pipe smoking on lung function: A systematic review and meta-analysis. CHEST Journal, 139(4), 764–774.CrossRefGoogle Scholar
  27. 27.
    Rayens, M. K., Ickes, M. J., Butler, K. M., Wiggins, A. T., Anderson, D. G., & Hahn, E. J. (2017). University students’ perceived risk of and intention to use waterpipe tobacco. Health Education Research, 32(4), 306–317.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Robinson, J. N., Wang, B., Jackson, K. J., Donaldson, E. A., & Ryant, C. A. (2017). Characteristics of hookah tobacco smoking sessions and correlates of use frequency among US adults: Findings from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine & Tobacco Research, Scholar
  29. 29.
    Salameh, P., Waked, M., Khoury, F., Akiki, Z., Nasser, Z., Abou Abbass, L., & Dramaix, M. (2012). Waterpipe smoking and dependence are associated with chronic bronchitis: A case-control study in Lebanon. East Mediterranean Health Journal, 18, 996–1004.CrossRefGoogle Scholar
  30. 30.
    Shepardson, R. L., & Hustad, J. T. (2015). Hookah tobacco smoking during the transition to college: Prevalence of other substance use and predictors of initiation. Nicotine & Tobacco Research, 18(5), 763–769.CrossRefGoogle Scholar
  31. 31.
    Sidani, J. E., Shensa, A., Shiffman, S., Switzer, G. E., & Primack, B. A. (2016). Behavioral associations with waterpipe tobacco smoking dependence among US young adults. Addiction, 111(2), 351–359.CrossRefPubMedGoogle Scholar
  32. 32.
    Smith, J. R., Edland, S. D., Novotny, T. E., Hofstetter, C. R., White, M. M., Lindsay, S. P., et al. (2011). Increasing hookah use in California. American Journal of Public Health, 101, 1876–1879.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Soule, E. K., Barnett, T. E., Curbow, B. A., Moorhouse, M. D., & Weiler, R. M. (2015). Hookah and alcohol use among young adult hookah smokers: A mixed methods study. American Journal of Health Behavior, 39(5), 665–673.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sterling, K. L., & Mermelstein, R. (2011). Examining hookah smoking among a cohort of adolescent ever smokers. Nicotine & Tobacco Research, 13(12), 1202–1209.CrossRefGoogle Scholar
  35. 35.
    Sutfin, E. L., McCoy, T. P., Reboussin, B. A., Wagoner, K. G., Spangler, J., & Wolfson, M. (2011). Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina. Drug & Alcohol Dependence, 115(1), 131–136.CrossRefGoogle Scholar
  36. 36.
    Trinidad, D. R., Pierce, J. P., Sargent, J. D., White, M. M., Strong, D. R., Portnoy, D. B., … Shi, Y. (2017). Susceptibility to tobacco product use among youth in wave 1 of the population Assessment of tobacco and health (PATH) study. Preventive Medicine, 101, 8–14.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    World Health Organization. (2013). WHO report on the global tobacco epidemic, 2013: Enforcing bans on tobacco advertising, promotion and sponsorship. Geneva: World Health Organization.Google Scholar
  38. 38.
    Zale, E. L., Dorfman, M. L., Hooten, W. M., Warner, D. O., Zvolensky, M. J., & Ditre, J. W. (2014). Tobacco smoking, nicotine dependence, and patterns of prescription opioid misuse: Results from a nationally representative sample. Nicotine & Tobacco Research, 17(9), 1096–1103.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Health and Human Performance ProgramUNC-PembrokePembrokeUSA
  2. 2.Health Promotion & EducationUniversity of CincinnatiCincinnatiUSA

Personalised recommendations