Hookah Use Among College Students: Recent Use, Knowledge of Health Risks, Attitude and Reasons for Use


Notwithstanding the efforts of health educators and other health professionals regarding tobacco and smoking cessation, research indicates that hookah smoking among college students remains a health concern. Research shows an upward trend in college students’ hookah use. The purpose of this study was to identify and describe potential patterns/differences in college students’ hookah use, and the relations among attitudes toward and knowledge about hookah use and use of this drug. A four-page, 20-item survey was used to collect data from participants (N = 403) and to measure participants ‘recent use, knowledge of health risks, attitudes and reasons for hookah use among college students. Results indicated increased prevalence rates (53.8%) among participants of this study. Participants’ recent hookah use was consistent with that of current research. Study findings supports current research, which found that college students have low negative perceptions of the health risks (addictive and detrimental properties) of hookah use. Analyses also determined that college students’ attitudes toward hookah was associated with use of this drug. Regarding reasons why students may use hookah, data analysis indicated statistical significance in lifetime hookah use based on reasons for use. Study provide information for health educators creating hookah risk awareness educational programs aimed at reducing rates of hookah smoking among college students.

This is a preview of subscription content, log in to check access.


  1. 1.

    Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  2. 2.

    Akl, E. A., Aleem, S., Gunukula, S. K., Honeine, R., Jaoude, P. A., & Irani, J. (2010). Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: A systematic review. BMC Public Health, 10(1), 415.

    Article  Google Scholar 

  3. 3.

    Allem, J. P., & Unger, J. B. (2016). Emerging adulthood themes and hookah use among college students in Southern California. Addictive Behaviors, 61, 16–19.

    Article  Google Scholar 

  4. 4.

    Baldwin, J. N., Scott, D. M., DeSimone II, E. M., Forrester, J. H., & Fankhauser, M. P. (2011). Substance use attitudes and behaviors at three pharmacy colleges. Substance Abuse, 32(1), 27–35.

    Article  Google Scholar 

  5. 5.

    Barnett, T. E., Shensa, A., Kim, K. H., Cook, R. L., Nuzzo, E., & Primack, B. A. (2013). The predictive utility of attitudes toward hookah tobacco smoking. American Journal of Health Behavior, 37(4), 433.

    Article  Google Scholar 

  6. 6.

    Barry, A. E. (2007). Using theory-based constructs to explore the impact of Greek membership on alcohol-related beliefs and behaviors: A systematic literature review. Journal of American College Health, 56(3), 307–315.

    Article  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    Branstetter, S. A., Blosnich, J., Dino, G., Nolan, J., & Horn, K. (2012). Gender differences in cigarette smoking, social correlates and cessation among adolescents. Addictive Behaviors, 37(6), 739–742.

    Article  Google Scholar 

  9. 9.

    Braun, R. E., Glassman, T., Wohlwend, J., Whewell, A., & Reindl, D. M. (2012). Hookah use among college students from a Midwest University. Journal of Community Health, 37(2), 294–298.

    Article  Google Scholar 

  10. 10.

    Conway, K. P., Green, V. R., Kasza, K. A., Silveira, M. L., Borek, N., Kimmel, H. L., … Compton, W. M. (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 & Alcohol Dependence. https://doi.org/10.1016/j.drugalcdep.2017.03.032.

    Article  Google Scholar 

  11. 11.

    Creamer, M. R., Loukas, A., Li, X., Pasch, K. E., Case, K., Crook, B., & Perry, C. L. (2016). College students’ perceptions and knowledge of hookah use. Drug and Alcohol Dependence, 168, 191–195.

    Article  Google Scholar 

  12. 12.

    El-Zaatari, Z. M., Chami, H. A., & Zaatari, G. S. (2015). Health effects associated with waterpipe smoking. Tobacco Control, 24, 31–43.

    Article  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    Fiestas, F., Radovanovic, M., Martins, S. S., Medina-Mora, M. E., Posada-Villa, J., & Anthony, J. C. (2010). Cross-national differences in clinically significant cannabis problems: epidemiologic evidence from ‘cannabis-only’ smokers in the United States, Mexico, and Colombia. BMC Public Health, 10(1), 152.

    Article  Google Scholar 

  15. 15.

    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 and Alcohol Abuse, 41(4), 272–280.

    Article  Google Scholar 

  16. 16.

    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.

    Article  Google Scholar 

  17. 17.

    Hingson, R. W., Zha, W., & Weitzman, E. R. (2009). Magnitude of and trends in alcohol-related mortality and morbidity among US college students ages 18–24, 1998–2005. Journal of Studies on Alcohol and Drugs, Supplement, 16, 12–20.

    Article  Google Scholar 

  18. 18.

    Huang, T., Elghafari, A., Relia, K., & Chunara, R. (2017). High-resolution temporal representations of alcohol and tobacco behaviors from social media data. In Proceedings of the ACM on Human-Computer Interaction, 1(CSCW).

    Article  Google Scholar 

  19. 19.

    Jamal, A. (2016). Current cigarette smoking among adults—United States, 2005–2015. MMWR. Morbidity and mortality weekly report, 65.

  20. 20.

    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, nts003, 1145–1153.

    Article  Google Scholar 

  21. 21.

    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.

    Article  Google Scholar 

  22. 22.

    Knishkowy, B., & Amitai, Y. (2005). Water-pipe (narghile) smoking: An emerging health risk behavior. Pediatrics, 116(1), e113-e119.

    Article  Google Scholar 

  23. 23.

    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, https://doi.org/10.1093/ntr/ntx123.

    Article  Google Scholar 

  24. 24.

    Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: A practice-friendly review of research. Journal of Clinical Psychology, 66(2), 201–214.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    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.

    Article  Google Scholar 

  26. 26.

    McCambridge, J., Hunt, C., Jenkins, R. J., & Strang, J. (2011). Cluster randomized trial of the effectiveness of motivational interviewing for universal prevention. Drug and Alcohol Dependence, 114(2), 177–184.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Nichter, M., Nichter, M., Carkoglu, A., Lloyd-Richardson, E., & Tobacco Etiology Research Network (2010). Smoking and drinking among college students: “It’s a package deal”. Drug and Alcohol Dependence, 106(1), 16–20.

    Article  Google Scholar 

  28. 28.

    Noonan, D., & Patrick, M. E. (2013). Factors associated with perceptions of hookah addictiveness and harmfulness among young adults. Substance Abuse, 34(1), 83–85.

    Article  Google Scholar 

  29. 29.

    Nuzzo, E., Shensa, A., Kim, K. H., Fine, M. J., Barnett, T. E., Cook, R., & Primack, B. A. (2013). Associations between hookah tobacco smoking knowledge and hookah smoking behavior among US college students. Health Education Research, 28(1), 92–100.

    Article  Google Scholar 

  30. 30.

    Park, A., Sher, K. J., & Krull, J. L. (2008). Risky drinking in college changes as fraternity/sorority affiliation changes: A person-environment perspective. Psychology of Addictive Behaviors, 22(2), 219.

    Article  Google Scholar 

  31. 31.

    Primack, B. A., Fertman, C. I., Rice, K. R., Adachi-Mejia, A. M., & Fine, M. J. (2010). Waterpipe and cigarette smoking among college athletes in the United States. Journal of Adolescent Health, 46(1), 45–51.

    Article  Google Scholar 

  32. 32.

    Primack, B. A., Shensa, A., Kim, K. H., Carroll, M. V., Hoban, M. T., Leino, E. V., … Fine, M. J. (2013). Waterpipe smoking among US university students. Nicotine & Tobacco Research, 15(1), 29–35.

    Article  Google Scholar 

  33. 33.

    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.

    Article  Google Scholar 

  34. 34.

    Rahman, S., Chang, L., Hadgu, S., Salinas-Miranda, A. A., & Corvin, J. (2013). Prevalence, knowledge, and practices of hookah smoking among university students, Florida, 2012. Preventing Chronic Disease, 11, e214-e214.

    Google Scholar 

  35. 35.

    Raosoft. (2004). Sample size calculator. Retrieved February 2, 2008, from http://www.raosoft.com/samplesize.html.

  36. 36.

    Rankin, K. V. (2011). Hookah smoking: A popular alternative to cigarettes. Texas Dental Journal, 128(5), 441–445.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    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.

    Article  Google Scholar 

  38. 38.

    Rigotti, N. A., Lee, J. E., & Wechsler, H. (2000). US college students’ use of tobacco products: Results of a national survey. The Journal of the American Medical Association, 284(6), 699–705.

    CAS  Article  Google Scholar 

  39. 39.

    Roskin, J., & Aveyard, P. (2009). Canadian and English students’ beliefs about waterpipe smoking: A qualitative study. BMC Public Health, 9(1), 10.

    Article  Google Scholar 

  40. 40.

    Sidani, J. E., Shensa, A., & Primack, B. A. (2013). Substance and hookah use and living arrangement among fraternity and sorority members at US colleges and universities. Journal of Community Health, 38(2), 238–245.

    Article  Google Scholar 

  41. 41.

    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 and Alcohol Dependence, 115(1), 131–136.

    Article  Google Scholar 

  42. 42.

    Tavafian, S. S., Aghamolaei, T., & Zare, S. (2009). Water pipe smoking and health-related quality of life: A population-based study. Archives of Iranian Medicine, 12(3), 232–237.

    Google Scholar 

  43. 43.

    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.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Bradley Fevrier.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fevrier, B., Nabors, L., Vidourek, R.A. et al. Hookah Use Among College Students: Recent Use, Knowledge of Health Risks, Attitude and Reasons for Use. J Community Health 43, 1037–1043 (2018). https://doi.org/10.1007/s10900-018-0519-8

Download citation


  • Shisha
  • Co-occurring substance use
  • Hookah
  • Alcohol
  • Marijuana
  • Hookah and other drug use