Hookah's new popularity among US college students: a pilot study of the characteristics of hookah smokers and their Facebook displays

OBJECTIVES: (1) To confirm the prevalence of hookah use among US college students. (2) To identify substances commonly smoked in hookahs and other substance use characteristics of hookah smokers. (3) Given the powerful influence of Facebook and its potential role in promoting behaviours, to assess the prevalence of hookah references on Facebook profiles. DESIGN: Cross-sectional study. SETTING: Two large US universities; www.Facebook.com. PARTICIPANTS: 307 Facebook profiles were coded and 216 of these profile owners completed an online survey. On average, participants were 18.8 years old (SD=0.7), women (54%), Caucasian (70.4%) and approximately half were from each university. OUTCOME MEASURES: Lifetime and frequency of hookah use, substance smoked in hookah, cigarette and marijuana use, hookah references displayed on Facebook. RESULTS: 27.8% of participants endorsed hookah use; there were no significant differences between age, gender, race or university for hookah use. Hookah users reported smoking tobacco (78%), hash (12%) and both tobacco and marijuana/hash (10%) in their hookah. Compared with non-hookah smokers, hookah smokers were more likely to report using cigarettes (OR=3.41, 95%CI=1.2 to 9.64) and marijuana (OR=15.01, 95%CI=6.5 to 34.65). Hookah references were present on 5% of Facebook profiles. CONCLUSIONS: More than one quarter of college students smoke hookah. Most smoke tobacco in their hookah, and hookah smoking is associated with polysubstance use. Hookah may present new risks for nicotine addiction in this population.