What are young adults smoking in their hookahs? A latent class analysis of substances smoked

• We explore substances that college students smoke in hookahs.
• 44% of students had smoked tobacco from a hookah in their lifetime.
• Most (90%) hookah users smoked flavored tobacco, 45% smoked marijuana, 37% smoked herbal (non-tobacco) shisha, and 18% smoked hashish in a hookah.
• Latent class analysis revealed two distinct classes of hookah users, based on the substances they smoked in hookahs, with differing demographic and behavioral profiles.

RationaleHookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked.MethodsIn fall 2010, 3447 students from 8 colleges in N.C. completed an online survey.Results44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first.ConclusionsRates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances.