Waterpipe smoking among U.S. university students.
BACKGROUND
While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics.


METHODS
We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever.


RESULTS
Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States.


CONCLUSIONS
After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.
Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. bprimack@pitt.edu
Brian A
BA
Primack
Ariel
A
Shensa
Kevin H
KH
Kim
Mary V
MV
Carroll
Mary T
MT
Hoban
E Victor
EV
Leino
Thomas
T
Eissenberg
Kathleen H
KH
Dachille
Michael J
MJ
Fine
D002947:Cities; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data; D014030:Tobacco, Smokeless; D014481:United States / Q000453:epidemiology; D014495:Universities; D044465:White People; D055815:Young Adult