title: Hookah use prevalence, predictors, and perceptions among Canadian youth: findings from the 2012/2013 Youth Smoking Survey.
abstract: OBJECTIVE
  Few national surveys currently assess hookah smoking among youth. This study describes the prevalence, patterns of use, and perceptions about hookah in a nationally representative survey of Canadian grades 9-12 students.
  
  
  METHODS
  The Youth Smoking Survey 2012/2013 was administered to 27,404 Canadian grades 9-12 students attending schools in nine Canadian provinces representing 96 % of Canadian population. Relevant dichotomous outcomes included ever use, use in the last 30 days, and the belief that hookah use is less harmful than cigarette smoking. Covariates included smoking status, sex, grade, province of residence, race/ethnicity, and amount of weekly spending money. Logistic regression models were used to examine: covariates related to the odds of ever and last-30-day hookah use; covariates related to perceptions about the harms of hookah smoking; the extent to which perceptions were associated with odds of hookah use; and whether survey year (2010/2011 or 2012/2013) was associated with hookah use, and marginal effects were calculated.
  
  
  RESULTS
  In Canada, 5.4 % of students in grades 9-12 currently use hookah and 14.3 % report ever using hookah. In 2012/2013, students had significantly higher odds of using hookah compared to students in 2010/2011 (OR 1.5, 95 % CI 1.2, 2.1). About half of hookah users (51 %) used flavored hookah. Students who believed that hookah use was less harmful than cigarette smoking had significantly higher odds of current hookah use (OR 2.6, 95 % CI 1.9, 3.5), as did students who reported higher amounts of weekly spending money. Current smokers had an 18 % higher predicted probability of currently using hookah compared to non-smokers.
  
  
  CONCLUSIONS
  Hookah use among youth is of growing concern in Canada. Findings can be used to inform policy development related to youth hookah smoking.
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada, lminaker@uwaterloo.ca.
authors.forename: Leia M
authors.initials: LM
authors.lastname: Minaker
authors.forename: Alanna
authors.initials: A
authors.lastname: Shuh
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Burkhalter
authors.forename: Steve R
authors.initials: SR
authors.lastname: Manske
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D010465:Perception; D015995:Prevalence; D012574:Schools; D012907:Smoking / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology*