Social Aspects of Hookah Smoking Among US Youth

BACKGROUND: We investigated 3 social dimensions of youth hookah smoking: frequency, places smoked, and descriptive social norms. METHODS: Data were from the 2016 National Youth Tobacco Survey of US sixth- to 12th-graders (n = 20 675). Hookah smoking frequency was classified as never, former, current occasional, and current frequent. Places where past 30-day hookah smoking occurred and students’ perceptions of their classmates’ hookah smoking prevalence were assessed. Descriptive and multivariable analyses were performed (P < .05). RESULTS: Overall, 10.5% reported smoking hookah ≥1 time in their lifetime. Of these, 65.8% were former, 26.3% were current occasional, and 7.9% were current frequent smokers. Overall, 59.3% of students overestimated hookah smoking prevalence in their grade. Current occasional smoking was predicted by female sex (adjusted odds ratio [aOR] = 1.54) and peer hookah-smoking overestimation (aOR = 9.30). Current frequent smoking was most strongly predicted by living with a hookah smoker (aOR = 20.56), speaking a second language other than English (aOR = 2.17), and co-use of mentholated cigarettes (aOR = 19.94) or other flavored noncigarette tobacco products (aOR = 17.59). The top 3 places hookah was smoked were a friend’s house (47.7%), the respondent’s own house (31.8%), and another family member’s house (20.8%). CONCLUSIONS: The home environment was the most common place for youth hookah smoking. Home-tailored interventions that encourage voluntary smoke-free rules and warn about the dangers of social smoking could help denormalize hookah smoking.