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Hookah Smoking Among Young Adults in Southern California

Rezk-Hanna, Mary; Macabasco-O'Connell, Aurelia; Woo, Mary

doi: 10.1097/NNR.0000000000000038

Background Hookah (water pipe) smoking is a form of tobacco use, historically from the Middle East and India that is fueling a contemporary epidemic of tobacco abuse and a nationwide public health crisis, particularly among young adults. There is little information on factors influencing hookah smoking and health beliefs of hookah smokers.

Objectives Guided by the health belief model, the purpose of this study was to assess young adult hookah smokers’ perceptions, attitudes, beliefs, and preferences toward hookah smoking and identify factors that may influence heavy (>3 times per week) versus light hookah smoking.

Methods A cross-sectional design was used for this study. Participants were recruited at hookah lounges in southern California. A sample of participants who smoke hookah and were between 18 and 30 years of age completed a short survey about their perceptions, attitudes, beliefs, initiation, and frequency of hookah smoking. Characteristics of light and heavy hookah smokers were compared using t tests and chi-square tests. Content analysis was used to analyze qualitative data.

Results Participants (N = 91) had a mean age of 24 (SD = 2.7), and 65% were men; 24% reported smoking before the age of 18, and 73.6% of participants smoked more than once a week. Men were heavier smokers in comparison to women (p = .006), 57% believed that hookah was not harmful to their health, and 60% reported socialization as the main reason why they smoked hookah.

Discussion It is critical to advocate for greater research on the health effects of hookah smoking and dissemination of these findings to the public, particularly to young adults.

Mary Rezk-Hanna, RN, NP-C, is Doctoral Candidate, School of Nursing, University of California, Los Angeles.

Aurelia Macabasco-O'Connell, PhD, RN, ACNP-BC, FAHA, is Associate Professor, Azusa Pacific University School of Nursing, California.

Mary Woo, DNSc, RN, FAAN, FAHA, is Professor, School of Nursing, University of California, Los Angeles.

Accepted for publication March 4, 2014.

The authors acknowledge the study was supported by the Deloras Jones Nursing Scholarship Program, and they would like to thank Joanne Wilborn for her hookah drawings for this manuscript.

The authors have no conflicts of interest to report.

Corresponding author: Mary Rezk-Hanna, RN, NP-C, c/o Professor Mary A. Woo, DNSc, RN, University of California, Los Angeles, Factor Building"School of Nursing, 700 Tiverton Avenue, Los Angeles, CA 90095-1702 (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.