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Am J Prev Med. 2016 Jan;50(1):e9-e14. doi: 10.1016/j.amepre.2015.07.006. Epub 2015 Sep 4.

Geographic Proximity of Waterpipe Smoking Establishments to Colleges in the U.S.

Author information

Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.
Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, Florida. Electronic address:
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, Miami, Florida; Syrian Center for Tobacco Studies, Aleppo, Syria.



Waterpipe tobacco smoking is prevalent among college students in the U.S. and increasing in popularity. Waterpipe smoking establishments are almost completely unregulated, and limited information exists documenting the expansion of this industry. The objective of this study was to identify U.S.-based waterpipe establishments and measure their proximity to colleges/universities.


Waterpipe establishments and their addresses were compiled using five Internet-based directories during 2014 and analyzed in 2015. Addresses were geocoded and overlaid on a U.S. map of accredited colleges/universities. Proximity of colleges/universities to the nearest waterpipe establishment was measured in 3-mile increments. Multinomial logistic regression was used to model the factors associated with proximity of waterpipe establishments to colleges/universities.


A total of 1,690 waterpipe establishments and 1,454 colleges/universities were included in the study. Overall, 554 colleges/universities (38.1%) were within 3 miles of a waterpipe establishment. Proximity of waterpipe establishments to colleges/universities was associated with higher full-time student enrollment. Public colleges/universities and those with a smoke-free campus policy were at lower odds of having waterpipe establishments within 3 miles of their campuses.


Waterpipe smoking establishments are more likely to be located near large colleges/universities. This study should inform initiatives aimed at reducing retail tobacco establishment exemptions.

[Indexed for MEDLINE]
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