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Prev Chronic Dis. 2019 Jan 10;16:E05. doi: 10.5888/pcd16.180093.

Adolescent Beliefs About Hookah and Hookah Tobacco Use and Implications for Preventing Use.

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Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052. Email:
Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC.
Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, Vermont.



Hookah tobacco use is popular among youths and there is evidence that perceived risks and normative beliefs are associated with hookah use. The aim of this study was to further examine associations between perceived risks of hookah use, normative beliefs, and lifetime hookah use among youths.


Participants were adolescents aged 12 to 17 years (n = 257, mean [standard deviation] age, 14.9 [1.6] years, 40% nonwhite, 66% female) attending well-visit checkups at an urban pediatric clinic. Participants completed a survey of measures of cigarette smoking, risk factors for smoking, hookah use, perceived risks, and normative beliefs. Analyses examined associations among lifetime hookah use, beliefs about hookah use, and other smoking risk factors.


Overall, 15% of the sample had ever tried hookah smoking and 60% had ever tried cigarette smoking or were susceptible to cigarette smoking. Of those who had tried hookah smoking, 84% had also tried cigarettes or were susceptible to trying cigarettes (P < .001). One-third (33%) indicated that hookah smoking was less harmful than cigarettes, 38% indicated hookah smoking is less addictive than cigarettes, and 48% perceived that hookah smoking is somewhat or very socially acceptable among friends. In multivariable analyses adjusting for demographic and cigarette smoking-related factors, perceiving hookah use to be somewhat or very socially acceptable was associated with a significantly higher odds of ever having tried hookah smoking.


The study findings indicate that stronger perceived social acceptability of hookah use is associated with a higher likelihood of trying hookah smoking among youths. These normative beliefs may be important targets of interventions aimed at preventing hookah use among youths.

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