Among incoming college students who had never smoked hookah, pre-college marijuana use was one of only two substances (along with alcohol) that predicted initiating hookah smoking during the first month of college.
Read this if you work in college health or substance use prevention.
13.8% of hookah-naive students initiated hookah in the first month of college, predicted by prior marijuana use (AOR = 1.30).
What the researchers found
Researchers tracked 936 incoming college students from before the start of their freshman year through the first 30 days of college. Hookah use prevalence increased from 9% before college to 13.1% during the first month.
Among students who had never used hookah before college, 13.8% initiated hookah during the first 30 days. Only two substances predicted this initiation: alcohol (AOR = 1.11) and marijuana (AOR = 1.30). Other tobacco products, cigarettes, and illegal drugs did not independently predict hookah initiation.
Hookah users were more likely to use all other substances compared to non-users, and one-fifth of former hookah smokers resumed use during the first month of college.
Why it matters
The transition to college is a period of heightened vulnerability for substance use initiation. This study identifies pre-college marijuana and alcohol use as specific risk markers for hookah initiation, suggesting these students may benefit from targeted prevention during orientation periods.
The numbers in context
936 students, 817 retained. Hookah prevalence: 9% pre-college to 13.1% first month. 13.8% of never-users initiated. Marijuana AOR = 1.30 (1.03-1.65). Alcohol AOR = 1.11 (1.05-1.17). 20% of former hookah users relapsed.
How the study worked
Longitudinal study of 936 incoming students (50% female) at a single university. Participants reported past 30-day substance use before the start of the Fall 2011 semester and again 30 days later (n=817 retained). Substances assessed included hookah, cigarettes, other tobacco, alcohol, marijuana, and other illegal drugs. Adjusted logistic regression identified predictors of hookah initiation.
What this study cannot tell us
Single university limits generalizability. Relatively short follow-up period (30 days). Self-reported substance use may be underreported. The study cannot determine whether marijuana use causally leads to hookah use or whether both reflect a common underlying propensity. The effect sizes were modest.
How to read the evidence
Moderate evidence from a prospective longitudinal study, though the single-university setting and short follow-up limit generalizability.
When this study was published
Published in 2016. College substance use patterns may have shifted with changing cannabis legalization and social norms.
The bigger picture
Substance use patterns cluster together, and the college transition accelerates experimentation. The finding that marijuana predicts hookah initiation (and not the reverse) suggests these substances may share social contexts or that marijuana-using students are more open to trying novel inhalation methods.
Questions still open
- Does the marijuana-hookah relationship persist beyond the first month of college? Is the association driven by shared social contexts (party environments, substance-using peer groups)? Would addressing marijuana use in prevention programs also reduce hookah initiation?
Common questions
Does marijuana use lead to hookah smoking?
Why does substance use increase in college?
Read the original research
Hookah Tobacco Smoking During the Transition to College: Prevalence of Other Substance Use and Predictors of Initiation.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 18(5), 763-9
Citation
Shepardson, Robyn L; Hustad, John T P. (2016). Hookah Tobacco Smoking During the Transition to College: Prevalence of Other Substance Use and Predictors of Initiation.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 18(5), 763-9. https://doi.org/10.1093/ntr/ntv170
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