Pre-College Marijuana Use Predicted Starting Hookah Smoking in the First Month of College
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 13.8% of hookah-naive students initiated hookah in the first month of college, predicted by prior marijuana use (AOR = 1.30).
- Evidence Grade:
- Moderate evidence from a prospective longitudinal study, though the single-university setting and short follow-up limit generalizability.
- Study Age:
- Published in 2016. College substance use patterns may have shifted with changing cannabis legalization and social norms.
- Original Title:
- Hookah Tobacco Smoking During the Transition to College: Prevalence of Other Substance Use and Predictors of Initiation.
- Published In:
- Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 18(5), 763-9 (2016)
- Authors:
- Shepardson, Robyn L, Hustad, John T P
- Database ID:
- RTHC-01265
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does marijuana use lead to hookah smoking?
This study found that pre-college marijuana use predicted starting hookah in the first month of college. However, this does not prove causation. It may be that marijuana-using students are more open to trying new substances or move in social circles where hookah is available.
Why does substance use increase in college?
The transition to college involves reduced parental oversight, new social environments, and peer pressure. This study found hookah prevalence jumped from 9% to 13.1% in just the first 30 days, highlighting how quickly substance use patterns can change during transitions.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-01265APA
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
MLA
Shepardson, Robyn L, et al. "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, 2016. https://doi.org/10.1093/ntr/ntv170
RethinkTHC
RethinkTHC Research Database. "Hookah Tobacco Smoking During the Transition to College: Pre..." RTHC-01265. Retrieved from https://rethinkthc.com/research/shepardson-2016-hookah-tobacco-smoking-during
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.