Trends and Correlates of Hookah Use among High School Students in North Carolina
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Trends and Correlates of Hookah Use among High School Students in North Carolina

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  • Alternative Title:
    N C Med J
  • Description:

    Although youth cigarette smoking has declined in the United States, use of alternative tobacco products, such as hookah, has increased. This study aims to assess changes in prevalence from 2011 to 2013 and examine factors associated with current hookah use among North Carolina high school students in 2013.


    Data came from the NC Youth Tobacco Survey (NCYTS) in 2011 (n=4,791) and 2013 (n=4,092). STATA logistic regression survey procedures account for the complex survey design and sampling weights.


    Prevalence of reported current hookah use significantly increased from 3.6% (95% CI: 2.8–4.5) in 2011 to 6.1% (95% CI: 4.9–7.5) in 2013 while reported lifetime hookah use increased from 9.8% (95% CI: 8.0–12.0) in 2011 to 12.6% (95% CI: 11.0–14.4) in 2013. Correlates of current hookah use included having a weekly disposable income over $50 (adjusted odds ratio (AOR)=2.05, 95% CI:1.25–3.35), currently smoking cigarettes (AOR=4.57, 95% CI:1.80–11.62), and living with hookah users (AOR=6.45, 95% CI:3.21–12.93). Self-reported positively commenting about or “Liking” tobacco in social media (AOR=1.83, 95% CI:1.84–4.52) and frequent exposure to online tobacco advertisements (AOR=1.61, 95% CI:1.13–2.28) were also associated with current hookah use.


    Comprehensive product-specific communication and policy interventions are needed to educate youth about the dangers of hookah use and reduce social acceptability among youth. To decrease hookah use in NC, policymakers should consider restoring funding for comprehensive tobacco prevention and control programs and equalizing tobacco tax rates for all tobacco product types.

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