Results from this survey of 744 undergraduates indicate that past 30-day waterpipe tobacco smoking was 20%. Given previous reports (2
), waterpipe tobacco smoking seems common on U.S. college campuses and the potential health risks of this behavior (5
) suggest that it and may become a significant public health problem. Results also indicate that past 30-day waterpipe users were much less likely than never-users to believe that waterpipe is as harmful as cigarettes. These perceptions of lower risk may contribute to the spread of waterpipe tobacco smoking in the U.S.
We also observed that, relative to respondents who had never smoked tobacco using a waterpipe, past 30-day waterpipe tobacco smokers were more likely to be men, younger than 20 years of age, and White. While the influence of sex and race is uncertain, the popularity of waterpipe use among younger students may be related to the fact that these individuals cannot access bars where alcohol is served, and may instead socialize in alcohol-free waterpipe cafes.
Waterpipe tobacco smokers in this sample also reported using other tobacco products (see ). Concurrent use of other tobacco products may contribute to development of nicotine/tobacco dependence, which can then maintain tobacco use via a variety of mechanisms (10
). In addition, concurrent use of other tobacco products can make the study of long-term health effects of waterpipe tobacco smoking challenging. Controlling for other tobacco products will be essential if we are to learn the influence of waterpipe tobacco smoking on cancer, cardiovascular disease, and lung disease.
These results, from a convenience sample taken from a single university in one U.S. state, along with other reports from other states (2
) should be a clarion call to the U.S. public health and medical communities. An appropriate response could include nationwide surveillance that can be used to identify the extent of waterpipe’s spread and gauge the effectiveness of interventions designed to reduce it. Future studies in the U.S. should assess prevalence of waterpipe in nationally representative samples, potential health-damaging and dependence-producing effects, and whether waterpipe use among youth serves as a “gateway” for use of other tobacco products or psychoactive substances.