2. The Emergent Threat of Community College Hookah Waterpipe Use

Abstract

Purpose: To examine prevalence and correlates of waterpipe use among U.S. college students and explore differences between 4-year schools and 2-year community colleges. Methods: Google Scholar with its 'cited by' tool was used to conduct a literature search of U.S. collegiate waterpipe use studies; no studies at community colleges have been published. A fall 2011 crosssectional in-classroom survey (n = 1,207) was undertaken at two demographically diverse (43% Latino, 25% White, 14% Multirace, 9% African American, 4% Asian) community colleges, 1 urban, and 1 suburban, in San Bernardino, Southern California. SPSS 20 was used to run descriptive statistics and univariate logistic regression to identify variables for processing fully adjusted multiple logistic models. Results: From 2004 to 2011, 15 peer-reviewed studies reported on 4-year college student waterpipe use. Lifetime prevalence ranges from 11% to 61% and current 30-day use from 5% to 30%. Common correlates of use are younger age (18-19), male gender, White race, past and concurrent substance use, the belief that the waterpipe is less harmful and addictive than cigarettes, and seeing it as highly socially acceptable. Results from each of the 15 studies are summarized in a table highlighting demographic correlates, tobacco and substance use correlates, and waterpipe beliefs and behaviors. Results from the community college study (n=1,207) found waterpipe use in the higher range of the collegiate literature (55.5%) reported ever using the waterpipe, and more than 1 in 3 (34.1%) used it in the previous year. No gender differences in use were found. More students haveexperimented with the waterpipe than a cigarette; “ever” cigarette use was 48.8%. Current waterpipe use (10.8%) is associated with current alcohol use (AOR = 2.8; p> .001), current cigar use (AOR = 2.5; p> .01), current cigarette use (AOR = 1.8; p> .05), and female binge drinking (AOR = 1.8; p> .05). Compared to African Americans, Whites are 2.9 times (p > .05) more likely to be current users. Students believing waterpipe use very socially acceptable are 21 times (p > .001) more likely to be current users than those who believe it not at all acceptable. No associations were found between smokeless tobacco and illegal drugs and any measure of waterpipe use. While “ever” use of marijuana (56.2%) was correlated with “ever” waterpipe use, current marijuana use (16.8%) was not associated with any waterpipe use. Economic variables such as receipt of financial aid, first generation to attend college, and number of hours worked each week had no bearing on use. Students who spent the least amount of money ($0) per week on entertainment and those who spent more than $21 were more likely to have used the waterpipe than those who spent $0. Conclusions: Our findings raise the possibility that the community college is a high risk environment for waterpipe use, adding a new dimension to this growing trend. Waterpipe health education and cessation programs are needed, as well as more stringent campus and municipal tobacco control measures. Regulations and ordinances must specifically reference the waterpipe and target locales where it is used, served, and sold.