Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study.

The increasing trend of hookah use in the United States (US) has become a growing public health concern. Recent studies have reported that many believe hookah smoking is less addicting than cigarettes,1–3 less harmful than cigarettes,2–5 and more socially acceptable or “cooler” than other tobacco products.1–3 Whereas these studies provide insight into the cognitions of young adults regarding hookah use, they only address a small domain of hookah use. Although hookah smoking is associated with cigarette smoking, 3,6–13 there are aspects of hookah smoking, such as its social components, that are particularly important and appealing to young adults. For instance, when examining motivational factors for smoking hookah, one previous study found that 29% of hookah smokers identified partying/socializing and 25% of hookah smokers identified relaxation as motivating factors for smoking hookah.14 Similar studies have reported that hookah users view hookah smoking as a way to socialize with friends15 and that many college students view hookah as attractive and socially acceptable.1 Other appeals and behaviors associated with hookah smoking need further investigation. Alcohol use may play a role in hookah use among young adults. Given that many young adults drink alcohol,16–19 research that establishes a positive association between hookah and alcohol use may indicate that many young adult drinkers could be at risk for hookah use. These associations have been found between other tobacco products and alcohol. College students smoke more cigarettes when they are in social environments and when drinking alcohol.20 The limited research on hookah and alcohol use indicates that many young adult hookah users also engage in alcohol use.14,15,21 Those who drink alcohol are more likely to be hookah smokers compared to non-drinkers12,22,23 and many hookah smokers drink alcohol and attend traditional bars in the same evenings and nights they also attend hookah bars.24 However, these studies do not attempt to describe the experience of drinking alcohol before, during, or after smoking hookah. With early research indicating hookah and alcohol use may be associated similarly compared to other tobacco use and alcohol use, it is important to understand the nature of how hookah and alcohol use fit together. To gain a greater understanding of how and why young adults engage in hookah and alcohol use, focus groups that included a survey component were conducted with young adult hookah smokers to examine the attitudes, beliefs, and behaviors concerning hookah and alcohol use.