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Longitudinal pathways of exclusive and polytobacco hookah use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
  1. Eva Sharma1,
  2. Maansi Bansal-Travers2,
  3. Kathryn C Edwards1,
  4. Michael J Halenar1,
  5. Kristie A Taylor1,
  6. Karin A Kasza2,
  7. Hannah Day3,
  8. Hoda T Hammad3,
  9. Gabriella Anic3,
  10. Jean Limpert3,
  11. Lisa D Gardner3,
  12. Nicolette Borek3,
  13. Heather L Kimmel4,
  14. Wilson M Compton4,
  15. Andrew Hyland2,
  16. Cassandra A Stanton1,5
  1. 1 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
  2. 2 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
  3. 3 Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
  4. 4 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
  5. 5 Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
  1. Correspondence to Dr Eva Sharma, Behavioral Health and Health Policy, Westat, Rockville, MD 20850, USA; EvaSharma{at}


Objective The goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older).

Design Data were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results Young adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes.

Conclusions Hookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.

  • surveillance and monitoring
  • non-cigarette tobacco products
  • prevention
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  • Contributors ES and CAS led the conceptual design. ES drafted the initial manuscript and all authors critically revised it. ES and MJH conducted the statistical analysis and all authors contributed to interpretation of results. All authors approved the work for journal publication and agree to be accountable for all aspects of the work.

  • Funding This manuscript is supported with federal funds from the National Institute on Drug Abuse, National Institutes of Health, and the Center for Tobacco Products, Food and Drug Administration, Department of Health and Human Services, under a contract to Westat (contract number HHSN271201100027C).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Department of Health and Human Services or any of its affiliated institutions or agencies.

  • Competing interests WMC reports long-term stock holdings in General Electric Company, 3M Company, and Pfizer Incorporated, unrelated to this manuscript. No financial disclosures were reported by the other authors of this paper.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted by Westat and approved by the Westat Institutional Review Board. All participants aged 18 and older provided informed consent, with youth participants aged 12–17 providing assent while their parent/legal guardian provided consent.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data from the PATH Study Wave 1 to Wave 3 are available for download as Public Use Files through a public, open access repository ( Conditions of use are available at the website above.

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