Waterpipe tobacco use in college and non-college young adults in the US Running head: Non-college hookah smoking

Background. Waterpipe tobacco smoking (WTS or “hookah”) is common among adolescents and college students in the United States. However, there has not yet been a large-scale, nationally-representative study independently examining WTS among young adults who are not in college. Objective. This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college. Methods. A total of 3131 US adults ages 18 to 30 completed an online survey about WTS behavior, attitudes, normative beliefs, and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status. Results. Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3% and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college (AOR=2.72; 95% CI, 2.00-3.71 and AOR=2.02; 95% CI, 1.50-2.71, respectively) and young adults in college (AOR=3.37; 95% CI, 2.48-4.58 and AOR=2.05; 95% CI, 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college. Conclusions. Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college.