Hookah and Electronic Inhalant Device Use and Perceptions among African American Youth and Young Adults: Are We Asking the Right Questions?

Objectives: Survey items used in surveillance systems to assess the use of emerging products like hookah and electronic inhalant devices (EIDs) may not match definitions used by high-risk populations. This qualitative study explored how African American youth and young adults (YYAs) (1) use hookah and EIDs and (2) identify patterns in the ways they describe and organize these products. Design: Individual in-person interviews were conducted among a sample of continuation high school and vocational school students in southern California. Participation was limited to those who had ever tried at least one tobacco product, self-identified as African American, and were between the ages of 14 and 26 years (n = 28). We conducted a content analysis to identify patterns in perceptions and use of these products. Results: African American YYAs recognized and described traditional hookah based on physical attributes, but for EIDs, including e-cigarettes, e-hookah, and vape pens, YYAs focused on reasons for using the product. Three primary categories emerged for reasons YYA used specific products: nicotine content and quitting, social facilitation, and use with marijuana. E-cigarettes were identified as quitting aids and as having nicotine but were not considered addictive. The term "hookah" recalled both the traditional and electronic pen-type products for YYAs. The terms vapes, "hookah," wax pens, and others are used in the context of describing product use with marijuana. Conclusions: A better understanding of why African American YYAs use these products is needed to develop better measures for accurate rates of use, uncover differences in use between product types, and to develop effective prevention messaging.