Document Type
Dissertation
Date of Degree
10-2025
Primary Advisor
Paige McDonald
Keywords
Hookah smoking; Young Adults; Mixed Methods; Health Communication
Abstract
Background: One tobacco trend of the 21 st century is smoking hookah or waterpipes. Hookah smoking is thriving on a false widespread belief that it is a safe alternate to smoking cigarettes when in fact it has adverse effects on health and is not safer. Hookah use has especially become popular for young adults and college students.
Study Objectives: The purpose of this study is to generate knowledge to inform university administration (health education personnel and campus policy makers) on what the psychosocial profile of a hookah smoker is, including risk factors, and how they can use messaging to reduce hookah smoking during college years and beyond.
Methods: The study followed a mixed methods convergent design. For the quantitative arm, data from the Population Assessment of Tobacco and Health (PATH) Study was subset to 18-24 year olds (N=1,459) and used to examine the potential predictors of hookah smoking for non-users and frequency. The primary outcome for the study, hookah smoking frequency, was examined across three different levels – specifically, daily/weekly, monthly, and every couple of months. For the qualitative arm, literature was used to explore hookah smoking in focus groups with undergraduate students (N=13). Data from the quantitative and qualitative arms were triangulated through the creation of a Venn diagram that shows the connections between results. Recommendations were generated for university administration on communication strategies to supplement tobacco control policies.
Results: Degree enrollment was a significant predictor of hookah smoking among ever users. For reasons for smoking hookah, two significant factors were predictive of smoking hookah daily/weekly when compared to monthly smokers: enrollment and smoking because of the different flavors. When daily/weekly smokers were compared to those smoking every couple of months, income and education were significant factors. Comparing enrolled to not enrolled, significant factors predictive of hookah smoking included gender, income, education, other tobacco product use, alcohol use, usually smoke at home, usually smoke at a hookah bar, addiction to tobacco products, strong cravings to smoke, belief on harmfulness to one’s own health and others, satisfaction with social activities, and self-perception of physical health/overall health/quality of life.
According to qualitative findings, the main factors influencing decisions to smoke are culture, family, level of knowledge, social interactions, ease of access, and lack of alternatives for other activities. Mixed methods results show that messaging needs to increase level of knowledge; give alternatives; come from people of influence; and be conveyed through social media, TV, and radio.
Conclusions: Based on the findings of this study, recommendations can be made to university personal on health communication strategies. Universities should raise awareness on factors outside the university influencing hookah smoking, share lists of alternative activities that give a similar experience, start a knowledge campaign to increase understanding of health effects, and utilize social media in their messaging. By implementing the recommendations, universities can help decrease the popularity of hookah smoking and ultimately provide a safer environment for the student body.
Recommended Citation
Mir, Rabia, "Understanding Strategies to Translate Knowledge on Hookah Smoking: A Mixed Methods Study" (2025). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 44.
https://hsrc.himmelfarb.gwu.edu/smhs_crl_dissertations/44
Open Access
1
Comments
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