Characteristics of U.S. waterpipe users: a preliminary report.

Waterpipe smoking, a traditional method of tobacco use, has experienced a resurgence in the Middle East and Indian subcontinent in recent years. Despite growing evidence of its dependence potential and health-damaging effects, waterpipe use has spread beyond these regions to many other countries, including the United States. Because little is known about waterpipe use in the United States, we surveyed convenience samples of users from two U.S. cities, Richmond, Virginia (n = 109), and Memphis, Tennessee (n = 34). Respondents in both cities were primarily young adults, a majority (75%) were men, and most were college students or had a college degree. Initial and current use usually occurred in a social context, with a group of friends in a cafe or restaurant or at home. Most respondents had smoked waterpipe for 2 or fewer years, and 67% currently smoked at least once a month (22% smoked at least once per week and 10% smoked daily). Most believed waterpipe use to be less addictive and harmful than cigarette smoking, believed they could quit use at any time, but had no plans or desire to quit. A majority of respondents used other tobacco products such as cigarettes, and 35% of those who did not smoke cigarettes said they would "probably" or "definitely" smoke one in the next year. Multivariate correlates of greater frequency of use included younger age at first use, ownership of a waterpipe, use occurring primarily with groups of friends, and the perception of being "hooked." Waterpipe users in these two convenience samples from the United States were young and educated, tended to experiment with multiple forms of tobacco, were unaware of the potentially harmful and addictive properties of waterpipe use, and planned to continue use in the future. Educational efforts are needed to increase awareness of the potential hazards of this increasingly popular form of tobacco use.