Background: Hookah (water pipe) smoking is a form of tobacco use, historically from the Middle East and India that is fueling a contemporary epidemic of tobacco abuse and a nationwide public health crisis, particularly among young adults. There is little information on factors influencing hookah smoking and health beliefs of hookah smokers. Objectives: Guided by the health belief model, the purpose of this study was to assess young adult hookah smokers' perceptions, attitudes, beliefs, and preferences toward hookah smoking and identify factors that may influence heavy (>3 times per week) versus light hookah smoking. Methods: A cross-sectional design was used for this study. Participants were recruited at hookah lounges in southern California. A sample of participants who smoke hookah and were between 18 and 30 years of age completed a short survey about their perceptions, attitudes, beliefs, initiation, and frequency of hookah smoking. Characteristics of light and heavy hookah smokers were compared using t tests and chi-square tests. Content analysis was used to analyze qualitative data. Results: Participants (N = 91) had a mean age of 24 (SD = 2.7), and 65% were men; 24% reported smoking before the age of 18, and 73.6% of participants smoked more than once a week. Men were heavier smokers in comparison to women (p = .006), 57% believed that hookah was not harmful to their health, and 60% reported socialization as the main reason why they smoked hookah. Discussion: It is critical to advocate for greater research on the health effects of hookah smoking and dissemination of these findings to the public, particularly to young adults.
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