This study examined correlates of hookah use and predictors of hookah trial at a six-month follow-up in a nationally representative, prospective sample of U.S. young adults. Data were drawn from a subset of participants, aged 18-24 years, at study entry from two waves of the Legacy Young Adult Cohort Study. Wave 5 was completed in July 2013 by 1,555 participants and 74 percent (n=1,150) completed follow-up six months later in January 2014. At baseline (Wave 5), almost 25 percent of the sample had ever used hookah and four percent reported past 30-day use. Eight percent of never users at baseline reported trying hookah six months later. Alcohol, marijuana, and cigarette use were more prevalent among ever and past 30-day hookah users than among never users. Significant predictors of hookah trial included college enrollment; alcohol, marijuana, and cigarette use; and perceptions that hookah is less harmful than cigarettes. Results highlight rapid transitions in hookah use and several risk factors for hookah experimentation.


  • 50%

    50% of young adults who have ever used hookah believe that smoking hookah is less harmful than cigarette smoking.

  • 84%

    84% of individuals who tried hookah for the first time reported some alcohol use at baseline.

  • 65%

    65% of people who tried hookah for the first time were currently enrolled in college.

  • 33%

    33% of people who tried hookah for the first time were past 30-day cigarette users at baseline.