Waterpipe smoking among American military recruits

Waterpipe smoking, a traditional Middle Eastern tobacco use method, has increased dramatically among Arab adolescents and young adults. Anecdotal evidence also suggests that usage is on the rise among young people in the U.S., but epidemiological data are lacking.

From self-report health surveys collected during 1999-2002, we examined the prevalence and predictors of waterpipe use among U.S. Air Force recruits (n = 20,673; mean age = 20.0 years; range = 17-35).

Waterpipe use was reported by 0.3% (n = 59) of recruits and was unrelated to age, gender, ethnicity, or family income. Compared to non-users, waterpipe users were more likely to plan to smoke cigarettes in the coming year (P value < 0.05) and to believe that switching from cigarettes to other tobacco products reduces smoking-related health risks (P values < 0.002). Multivariate (logistic regression) analyses revealed several factors that distinguished waterpipe users from non-users, including higher education level (odds ratio [OR] = 1.94), having experimented with cigarettes before Basic Military Training (BMT; OR = 1.99), and using cigarettes (OR = 2.17) and other tobacco products (OR = 13.81) at the time of entry into BMT. Compared to recruits who used cigarettes only, waterpipe smokers were more educated (OR = 1.83), more likely to have engaged in experimental (OR = 3.30) or regular (OR = 3.87) use of tobacco products other than cigarettes prior to BMT, and less likely to have been a current (OR = 0.10) or former (OR = 0.11) smoker at the time of entry into BMT.

Despite concerns that waterpipe smoking is increasing among young people in the U.S., use was low among military recruits.