Intention to smoke tobacco using a waterpipe among students in a southeastern U.S. College

Guided by the Theory of Reasoned Action, this study examined the association of behavioral beliefs, attitudes, normative beliefs, and subjective norms with waterpipe tobacco smoking intention in college students.

A cross-sectional design was used. A Web-based survey was sent to a random sample of 1,000 undergraduate students from a public institution in the southeast to recruit participants.

The Theory of Reasoned Action Waterpipe Questionnaire, a modified version of the Fishbein-Ajzen-Hanson Questionnaire, was used to capture modal constructs of the Theory of Reasoned Action related to waterpipe use. Cronbach's α coefficients for the scales of the Theory of Reasoned Action Waterpipe Questionnaire ranged from .76 to .95.

Of the sample (n=223), 13.5% currently smoked a waterpipe and 61% had ever done so. Using multiple regression, attitudes, behavioral beliefs, and subjective norms were associated with intention to smoke a waterpipe in the next 3 months and collectively explained 35% of the variance in intention. The full model, which included all the constructs of the Theory of Reasoned Action, demographic variables, and tobacco use variables, explained 83% of the variance in intention to smoke a waterpipe in the next 3 months.

This study provides valuable information that may be used to target students at risk for waterpipe smoking and serves as a starting point in developing theoretically driven interventions to prevent waterpipe smoking.