Preferences and Perceptions of Flavored Hookah Tobacco among US Women

We assessed preferences, perceptions, and intentions to use flavored waterpipe (hookah) tobacco (HT) among women of reproductive age in the United States.

A convenience sample of women 18-44 years of age (N = 238; mean age = 28; 74% white) were recruited via Amazon Mechanical Turk to complete a survey assessing preferences, perceptions, and intentions to use flavored HT.

Of the women who had ever used hookah (62%), most (82%) used hookah sweetened with fruit flavors. Preferences for hookah flavors were statistically different between flavors such that women overall preferred sweet flavors (fruits, candy or other sweets, chocolate) versus other flavors (menthol/mint, clove/spice, alcohol, other beverages, tobacco/unflavored). Perceptions of general or pregnancy-related harmfulness did not differ between flavors. Sweet flavors (fruits, candy or other sweets, chocolate) were perceived to be less harsh than tobacco/unflavored hookah among women who had ever used hookah. Flavor preferences (but not perceptions of harmfulness or harshness) predicted intentions to use flavored HT in the future.

Sweet flavored tobacco is preferred and used by reproductive-age women. Prohibiting flavorings in HT will likely lessen the appeal of smoking hookah to protect the health of women and children.