Reasons for Young Adult Waterpipe Use in Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health Study

Waterpipe use is common among U.S. young adults (aged 18–24 years), with estimates considerably higher than other age groups. Although studies have examined attitudes and beliefs associated with waterpipe use, no study has examined reasons for use in a nationally representative sample. Using latent class analyses, this study examined subgroups based on self-reported reasons for use of past 30-day young adult (aged 18–24 years) waterpipe users (n=1,198) from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health Study. Data analyses were conducted in 2017. Covariates included sociodemographic characteristics, substance use, and internalizing and externalizing problems. A three-class model was identified: Class 1 (socializing and flavors, 57%), Class 2 (many reasons [flavors, socializing, less harmful than cigarettes, and affordability], 20%), and Class 3 (socializing, 23%). Class 3 was considered the referent group. Compared with non-Hispanic whites, non-Hispanic blacks were less likely to belong to Class 1, whereas Hispanics were more likely to belong to Class 2. Compared with less than high school education, greater than high school education was associated with membership in Class 1; however, high school graduation was associated with membership in Class 2. Past-year alcohol users compared with non-users were less likely to belong to Class 2. Past 30-day poly-tobacco users compared with non-users were more likely to belong to Class 2. This study revealed distinct classes of waterpipe users based on self-reported reasons for use. Findings inform targeted policies for waterpipe tobacco control as part of public health efforts to mitigate harms associated with tobacco use.