American Academy of Pediatrics

TABLE 2

Multinomial Logistic Regression Analyses of Factors Associated With Frequency of Hookah Smoking Among US Middle and High School Students, NYTS, 2016 (n = 20 675)

Characteristic	Former Versus Never,^a aOR (95% CI)	Occasional Current Versus Never,^a aOR (95% CI)	Frequent Current Versus Never,^a aOR (95% CI)
Overestimation of peer hookah use^b
No (referent)
Yes	3.41 (3.39–3.43)^*	9.30 (9.18–9.42)^*	6.54 (6.42–6.66)^*
Indeterminate	3.44 (3.40–3.49)^*	7.55 (7.38–7.73)^*	7.74 (7.50–7.99)^*
Tobacco use by household member
None (referent)
Hookah (alone or with other products)	3.29 (3.26–3.32)^*	7.81 (7.73–7.89)^*	20.56 (20.27–20.86)^*
Nonhookah only^c	1.58 (1.57–1.58)^*	1.09 (1.09–1.10)^*	1.54 (1.52–1.56)^*
Sex
Male (referent)
Female	1.12 (1.12–1.13)^*	1.54 (1.53–1.55)^*	0.65 (0.65–0.66)^*
Indeterminate	1.13 (1.10–1.16)^*	0.46 (0.44–0.48)^*	1.41 (1.35–1.46)^*
School
Middle (referent)
High	2.66 (2.64–2.67)^*	1.61 (1.60–1.62)^*	1.25 (1.24–1.27)^*
Indeterminate	1.99 (1.93–2.04)^*	1.02 (0.97–1.07)	4.59 (4.40–4.78)^*
Race and/or ethnicity
White, non-Hispanic (referent)
African American, non-Hispanic	1.01 (1.00–1.01)	1.49 (1.48–1.51)^*	1.39 (1.37–1.41)^*
Asian American, non-Hispanic	0.76 (0.75–0.77)^*	0.47 (0.46–0.48)^*	0.73 (0.70–0.76)^*
Hispanic	1.46 (1.46–1.47)^*	1.67 (1.66–1.69)^*	2.15 (2.12–2.17)^*
Other, non-Hispanic	1.23 (1.22–1.24)^*	1.25 (1.24–1.27)^*	2.07 (2.03–2.10)^*
Indeterminate	1.03 (1.02–1.04)^*	1.77 (1.75–1.80)^*	0.66 (0.64–0.68)^*
Do you speak a language other than English at home?
No (referent)
Yes	1.36 (1.35–1.36)^*	1.68 (1.67–1.69)^*	2.17 (2.15–2.19)^*
Indeterminate	1.52 (1.50–1.54)^*	1.69 (1.65–1.72)^*	1.26 (1.22–1.29)^*
Perceived harm of hookah
No and/or little harm (referent)
Some and/or a lot of harm	0.33 (0.33–0.33)^*	0.21 (0.21–0.22)^*	0.15 (0.15–0.16)^*
Indeterminate	0.31 (0.31–0.31)^*	0.21 (0.21–0.21)^*	0.51 (0.50–0.52)^*
Cigarette smoking status (past 30 d)^d
Noncurrent and/or never smoking (referent)
Nonmenthol cigarette	2.51 (2.49–2.52)^*	4.52 (4.48–4.56)^*	9.84 (9.71–9.98)^*
Menthol cigarette	2.95 (2.92–2.97)^*	6.20 (6.14–6.25)^*	19.94 (19.69–20.20)^*
Indeterminate	2.20 (2.17–2.22)^*	3.88 (3.83–3.93)^*	15.18 (14.95–15.40)^*
Other tobacco product use status (past 30 d)^e
Noncurrent and/or never use (referent)
Nonflavored and/or menthol	4.45 (4.43–4.48)^*	10.20 (10.11–10.28)^*	15.26 (14.99–15.54)^*
Flavored	4.43 (4.41–4.45)^*	14.83 (14.72–14.94)^*	17.59 (17.30–17.89)^*
Indeterminate	2.85 (2.83–2.87)^*	8.52 (8.42–8.61)^*	27.33 (26.83–27.84)^*

Characteristic	Former Versus Never,^a aOR (95% CI)	Occasional Current Versus Never,^a aOR (95% CI)	Frequent Current Versus Never,^a aOR (95% CI)
Overestimation of peer hookah use^b
No (referent)
Yes	3.41 (3.39–3.43)^*	9.30 (9.18–9.42)^*	6.54 (6.42–6.66)^*
Indeterminate	3.44 (3.40–3.49)^*	7.55 (7.38–7.73)^*	7.74 (7.50–7.99)^*
Tobacco use by household member
None (referent)
Hookah (alone or with other products)	3.29 (3.26–3.32)^*	7.81 (7.73–7.89)^*	20.56 (20.27–20.86)^*
Nonhookah only^c	1.58 (1.57–1.58)^*	1.09 (1.09–1.10)^*	1.54 (1.52–1.56)^*
Sex
Male (referent)
Female	1.12 (1.12–1.13)^*	1.54 (1.53–1.55)^*	0.65 (0.65–0.66)^*
Indeterminate	1.13 (1.10–1.16)^*	0.46 (0.44–0.48)^*	1.41 (1.35–1.46)^*
School
Middle (referent)
High	2.66 (2.64–2.67)^*	1.61 (1.60–1.62)^*	1.25 (1.24–1.27)^*
Indeterminate	1.99 (1.93–2.04)^*	1.02 (0.97–1.07)	4.59 (4.40–4.78)^*
Race and/or ethnicity
White, non-Hispanic (referent)
African American, non-Hispanic	1.01 (1.00–1.01)	1.49 (1.48–1.51)^*	1.39 (1.37–1.41)^*
Asian American, non-Hispanic	0.76 (0.75–0.77)^*	0.47 (0.46–0.48)^*	0.73 (0.70–0.76)^*
Hispanic	1.46 (1.46–1.47)^*	1.67 (1.66–1.69)^*	2.15 (2.12–2.17)^*
Other, non-Hispanic	1.23 (1.22–1.24)^*	1.25 (1.24–1.27)^*	2.07 (2.03–2.10)^*
Indeterminate	1.03 (1.02–1.04)^*	1.77 (1.75–1.80)^*	0.66 (0.64–0.68)^*
Do you speak a language other than English at home?
No (referent)
Yes	1.36 (1.35–1.36)^*	1.68 (1.67–1.69)^*	2.17 (2.15–2.19)^*
Indeterminate	1.52 (1.50–1.54)^*	1.69 (1.65–1.72)^*	1.26 (1.22–1.29)^*
Perceived harm of hookah
No and/or little harm (referent)
Some and/or a lot of harm	0.33 (0.33–0.33)^*	0.21 (0.21–0.22)^*	0.15 (0.15–0.16)^*
Indeterminate	0.31 (0.31–0.31)^*	0.21 (0.21–0.21)^*	0.51 (0.50–0.52)^*
Cigarette smoking status (past 30 d)^d
Noncurrent and/or never smoking (referent)
Nonmenthol cigarette	2.51 (2.49–2.52)^*	4.52 (4.48–4.56)^*	9.84 (9.71–9.98)^*
Menthol cigarette	2.95 (2.92–2.97)^*	6.20 (6.14–6.25)^*	19.94 (19.69–20.20)^*
Indeterminate	2.20 (2.17–2.22)^*	3.88 (3.83–3.93)^*	15.18 (14.95–15.40)^*
Other tobacco product use status (past 30 d)^e
Noncurrent and/or never use (referent)
Nonflavored and/or menthol	4.45 (4.43–4.48)^*	10.20 (10.11–10.28)^*	15.26 (14.99–15.54)^*
Flavored	4.43 (4.41–4.45)^*	14.83 (14.72–14.94)^*	17.59 (17.30–17.89)^*
Indeterminate	2.85 (2.83–2.87)^*	8.52 (8.42–8.61)^*	27.33 (26.83–27.84)^*

Multinomial logistic regression analyses were controlled for all factors listed. Hookah smoking frequency was classified as never smoker (not even 1 or 2 puffs; n = 17 562), former smoker (last smoked hookah >30 d ago; n = 1395), current occasional smoker (smoked hookah on less than one-third of the past 30 d [1–9 d]; n = 564), and current frequent smoker (smoked hookah on greater than or equal to one-third of the past 30 d [10–30 d]; n = 199). Indeterminate responses include missing or “not sure” responses. CI, confidence interval.

Never hookah smokers were the reference category within the multinomial logistic regression analyses.

Respondents were asked how many students in their grade they thought used hookah out of 10 (perceived prevalence). A difference score (δ) was computed to measure the gap between perceived prevalence and grade-specific actual prevalence. Respondents were then dichotomized as either overestimating (δ >0) or not overestimating (δ ≤0) peer hookah use.

Assessed nonhookah product use by household members included e-cigarettes, cigarettes, bidis, cigars, pipes, and smokeless tobacco.

Menthol cigarette smoking was a report of smoking mentholated cigarettes or predominantly menthol brands (Newport and/or Kool).

Assessed other noncigarette tobacco products included e-cigarettes, bidis, cigars, pipes, roll-your-own tobacco, and smokeless tobacco Flavored noncigarette tobacco products were those that tasted like “menthol (mint), alcohol (wine, cognac), candy, fruit, chocolate, or other sweets.”

P < .05.

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