Background:
Existing research regarding hookah use among young adults highlights the influences of perceptions of harm, social factors, and the draw of product design and marketing. However, limited research has quantitatively examined who is most likely to initiate or sustain hookah use, the characteristics of hookah use among users, or the range of potential reasons for hookah use or discontinued use. This study addresses these gaps by assessing:
1) differences in sociodemographics and other substance use among current, never, and former hookah users;
2) use characteristics among current users (e.g., types of devices/flavors used, quit intentions); and
3) reasons for use, potential use, and discontinued use among young adult current, never, and former hookah users.

Methods:
We analyzed data from a cohort study of students aged 18-25 recruited from seven United States colleges/universities.

Results:
Of 2,865 participants, 56.3% were never users, 12.4% current (past 4-month), and 31.3% former. Correlates of being a current (vs. never) hookah user included being “other race” (vs. White), attending an HBCU (vs. a technical college), and use of any other tobacco product, marijuana, or alcohol. Correlates of being a former (vs. never) hookah user included being older, being “other race” (vs. White), attending an HBCU (vs. a technical college), and use of any other tobacco product (except cigars), marijuana, or alcohol. Among current users, 73.7% reported no intention to quit; only 26.2% reported attempting to quit in the past 12 months. Two factors regarding current hookah use included:
1) instrumentality (e.g., flavors); and
2) social reasons. One factor emerged regarding potential use among never users, reflecting influences related to social factors and flavors. Three factors regarding discontinued use included:
1) inconvenience (e.g., messy/expensive);
2) anti-tobacco attitude (e.g., unhealthy); and
3) social reasons.

Conclusions:
These results may inform policy and interventions to address hookah use in young adults.