The primary goal of this study was to characterize the role of demographic and psychosocial factors that influence waterpipe use among college students. Data were gathered in two stages that incorporated mixed methods. A series of 59 in-depth interviews were conducted with college students who were established waterpipe smokers. Participants identified socializing as the main reason to smoke waterpipe. Other reasons included social acceptance of waterpipes compared to cigarettes, peer influence, relaxation, perception of looking "cool" and physiological effects commonly referred to as "buzz." Perceptions that smoking waterpipe was safer and less addictive than smoking cigarettes were fairly common.

The second stage involved a cross sectional survey (n=378), conducted among college students. The goal of the survey was to examine the association between demographic factors, background variables (involvement in Greek organizations, participation in athletics, and living arrangements), and psychosocial factors (perceived risks, resistance self efficacy, peer influence) in relation to waterpipe use among college students. Ever use of waterpipe smoking was reported by 59%. Students who had ever smoked cigarettes or cigars and had a best friend who smoked waterpipes were more likely to ever smoke waterpipe. Also, college students with high levels of resistance self-efficacy were less likely to ever smoke waterpipe.

The secondary aim of the study was to develop an instrument that measured the social contexts of smoking waterpipe among college students. A pool of 50 items was administered to a purposive sample of college students (n=274), who were regular waterpipe users. Three factors emerged that accounted for a cumulative variance of 47% and possessed adequate reliability. These factors were labeled "social facilitation", "family/cultural influence", and "alternatives to cigarettes." The summed scores for the three social context subscales were examined across frequencies of waterpipe use. Those who reported smoking waterpipe at least on weekly basis reported significantly higher scores on social facilitation than the other two groups. Similar effects were observed for family/cultural influence; weekly smokers used waterpipe more frequently in a context of family/cultural influence than occasional smokers.

Understanding patterns of correlates of waterpipe use among college students is critical in developing interventions.