Concurrent Hookah (Waterpipe) and Substance Use among Sexual Minority Adults in the United States: Findings from the Population Assessment of Tobacco and Health Study

Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p < 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.