• Mary Rezk-Hanna, Joy Toyama, Ebahi Ikharo, Mary-Lynn Brecht, and Neal L Benowitz.
• School of Nursing, University of California, Los Angeles, Los Angeles, California; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: mrezk@ucla.edu.
• Am J Prev Med. 2019 Nov 1; 57 (5): e163-e173.

IntroductionENDS are evolving quickly with increasing use in the U.S. More recently, e-hookahs have been introduced as healthier alternatives to the traditional hookah-flavored tobacco smoking. To date, virtually all studies of ENDS have focused on e-cigarettes; consequently, little is known about e-hookah use.MethodsData were drawn from the 2014-2015 Wave 2 Population Assessment of Tobacco and Health study, a nationally representative sample of adults aged ≥18 years (n=28,362) and youth aged 12-17 years (n=12,172). Weighted analyses, conducted in 2018-2019, estimated the prevalence of e-hookah versus e-cigarette and examined comparisons among users and sociodemographics, patterns of use, and co-use of tobacco products and substances.ResultsOverall, 4.6% of adults reported ever e-hookah use; of these, more than a quarter (26.8%) reported current use. For e-cigarettes, 22.5% reported ever use with 24.8% reporting current use. Among youth, 7.7% reported ever e-hookah use versus 14.3% for e-cigarette use. Comparing e-hookah versus e-cigarette only users, the majority were young adults aged 18-24 years versus ≥25 years (60.5% vs 17.3%, p<0.0001) with the majority being female (58.8% vs 46.0%, p<0.0001). Although alcohol and marijuana were the most common substances used among e-hookah and e-cigarette users, both adult and youth e-hookah only users had a higher prevalence of use than e-cigarette only users.ConclusionsAlthough e-hookahs are used less commonly than e-cigarettes, e-hookah use is not rare. Compared with e-cigarette users, e-hookah users have a different profile in terms of user demographics and co-use of substances. Given the rapid uptake of ENDS by young adults, these findings suggest the need to understand e-hookah products' distinct characteristics and users' smoking patterns and behaviors to help inform tobacco regulation specific to hookah.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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