Graduation Year


Document Type




Degree Granting Department

Community and Family Health

Major Professor

Carol Bryant, Ph.D.

Co-Major Professor

Robert McDermott, Ph.D.

Committee Member

Moya Alfonso, Ph.D., MSPH

Committee Member

Eric Buhi, Ph.D.

Committee Member

David Himmelgreen, Ph.D.


Health, Hookah, Lungs, Shisha, Smoke


Waterpipe tobacco smoking has migrated from being a custom of some cultures to becoming a staple around college campuses. The social nature and flavored tobacco encourage initiation in this tobacco naïve age group.

The study was a sequential mixed method design, employing primary data collection and analysis of a random sample of university students who live on campus at a single university. The study involved observations (N=6), intercept interviews with smokers and nonsmokers (N=63), three focus groups (N=31), and an online survey (N=288).

Findings were centered on the constructs of the Theory of Reasoned Action by Ajzen and Fishbein (1975), who propose there are specific precursors that lead to intention to perform a behavior. The data suggested that attitudes were more positively correlated with intention to smoke waterpipe tobacco than subjective norm. Attitude is influenced by outcome expectancies. The data suggest that positive outcome expectancies are influenced primarily by the social nature of hookah smoking and other perceived positive benefits. Negative health effects and family/culture were also influential, albeit to a lesser extent. Development of interventions focused on an attitudinal shift may help to decrease uptake and continuation of waterpipe tobacco smoking in this population.