Introduction:
The use of hookah (waterpipe) is increasing rapidly among US adolescents, nearly doubling from 2011-2014. Further information is needed about characteristics of those who use hookahs and how key characteristics associated with use may be changing.

Methods:
Data from the nationally representative 2014 National Youth Tobacco Survey (NYTS), n=22,007, were analyzed to determine adolescents’ characteristics independently associated with use of hookahs, using bivariate and multivariate analyses. Additionally, NYTS 2011-2014 data were analyzed to investigate changes in prevalence of hookah use over time, by sex.

Results:
Among adolescents in 2014, female sex and past 30-day use of cigarettes or e-cigarettes were each independently associated with higher odds of past 30-day use of hookahs (AOR=1.41, 95% CI 1.15-1.72; aOR=4.01, 95% CI 3.19-5.05; AOR=6.85, 95% CI 5.29-8.88, respectively). Hispanic adolescents (AOR=1.91, 95% CI 1.51-2.42) and adolescents who live with someone who uses hookah (AOR=8.56, 95% CI 6.02-12.18) had greater odds of past 30-day use. From 2011 to 2014, use among males and females increased, with a percent change of 87% for males (1.60% to 2.99%) and 175% for females (1.21% to 3.33%).

Conclusions:
These data demonstrate the magnitude of adolescent hookah use, particularly among adolescents who use electronic or traditional cigarettes. Most strikingly, rates of female adolescent use have increased much more rapidly than has male use, and adolescent females are for the first time more likely to smoke hookahs than adolescent males in the US nationwide. These findings urgently call for better understanding of the changing correlates of hookah use, including polytobacco use.