The interplay of perceived stress, anxiety, and depression in susceptibility to hookah tobacco smoking among young adults.

Tobacco use remains the leading cause of preventable death in the U.S., with hookah smoking particularly popular among young adults. While stress, anxiety, and depression may influence susceptibility to HTS, their role in predicting this risk has not been extensively studied, despite their potential as triggers for smoking. This study explores the impact of perceived stress, anxiety, and depression on susceptibility to HTS among individuals who have never smoked.Two web-based pilot studies were conducted (April 2021 - October 2023) with young adults aged 18-32. Study 1 focused exclusively on those who have never smoked hookah, while Study 2 included both those who currently smoke and those who have never smoked hookah. Participants, recruited via an online platform, completed surveys assessing demographics, perceived stress, susceptibility to HTS, anxiety, and depression.In Study 1 (N = 117), susceptible individuals reported significantly higher perceived stress (M = 23.87) compared to non-susceptible peers (M = 20.21, p = 0.0038). Logistic regression confirmed perceived stress as a significant predictor of susceptibility. Study 2 (N = 216) revealed strong correlations among perceived stress, anxiety, and depression, but no individual predictors reached statistical significance in the multivariable context.This study identifies perceived stress as a correlate of HTS susceptibility among young adults. Stress, anxiety, and depression are interconnected in ways that require further investigation to understand how they collectively influence tobacco use behaviors.

Duke Scholars

Author Wei Pan School of Nursing

Author Isaac Marcelo Lipkus School of Nursing

Author Devon Noonan School of Nursing