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This study compared the harm perception, motivation, and basic psychological needs of adolescent hookah pipe users and non-users. We surveyed 1 201 adolescents aged 13–19 years old from South Africa who were hookah users ( n  = 256) and non-users ( n  = 909). Most participants were female (66.7%) and coloured/mixed race (57.5%), followed by black (37.5%), other (3.8%) and white (1.3%) participants. Independent  t -tests results indicated both users and non-users had similar harm perceptions of smoking the hookah pipe and basic psychological needs. Users reported that they were intrinsically motivated to smoke. Non-users reported that they were intrinsically motivated not to smoke. These findings suggest South African adolescent hookah pipe users to be experimental rather than committed users, which would make them amenable to intervention to quit hookah pipe use.

Adolescent hookah pipe use: Comparing users’ and non-users’ harm perception, needs, and motivation