Study: Hookah use may spread among youth in the U.S.

An alternative and harmful form of tobacco use, known as the hookah or water pipe, may be spreading among youth in the United States according to researchers from the University of California, San Diego's Department of Family and Preventive Medicine and San Diego State University. This trend is emerging even as cigarette smoking among high school students is on the decline nationally.

The team of researchers examined patterns of use, risk perception, and psychosocial risk factors among users, former users, and nonusers of hookah at three San Diego high schools. The paper, "Determinants of Hookah Use among High School Students," was published in the April edition of Nicotine and Tobacco Research.

Wael Al-Delaimy, MD, PhD, associate professor and chief of the Division of Global Health in the Department of Family and Preventive Medicine at UCSD School of Medicine is the team's senior author and a research expert in the field of tobacco control. "Our study suggests that hookah smoking is taking hold in some high school-aged students at a rate higher than previously reported, which is rather alarming as an emerging public health problem," said Al-Delaimy. "Our data show that inaccurate perception about hookah harmfulness, its social acceptability, and presence of hookah lounges in residential areas, is driving the higher use among the teens in our study."

More than a quarter of the surveyed students (26.1 percent) reported they have tried hookah, and 10.9percent smoked hookah in the past month, which is comparable to the percentage of high school students in this study population who smoked cigarettes in the past month (11 percent). Furthermore, close to one third of hookah users have no intention of quitting this habit.

"Understanding the hookah habits of teens is important because a person's tobacco use pattern - whether or not, and how often - is usually established by age 18," said Al-Delaimy. "Hookah use is related to diseases, including coronary heart disease, adverse pulmonary effects and cancers of the lung, mouth and bladder. Hookah smoke also contains many of the same carcinogens and heavy metals as cigarette smoke; longer hookah smoking sessions, combined with increased smoke volume, makes it potentially more dangerous than cigarettes."

Joshua Smith, PhD, from Al-Delaimy's laboratory, surveyed 689 students from three high schools within San Diego County and found more than half of the students first learned about hookah from friends (50.3 percent) and another 20.9 percent learned about it when they saw a nearby hookah lounge.

"The concern here is that the students surveyed believed hookah use to be more socially acceptable than cigarettes, and friends seem to be introducing this habit to others. They also believe it is less harmful than cigarettes, cigars, and smokeless tobacco, which has not been reported previously among high school students," said Smith.

Researchers recommend that the legality of hookah lounges in California and other states be addressed, adding that the banning of one product (cigarettes) with the legality of another (hookah) may suggest an element of reduced risk associated.

"Policy makers and the tobacco research community should reassess priorities for this age group and address the growing hookah epidemic through continued research, media messaging, and restrictions on hookah lounges," said Al-Delaimy.