New research highlights growing epidemic of hookah use among young adults in the U.S.

Dr. Michael Weitzman and his co-authors from New York University's College of Global Public Health and The Departments of Pediatrics and Population Health of the New York University School of Medicine have published important new research on the growing epidemic of hookah use among America's youth and young adults. As reported in the journal Nicotine & Tobacco Research, the study found that current waterpipe use has doubled among US adults in a very short time span.

Based on the recently released National Adult Tobacco Survey (NATS) 2012-2013, Dr. Weitzman and his team mapped and calculated hookah use according to state-specific prevalence over participants' lifetime as well as current use. The results were both surprising and alarming -- twelve percent of Americans have smoked hookah during their lifetime.

"We believe that our research adds to the understanding of the geographic and socio-demographic factors underlying hookah use," said Weitzman, building on past research, demonstrating significant changes in rates of hookah smokers over a very short time period of only a few years. The prevalence of young adults (ages 18-24 years) currently using hookah is almost 20%, virtually identical to the current use of cigarettes.

Hookah is addictive, causes similar health effects as cigarettes, and results in substantially higher inhalation of smoke than cigarette smoking, yet misperceptions persist that its use is safer than cigarette smoking, erroneously increasing its social desirability. In addition, there are marked variations in use by region and state in the US.

Other studies cited in this article indicate that most individuals perceive hookah use as "less harmful, addictive, and detrimental, and as having higher social approval." Also, studies have found a significant association with positive attitudes towards hookah use and increased rates of initiation of its use. Attitudes towards hookah contrast greatly with the stigmatized view of cigarette smoking among individuals of the same age.

"The study, Analysis of state-specific prevalence, regional differences, and correlates of hookah use in U.S. adults, 2012-2013, will be useful for guiding the development of strategies and regulatory policies to prevent hookah use in the future as the characteristics of hookah users are different from cigarette smokers," said Weitzman. Increases in hookah smoking are more prevalent among single, adult males, and those with higher education and income status. This is in stark contrast to cigarette smoking, which is more common among poorer and more poorly educated individuals.

"Given the existing state level autonomy in developing hookah sensitive regulations, continuous monitoring of state level hookah related policies and prevalence of use could help explicate 'what works' within the US context at the state level, " said Weitzman. "Such monitoring can help guide the development, implementation and evaluation of evidence-based targeted interventions for the prevention of hookah use that are responsive to the state level policy and regulatory context."

The study notes a paucity of information available concerning state and local regulations regarding hookah bars and use of hookah-related advertising. Thus, this study did not allow the investigators to examine how geographic usage rates vary with existing public policies. Future studies are suggested to determine associations between usage rates and policies. Also, the study recommends additional research into the health impact of non-smokers being exposed to secondhand hookah smoke.