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Hookah smoking on the rise among teens

According to a new study, one in five teens has used a hookah pipe in the last year.
According to a new study, one in five teens has used a hookah pipe in the last year.
David Silverman/Getty Images

While cigarette smoking has been declining among youth, there is evidence that American teens are using other forms of tobacco products in its place. According to a study published in the July 7 online journal Pediatrics, one in five high school seniors has tried smoking a hookah pipe in the last year.

Hookah is an ancient form of smoking in which charcoal-heated tobacco is passed through water before it is inhaled. Also known as a water pipe, the device is rapidly gaining popularity among U.S. teens, especially among students of higher socioeconomic status.

“Surprisingly, students with more educated parents or higher personal income are at high risk for [hookah] use,” study author Joseph Palamar, PhD, an assistant professor in the department of population health at NYU Langone Medical Center (NYULMC), said in a news release.

“We also found that hookah use is more common in cities. So Hookah use is much different from cigarette use, which is more common in non-urban areas,” added Palamar.

To determine hookah use among American teens, Palamar and his colleagues analyzed the results of a 2010 to 2012 poll that surveyed more than 5,500 seniors from 130 high schools around the country. Study respondents were almost equally divided between boys and girls, and more than 60 percent were white. Almost 45 percent were under the age of 18, and nearly 15 percent were 18 or over.

The researchers found that about 18 percent of the teens had used a hookah in the last year. Teens who smoked cigarettes – or who used to – were more likely to use hookahs, as were those who used alcohol, marijuana or other illicit drugs.

The investigators point to several reasons for the rise in hookah use. Hookah smoking most often happens at a Hookah bar and because several people can share one pipe, it has become a way for teens to socialize. One expert cites the “cool factor” associated with hookah smoking.

Hookah pens are also contributing to the growth of this smoking option. Similar to e-cigarettes, hookah pens come in different flavors and provide a convenient delivery method that could lead to hookah use in everyday settings.

What concerns the researchers the most, however, is the mistaken belief that hookah smoking is safer than smoking cigarettes. Because hookah users inhale significant amounts of nicotine and cancer-causing toxins, it is just as harmful and addictive as cigarettes, say healthcare providers.

“The big myth is that because smoke bubbles up through water it’s somehow purified and safe. But lots and lots of studies have shown that the smoke users inhale contain all the toxic compounds that are inhaled in smoking a cigarette,” Norman Edelman, MD, a senior medical consultant for the American Lung Association and a professor of medicine at the State University of New York at Stoney Brook, told HealthDay.

“And the other thing is that when people smoke they often do it for a long time. So they get a lot of it. And that means just one session with a hookah appears to be equivalent to smoking a whole pack of cigarettes,” explained Edelman.

Palamar and his team concluded that delivery systems like the hookah pen and the increased normalization of hookah will make this smoking method even more popular. “This portends a potential epidemic of a lethal habit growing among upper and middle class adolescents,” they wrote.

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