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Hookah smoking soaring among high school seniors

The researchers found that hookah use varied based on gender, ethnicity, and income
The researchers found that hookah use varied based on gender, ethnicity, and income
Robin Wulffson, MD

In recent years, smoking a hookah, or water pipe, has increased in popularity in the United States, particularly among younger individuals. A new study has examined hookah smoking among US high school seniors. They found that use varied based on gender, ethnicity, and income. The study was published online on July 7 in the journal Pediatrics by researchers in the Department of Pediatrics and Environmental Medicine, New York University Langone Medical Center, New York, New York.

Healthcare experts note that the soaring popularity of hookahs has been fueled in part by the belief that the water pipes are more socially acceptable than cigarettes and the erroneous belief that inhaling tobacco smoke drawn through the water filters out some of its toxins. Another factor in their popularity is that hookah tobacco comes in flavors such as apple, honey, mint, and strawberry.

Last December, the California Department of Public Health issued a warning that hookah smoking was at least as harmful as cigarette smoking. Smoke from hookah tobacco retains all the carcinogens of cigarette smoke; furthermore, it contains more carbon monoxide and added carcinogens from the use of burning coals that are used to keep the nicotine flowing. According to the Centers for Disease Control and Prevention (CDC), during a typical hour-long session, a hookah user inhales 100 to 200 times the volume of smoke inhaled from a single cigarette.

The authors of the new study note that the prevalence of hookah use is increasing significantly among teens; therefore, they conducted a study to examine the demographic and socioeconomic factors related to hookah use among high school seniors in the US. They theorized that more impoverished teens and those who smoked cigarettes would be more likely to use hookahs.

The study group comprised 5,540 high school seniors enrolled in the annual, nationally representative survey of high school seniors: Monitoring the Future (years 2010–2012), an annual nationally representative survey of high school students in the United States. They subjected the data to statistical analysis to define hookah use during the last 12 months.

The investigators found that 18% of students reported hookah use during the past year. Compared to Caucasian students, African American students were less likely to smoke hookahs (0.27-fold decreased risk). A higher parental education level increased hookah use (1.58-fold increased risk), and student weekly income from a job of more than $50 per week (1.26-fold increased risk) or $11 to $50 per week from other sources (1.35-fold increased risk) also increased use. Males and urban students were also more likely to smoke hookahs; they were also more likely to use alcohol, marijuana, and other illegal substances. Former cigarette smokers as well as current cigarette smokers were at the highest risk for use.

The authors concluded that teens with a higher socioeconomic status appeared to be at particularly high risk for hookah use in the US. They recommended that prevention efforts should be focused on this group as hookah use continues to increase.