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UCLA School of Nursing finds Southland hookah lounge patrons unaware of dangers

Despite a growing body of evidence that hookah smoking can be even more dangerous than cigarette smoking, many young adults believe that using them is not harmful to their health
Despite a growing body of evidence that hookah smoking can be even more dangerous than cigarette smoking, many young adults believe that using them is not harmful to their healthRobin Wulffson, MD

Hookah smoking is soaring in popularity among teens and young adults in the US. Researchers at the UCLA School of Nursing visited three Southern California hookah lounges to assess whether patrons were aware of the harmful effects of inhaling the smoke. They found that many of the water pipe smokers were unaware that it was harmful. They published their findings in the July–August edition of the journal Nursing Research.

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.

Despite a growing body of evidence that hookah smoking can be even more dangerous than cigarette smoking, many young adults believe that using them is not harmful to their health. The UCLA investigators queried patrons between the ages of 18 and 30 at the lounges and found that many were totally unaware that the practice was harmful. They asked the patrons whether they belied that hookah smoking is harmful to your health. They found that 57% said they thought that it was not. When the patrons were asked why they thought hookahs were not harmful, 47% said they believed that the smoke gets filtered through water, and 35% said they thought that fruit used to flavor the tobacco detoxified tobacco’s harmful chemicals. Some (16%) made the ridiculous statement that hookahs are not harmful because the tobacco is not addictive and does not contain nicotine. All of these responses were glaring misconceptions.

“With hookah smoking on the rise, particularly among young adults, our goal was to identify factors influencing perceptions, attitudes and preferences toward hookah smoking,” explained lead researcher Mary Rezk-Hanna, a UCLA nursing doctoral student. She noted that other recent studies have reported that even as cigarette use continues to decline, hookah smoking is increasing, particularly among college students. It is the only tobacco use practice that is not regulated in the US; furthermore, its exemption from clean indoor air legislation, such as the California Clean Air Act, is fueling its rapidly growing popularity. California alone contains more than 2,000 shops that sell hookah tobacco and related products; furthermore, a disproportionate number (175) of hookah lounges and cafes are in Los Angeles, near universities and colleges.

The investigators queried the hookah lounge patrons why they considered hookah smoking to be a more attractive to cigarette smoking; 60% said that it was a trendy way of socializing. Although 43% were aware that hookah smoking was harmful, they were of the opinion that socializing with friends outweighed the health concerns. Ms. Rezk-Hanna explained that hookah smoking is heavily marketed in the US to young adults of all ethnic backgrounds as an attractive social phenomenon and a non-addictive, healthier alternative to cigarette smoking. She noted, “This study underscores the urgent importance of more research and campaigns to increase public knowledge on the dangers of hookah smoking, especially among young adults. Understanding the basis of these perceptions and beliefs is of particular relevance for helping healthcare professionals design effective prevention and intervention strategies that target young-adult hookah smokers.”