Students swayed by 'relaxing, fun' image of hookah smoking ignore health harms

The research, supported by the National Cancer Institute, examined the sequence of events around which university students first smoke tobacco from a hookah, also known as a water pipe, in an effort to determine the driving factors behind the decision. It will be published in the June issue of the journal Nicotine & Tobacco Research and is online now. Because hookah tobacco smoking exposes the user to substantial amounts of toxicants such as carbon monoxide, nicotine, carcinogens and tar, initiation of this behavior is of concern.

"It was surprising to learn that college students, even when they were aware of the health dangers associated with hookah tobacco smoking at baseline, still went on to use a hookah for the first time," said lead author Jaime Sidani, Ph.D., M.P.H., senior research specialist in the Program for Research on Media and Health (PROMH) at Pitt. "However, students who had less positive attitudes toward hookah smoking were significantly less likely to initiate. This suggests that countering positive attitudes may be at least as effective as emphasizing harm in preventing initiation of hookah tobacco smoking."

Dr. Sidani and her colleagues analyzed a sample of 569 first- and second-year University of Florida college students who were surveyed twice over a seven-month period about their attitudes, knowledge and behaviors regarding hookah smoking. During that time, 13 percent of the students initiated hookah tobacco use.

The students were more likely to initiate hookah use if they had positive attitudes toward hookah smoking -- which is frequently promoted as relaxing, pleasurable, fun and sexual -- and if they thought it was a socially acceptable practice among their peers.

"Hookah tobacco smoking does not seem to be hampered by many of the negative social stigmas of cigarette smoking," said Dr. Sidani. "If educational programs can help students to cut through the positive portrayals and marketing of hookah smoking, it may be possible to make hookah smoking less attractive and socially acceptable, resulting in less initiation."

Senior author Brian Primack, M.D., Ph.D., director of PROMH, added that regulation of hookah tobacco smoking and marketing in the United States is confusing and less rigorous than laws meant to prevent cigarette smoking, which may contribute to misperceptions around hookah smoking.

"Clear policy measures addressing the sale and marketing of hookah products and regulation of hookah bars and cafes may be another way to counteract the positive attitudes young adults hold toward hookah smoking," Dr. Primack said.