Hookah tobacco smoking seems to be increasing in both prevalence, frequency

The findings, published online and scheduled for a coming print issue of the American Journal of Preventive Medicine, add to evidence that hookah use among adolescents is increasing in both prevalence and frequency. They also suggest that it is important to add hookahs to tobacco surveillance and intervention efforts.

"Hookah smoking does not seem to be just a fad; it seems to be a practice that is increasing steadily over time nationwide," said lead author Brian A. Primack, M.D., Ph.D., director of CRMTH and assistant vice chancellor for health and society in Pitt's Schools of the Health Sciences. "And, among hookah smokers, it's not just something they do once and that's it. A substantial and increasing proportion of people, particularly adolescents, seems to be smoking hookahs with enough regularity to create a significant public health concern. "

Dr. Primack points out that despite indications that hookah use is increasing, the long-term surveillance efforts necessary to target interventions have not kept pace. For example, the 2015 Youth Risk Behavior Surveillance Survey for U.S. high school students asks about smokeless tobacco, cigars and electronic cigarettes. However, it does not ask about hookah tobacco use.

Hookahs, also known as waterpipes or narghiles, are devices that allow users to smoke tobacco. Users are exposed to many of the same toxicants in cigarettes--including tar, nicotine, carbon monoxide and polycyclic aromatic hydrocarbons. While it is hard to quantify relative exposures because there is so much variability, comparisons suggest that a one hour-long hookah smoking session exposes the user to about 20 to 40 times the tar of a single cigarette. Consistent with this, preliminary reports associate hookah use with cancer, cardiovascular disease, decreased pulmonary function and nicotine dependence.

Dr. Primack and his team analyzed data collected through the University of Michigan's Monitoring The Future study, which obtains a nationally representative sample of students attending public and private schools in the 48 contiguous United States. They focused on the 8,737 high school seniors who were asked between 2010 and 2013 about hookah smoking.

When asked how many times they'd smoked tobacco from a hookah in the past 12 months, 19 percent replied that they had at least once. Of those, 38 percent reported smoking tobacco from a hookah at least six times in the past year, an amount that the researchers defined as "sustained use" because it indicated use beyond isolated events and corresponded to tar inhalation equivalent to smoking at least one pack of cigarettes per month.

Sustained hookah smokers were more likely to be male and Caucasian and to live in single-parent households. Compared to their peers, they were more likely to have poorer grades, more truancy and more active social lives.

Among those who reported hookah use at least once in the past year, 54 percent reported that they were not current cigarette smokers.

"While traditional cigarette smoking is decreasing, use of other forms of nicotine and tobacco is increasing," said Dr. Primack. "If we want to counteract this potentially problematic trend, tobacco prevention and intervention efforts must also address hookah use, and we must continue to collect data specific to hookah use."