Hookah smoking increasingly common among first-year college women

The study, published online by Psychology of Addictive Behaviors, suggests a possible link to alcohol and marijuana use. Researchers found the more alcohol women consumed, the more likely they were to experiment with hookah smoking, while women who used marijuana engaged in hookah smoking more frequently than their peers.

They say the findings are troubling since hookah smoking rates have increased dramatically among young adults over the last two decades, with some studies putting it on par with cigarette smoking. Many college students also mistakenly believe hookah smoking is safer than cigarettes, even though hookah use has been linked to many of the same diseases caused by cigarette smoking, including lung cancer, respiratory illness and periodontal disease.

"The popularity and social nature of hookah smoking, combined with the fact that college freshmen are more likely to experiment with risky behavior, could set the stage for a potential public health issue, given what we know about the health risks of hookah smoking," said lead author Robyn L. Fielder, M.S., a research intern at The Miriam Hospital's Centers for Behavioral and Preventive Medicine.

Originating in ancient Persia and India, hookah smoking is a highly social activity during which users smoke tobacco filtered through a water pipe, according to the American Lung Association. The tobacco mixtures used in the hookahs vary in composition, with some having flavorings and additives, such as candy and fruit flavors, that help disguise the harshness of the smoke. Hookah smokers are exposed to higher doses of nicotine compared to cigarettes, as well as carbon monoxide and a very high volume of smoke, which contains toxic and cancer-causing smoke particles.

In the study, 483 first-year female college students completed an initial survey about their precollege hookah use, followed by 12 monthly online surveys about their experience with hookah smoking. Of the 343 participants who did not report precollege hookah use, 23 percent (79 students) tried hookah tobacco smoking during their first year of college.

An analysis revealed alcohol consumption predicted the likelihood of hookah use, while marijuana use and certain personality styles, such as a higher level of impulsivity and a strong tendency to compare oneself to others, predicted frequency of use.

Fielder says the findings corroborate prior research showing strong correlations between hookah and other substance use, but their research is the first to show that alcohol and marijuana use are prospectively related to hookah initiation.

"Youth tend to overestimate the extent to which their peers use substances, and because it's important to fit in with one's peers, this can lead to greater risk-taking," said Fielder. "Our research suggests prevention and intervention efforts should jointly target all substance use, including hookah, alcohol, marijuana and cigarettes, to optimize the public health impact."

The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Co-authors include Michael P. Carey, Ph.D., director of The Miriam Hospital's Centers for Behavioral and Preventive Medicine, and Kate B. Carey, Ph.D., of Brown University.

Robyn L. Fielder, M.S., is completing a research placement at The Miriam Hospital (a member hospital of the Lifespan health system in Rhode Island) as part of her clinical psychology internship at The Warren Alpert Medical School of Brown University.

This grant is supported by the National Institute on Alcohol Abuse and Alcoholism under award number R21-AA018257.