This article is more than 5 years old. Information may no longer be current.
Hookah smoking accounts for more than half of tobacco smoked by young adults
In the United States, hookah smoking attributed to approximately 55% of tobacco smoke volume consumed by hookah and cigarette smokers aged between 18 and 30 years, according to research published in Tobacco Control.
“Known colloquially as ‘hookah smoking,’ [waterpipe tobacco smoking] is particularly popular among young adults,” Brian A. Primack, MD, PhD, from the University of Pittsburgh, and colleagues wrote.
“[Waterpipe tobacco smoking] is described as less irritating compared with cigarette smoking,” they added. “However, compared with a single cigarette, one 45 min [waterpipe tobacco smoking] session is associated with exposure to higher levels of toxicants such as tar, carbon monoxide and nicotine.”
Primack and colleagues analyzed survey data to determine the population levels of total smoke volume, tar, carbon monoxide and nicotine consumed among young adults via hookah smoking vs. cigarette smoking.
The researchers surveyed a nationally representative sample of 3,254 smokers and nonsmokers aged between 18 and 30 years about how much and how often they smoked hookahs and cigarettes. They used meta-analytic data to determine toxicant exposures.
Approximately 5% of participants were hookah smokers, 23% smoked cigarettes and 3% smoked both cigarettes and hookahs within the past 30 days. A majority of those who smoked cigarettes reported smoking almost every day.
A total of 54.9% of smoke, 20.9% of tar, 10.3% of carbon monoxide and 2.4% of nicotine consumed was attributed to hookah smoking.
“Most hookah smokers in the U.S. are not daily users, whereas many cigarette smokers smoke multiple times a day, so it may seem that the vast majority of public health and policy-related interventions should be directed at cigarette smoking,” Primack said in a press release. “What our research shows is that hookah smoking contributes significantly to the burden of tobacco smoke-related toxicants inhaled by our young people. Therefore, public health and policy efforts should explicitly address hookah smoking in addition to cigarette smoking.”
The researchers noted that while smoking a cigarette typically takes 10 to 12 puffs which contain 50 mL of smoke each, one 45- to 60-minute session of hookah smoking typically takes 100 inhalations which contain 500 mL each, thus attributing to large smoke loads even when used infrequently.
“Smoking tobacco from a waterpipe attracts young users because it is flavored and sweetened, done in a social setting and is often less irritating compared to cigarette smoking,” Primack said. “Besides being a direct source of toxicants itself, hookah smoking has been linked to transition to cigarette smoking. All of this, combined with our new findings around the volume of hookah smoke consumed, should guide future efforts to prevent young adults from becoming hookah smokers.” – by Alaina Tedesco
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to Top
Hookah smoking is becoming very popular with young people. Part of it is the misperception of safety; however, fruit and candy flavors, as well as the social ritual, are attracting young people.
Hookah smokers inhale smoke from not just tobacco, but also the charcoal used to keep the tobacco burning and the flavoring agents added. Bubbling the smoke through water may cool it, but does not make it any less harmful. Hookah smokers have to inhale with more force to get the smoke through the water, and often hold the smoke in their lungs for longer than cigarette smokers. Hookah sessions are often 45 minutes to 1 hour, with an amount of smoke inhaled estimated as 100 to 200 times that of a single cigarette.
Primack et al. estimated the amount of toxicant exposure from water pipe smoking compared to cigarette smoking from an internet-based representative survey of young adults 18 to 30 years of age. Even though there were many more current cigarette smokers (23.4% of participants) than current hookah smokers (5.1%) in their sample, hookah smoking accounted for 55% of the smoke inhaled and 21% of the tar inhaled.
The FDA Center for Tobacco Products appears to be focusing most of its efforts on lowering the nicotine level in cigarettes to get smokers to switch to less toxic products. This study shows that harms from tobacco are not restricted to cigarettes and that other tobacco products, such as hookah, may in fact be more harmful than cigarettes. Focusing regulatory efforts on cigarettes alone is short sighted, especially when so many other tobacco products are attracting young people. If we are going to be serious about tobacco control, we need effective policies and regulations to protect young people from ALL tobacco products.
Further, as young people are smoking much more than just cigarettes, clinicians need to ask about more than just cigarettes. Pediatricians and parents need to talk to children from as early as they can understand about the importance of staying free from ALL tobacco products.
Read more about