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Rapid increase, misperceptions of hookah use jeopardizes health of young adults

Hookah use has increased among adults in the United States since 2011, according to a new study published in Nicotine and Tobacco Research.

“Hookah use has increased rapidly in the United States, especially among adolescents…[while] cigarette use has decreased significantly… in recent years,” Michael Weitzman, MD, from the New York University’s College of Global Health and New York University School of Medicine, and colleagues wrote.

Weitzman and colleagues measured and mapped state-specific prevalence of lifetime and current hookah use based on data from the 2012-2013 National Adult Tobacco Survey. They also used a multivariate logistic regression model to identify socio-demographic features and regional differences in relation to hookah use.

Results indicated that 12.3% of U.S. adults aged 18 years or over have used hookah during their lifetime, and 3.9% of adults currently use hookah.

The researchers found variations in use by region with higher rates of use in the West and lower rates of use in the South.

“We believe that our research adds to the understanding of the geographic and socio-demographic factors underlying hookah use,” Weitzman said in a news release related to the study.

According to the researchers, approximately 20% of young adults aged 18 to 24 years currently smoke hookah, which is virtually the same prevalence of young adults who currently smoke cigarettes. This study, and others, found that using hookah is addictive and affects the user’s health in a similar way to cigarettes, yet is often misperceived to be safer and less addictive than cigarettes, which increases its overall social approval and desirability.

In addition, many young adults have a stigmatized perception of cigarette use, but a positive attitude towards hookah.

“The study… will be useful for guiding the development of strategies and regulatory policies to prevent hookah use in the future as the characteristics of hookah users are different from cigarette smokers,” Weitzman said in the release.

For instance, hookah smoking was more prevalent among those with a higher education and salary, while cigarette smokers tended to have fewer years of education and a lower income.

“Given the existing state level autonomy in developing hookah sensitive regulations, continuous monitoring of state level hookah-related policies and prevalence of use could help explicate ‘what works’ within the U.S. context at state level,” Weitzman wrote. “Such monitoring can help guide the development, implementation and evaluation of evidence-based targeted interventions for the prevention of hookah use that are responsive to the state level policy and regulatory context.”

“Future research, including longitudinal studies, are needed to identify geographic and socio-demographic characteristics and trends among hookah users, investigate hookah-related health outcomes, and evaluate targeted public health efforts aimed at this emerging threat,” Weitzman and colleagues concluded. – by Alaina Tedesco

Disclosure: The researchers report funding by the Cancer Institute at the National Institutes of Health. Please see full study for complete list of relevant financial disclosures.