Teenage Use of Hookah on the Rise, Cigarette Use Declines

High school students are trading cigarettes for hookah — an alternative form of tobacco — according to a 2010 study led by epidemiology associate professor Wael Al-Delaimy and postdoctoral student Joshua Smith.

According to a 2009 national Youth Risk Behavior Survey administered to high school students by the Centers for Disease Control and Prevention, the number of students who have smoked a cigarette dropped from 70.4 percent to 46.3 percent over 10 years.

Al-Delaimy said the decline may be a result of effective educational campaigns. But while it suggests that overall nicotine intake levels have decreased among teens, researchers believe that people are smoking tobacco in other forms, Smith explained.

Researchers surveyed 689 students from three San Diego county high schools to compare demographics with patterns of use. Students were given a 44-question survey on use of cigarettes, chewing tobacco and hookah. Students were also asked about the proximity of hookah lounges to their communities.

“This is the first study to document hookah use of teens in such detail,” Al-Delaimy said.

Smith said lifelong tobacco use usually begins in adolescence and is established by the age of 18, making high school students optimal subjects.

Researchers found that 26.1 percent of students have tried hookah and that most students — 50.3 percent of those surveyed — know about hookah from their friends. About 30 percent of those surveyed who have tried hookah intend to use it again in the future, and a majority of students know of hookah lounges in their communities.

Smith said the rise of hookah in the county can be attributed to word of mouth and an increasing presence of hookah lounges within the last decade.

“One out of 10 students interviewed have smoked hookah in the last 30 days,” Smith said. “This is equal to current cigarette smoking.”

Al-Delaimy said hookah use is a social practice that gained popularity within the past five years. Hookah use is potentially more dangerous than cigarette smoking, Al-Delaimy said, because of the social nature of the practice: Each session lasts about 45 to 60 minute, enabling the user to intake high amounts of tobacco.

“The important message to take away is that people who have tried hookah are similar to those who have tried cigarettes,” Al-Delaimy said.

Jasmin Wu/UCSD Guardian

The researchers argue that hookah has many of the same risks and nicotine levels as cigarette smoking. They said hookah users were more likely than nonusers to have smoked a cigarette.

Of the students who had heard of hookah, 59.5 percent believed it to be more socially acceptable than cigarettes and 46.3 percent believed it to be safer than cigarettes. Most users are unaware of the risks and diseases associated with hookah smoking. Al-Delaimy said it is related to several preventable diseases, including coronary heart disease and cancers of the lung, mouth and bladder.

The researchers recommend that hookah lounges have the same regulations as cigarettes. Although the legal age to enter a lounge is 18, 13.5 percent of those that claimed they visited lounges while underage, suggesting some establishments are lax in enforcing the age restriction.

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