New study measures hookah use among Florida teens

November 9, 2009

GAINESVILLE, Fla. — Hookah pipe smoking has gained a foothold with Florida teens, according to a new University of Florida study, which shows 11 percent of high school students and 4 percent of middle school students have tried it.

The findings were presented today (Nov. 9) at the American Public Health Association’s annual meeting in Philadelphia and appear in the November issue of the American Journal of Public Health. The study was conducted in collaboration with the Florida Department of Health.

Rooted in Middle Eastern culture, hookah pipes burn charcoal and tobacco, also known as shisha. Air is drawn through the tobacco and into the pipe, where it passes through water.

Hookah smokers widely but mistakenly believe that the pipe is a harmless alternative to other forms of tobacco smoking, said lead researcher Tracey Barnett, an assistant professor in the UF College of Public Health and Health Professions’ department of behavioral science and community health.

“Users tend to think smoking with a hookah is safe because they believe the water in the pipe acts as a filter,” Barnett said. “Many actually don’t think that shisha has tobacco, while others feel it’s a more pure form of tobacco that doesn’t have as many chemicals, although there’s really no reason to believe this.”

In fact, during a typical 20- to 80-minute hookah session, users may smoke the equivalent of 100 or more cigarettes, according to the World Health Organization. Hookah smoking can deliver 11 times more carbon monoxide than a cigarette, in addition to high levels of other carcinogenic toxins and heavy metals found in cigarettes. While the water in the hookah pipes does absorb some nicotine, researchers believe smokers are exposed to enough to cause addiction.

The UF researchers’ findings are based on data from the 2007 Florida Youth Tobacco Survey, an anonymous, annual survey administered by the Florida Department of Health to a random sample of public middle and high schools. The 2007 survey, completed by 9,000 students, was the first to include questions about hookah use.

There are at least 100 hookah lounges in Florida and most have opened in the past few years, Barnett said. Hookah is typically shared in groups and smoked with sweetened, flavored tobacco.

“The social nature of hookah smoking appeals to young people,” Barnett said. “An 18-year-old high school senior can’t get into clubs where alcohol is served, but he or she can legally smoke.”

The state of Florida’s minimum smoking age is 18.

While a few previous studies have estimated hookah use among college students, the UF study is only the second population-based study to examine hookah use in middle and high school students. A University of Pittsburgh study of Arizona students found that 10 percent of high school students and 2 percent of middle school students had smoked a hookah, according to data from a 2005 survey.

In addition to overall prevalence of hookah smoking, the UF researchers found that hookah usage rates were higher among boys, students who reported a history of cigarette smoking, and those who believe that cigarette smoking can relieve stress and help people feel more comfortable in social situations. Rates also increased with each advancing grade. Twelfth-graders were eight times more likely to have used a hookah than sixth-graders.

“Beliefs about the relative lack of harm associated with hookah use may also be held by policymakers, scientists and the general public. This could explain the slow response to both restricting hookah use in public settings and mounting a full-scale research effort to understand its health effects,” said Barbara Curbow, one of the study’s co-authors and chair of the UF department of behavioral science and community health. “We hope that our work encourages policymakers and researchers to become more involved in understanding the phenomenon.”

The new UF study team adds considerably to the emerging evidence of the widespread use of water pipe smoking among youth in the United States, said Dr. Wasim Maziak, an associate professor at the University of Memphis and the director of the Syrian Center for Tobacco Studies.

“Just a decade ago questions about water pipe use were not even considered in most youth tobacco surveys, and evidence suggests that water pipe smoking is no less harmful or addictive than cigarettes,” Maziak said. “In fact, water pipe smoking can be the first means for introducing nicotine to tobacco-naïve adolescents. All this calls for concerted efforts to continue active surveillance of this emerging tobacco-use method among U.S. youths, and to invest in research aimed at developing effective means to curb its spread.”