Hookah Smoking Increasing Among Adolescents

Larry Hand

July 07, 2014

Hookah smoking risk was greater among adolescents with higher socioeconomic status, urban students, white students, boys, and those who earn at least $50 a week, according to an article published online July 7 in Pediatrics.

Joseph J. Palamar, PhD, MPH, from the Department of Population Health, New York University Langone Medical Center, New York City, and colleagues analyzed data on 5540 US high school seniors in the Monitoring the Future (MTF) study for the years 2010 to 2012.

MTF is an annual survey of seniors in about 130 randomly selected public and private high schools and is funded by the National Institute on Drug Abuse. Surveyors collect demographic data from about 15,000 seniors annually, including age, parental education and living arrangements, and teenager job income. About a sixth of the sample population is included in this analysis. MTF researchers recently reported that 12-month hookah use increased from 18.3% to 21.4% among high school seniors from 2012 to 2013.

Hookah is an ancient method of smoking in which smoke from burning an herb (shisha) that may or may not be tobacco-based passes through water before it is inhaled.

In this study, researchers attempted to determine potential predictors for teenagers choosing to use hookahs.

Most at Risk

Using multivariable logistic regression analysis, the researchers found that male, nonblack, and nonreligious students were more likely to have used hookah at least once during the last year. In addition, they found that students who earned more money, lived in urban areas, and had smoked tobacco or marijuana or drank alcohol at some point also were more likely to use hookah.

Girls were 19% less likely than boys to use hookah (adjusted odds ratio [AOR], 0.81), and black students were 73% less likely than white students to use hookah (AOR, 0.27). Compared with students who lived in nonmetropolitan areas, students in small and large cities were more than twice as likely to use hookah (AOR, 2.67 small; AOR, 2.64 large).

Moderate to high parental education was also associated with higher hookah use among seniors (AOR, 1.58), and students who earned at least $50 a week were more likely to use hookah (AOR, 1.26).

"A common belief among adolescents and young adults is that hookah use is less harmful and addictive than cigarettes," the researchers write. "This misconception probably leads to the social normalization of hookah use as a trendy and acceptable way to have fun with friends."

They conclude, "[I]t is crucial for educators, health professionals, researchers, and policy makers to collaborate to fill in gaps in public understanding of its harm and guide public interventions to diminish problematic hookah smoking."

The authors have disclosed no relevant financial interests.

Pediatrics. Published online July 7, 2014.

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