Hookah Use Among College Students

Hookah smoking is a fast-growing trend in tobacco consumption in high school and college students. One study found that hookah smoking exceeded cigarette smoking in the university setting for both ever use and past-year use, with males and females smoking hookah at similar rates, and hispanic students with the highest prevalence rate of current use. Students are more likely to use both cigarettes and hookah than hookah alone, and among students who did not use cigarettes, those with hookah experience were more likely to express intent to try cigarettes soon. Hookah has been found to me perceived as more socially acceptable and less harmful than cigarettes by those who use it. Use of hookah is often connected to other substance use, including alcohol, marijuana, and other tobacco products. A 2009 study found that college athletes may be susceptible to hookah use as compared to their non-athletic counterparts. When students were asked about intentions to quit hookah, it was found that there is a very low interest in cessation among hookah users.

A comprehensive examination of hookah smoking in college students: Use patterns and contexts, social norms and attitudes, harm perception, psychological correlates, and co-occourring substance use. 
(Addictive Behaviors, 2013)

A Multiyear Survey of Waterpipe and Cigarette Smoking on a US University Campus
(Journal of American College Health, 2012)

Associations of Mental Health Programs With Waterpipe Tobacco and Cigarette Smoking Among College Students
(Substance Use & Misuse, 2013)

Beliefs and Norms Associated with Smoking Tobacco Using a Waterpipe among College Students
(Journal of Addictions Nursing, 2012)

Differing psychological risk profiles of college freshmen waterpipe, cigar, and cigarette smokers
(Addictive Behaviors, 2008)

Ethnicity and waterpipe smoking among US students
(International Journal of Lung Diseases, 2012)

Evidence of emerging hookah use among university students: a cross-sectional comparison between hookah and cigarette use
(BMC Public Health, 2013)

Hookah’s new popularity among US college students: a pilot study of the characteristics of hookah smokers and their Facebook displays
(BMJ Open, 2012)

Hookah Use Among U.S. College Students: Results From the National College Health Assessment II
(Nicotine & Tobacco Research, 2012) 

Increasing Hookah Use in California
(American Journal of Public Health, 2011)

Intention to Smoke Tobacco Using a Waterpipe Among Students in a Southeastern U.S. College
(Public Health Nursing, 2011)

Knowledge and Attitudes Toward Hookah Usage Among University Students 
(Journal of American College Health, 2013)

Predictors of Initiation of Hookah Tobacco Smoking: A One-Year Prospective Study of First-Year College Women
(Psychology of Addictive Behaviors, 2012)

Prevalence, frequency, and initiation of hookah tobacco smoking among first-year female college students: A one-year longitudinal study
(Addictive Behaviors, 2011) 

Prevalence of and Associations with Waterpipe Tobacco Smoking among U.S. University Students
(Annals of Behavioral Medicine, 2008) 

Psychological Factors and Health-Risk Behaviors Associated with Hookah use among College Students
(Addiction Research & Therapy, 2011) 

Social Context of Smoking Hookah Among College Students: Scale Development and Validation
(Journal of American College Health, 2013)

Sociodemographic risk indicators of hookah smoking among White Americans: A pilot study
(Nicotine & Tobacco Research, 2010)

Waterpipe and Cigarette Smoking Among College Athletes in the United States
(Journal of Adolescent Health, 2009)

Waterpipe Smoking Among College Students in the United States: A Review of the Literature
(Journal of American College Health, 2012) 

Waterpipe Smoking Among Students in One US University: Predictors of an Intention to Quit
(Journal of American College Health, 2012) 

Waterpipe Tobacco Smoking on a U.S. College Campus: Prevalence and Correlates
(Journal of Adolescent Health, 2008) 

Young Adult Waterpipe Smokers: Smoking Behaviors and Associated Subjective and Psychological Effects
(Addictive Behaviors, 2014) 

Hookah Use Among High School Students

Hookah use is increasing among young people, but information is still somewhat limited on hookah use among high school students. One study found ever-use of hookah in high school students to be 26.1% with current hookah use at 10.3% (in 2011). Most students learned about hookah use from friends. Students believed that hookah was more socially acceptable and less harmful than cigarettes. Hookah use is high in youth who have already tried cigarettes, and is an emerging way for young people to use tobacco.

Determinants of Hookah Use among High School Students
(Nicotine & Tobacco Research, 2011)

Do household smoking behaviors constitute a risk factor for hookah use? 
(Nicotine & Tobacco Research, 2011)

Examining Hookah Smoking Among a Cohort of Adolescent Ever Smokers
(Nicotine & Tobacco Research, 2011) 

Hookah Use Among US High School Senior
(Pediatrics, 2014) 

Opportunities for Policy interventions to Reduce Youth Hookah Smoking in the United States
(Centers for Disease Control and Prevention, 2012) 

The Global Epidemic of Waterpipe Smoking
(Addictive Behaviors, 2010)

The Waterpipe; a New Way of Hooking Youth on Tobacco
(American Journal on Addictions, 2011) 

Water Pipe Smoking Among the Young: The Rebirth of an Old Tradition
(Nursing Clinics of North America, 2011)

Hookah Beliefs and Perceptions

Individuals may believe that smoking hookah is less harmful than smoking cigarettes. Common reasoning for this includes the notion that the water “cleans” the smoke. Misinformation about Hookah is frequently spread through word of mouth, and centers around common themes including: (1) hookah smoke is cleaner than cigarette smoke, (2) hookah smoking does not lead to tobacco addiction, (3) hookah use induces relaxation and relieves stress. The health risks related to hookah use should be communicated to youth and young adults, and efforts should me made to dispel the myths around benefits or tobacco use.

Attitudes and Practices of Hookah Smokers in the San Francisco Bay Area
(Journal of Psychoactive Drugs, 2011) 

Hookah Smoking: A Popular Alternative to Cigarettes 
(Texas Dental Journal, 2011) 

Hookah Smoking: Behaviors and Beliefs among Young Consumers in the United States
(Social Work in Public Health, 2014)

Hookah Use: Going Down in Smoke
(Journal of Addictions Nursing, 2012)

Hubble Bubble Trouble: The Need for Education About and Regulation of Hookah Smoking
(Journal of Public Policy & Marketing, 2011)

Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users
(Tobacco Induced Diseases, 2009)

The rise of narghile (shish, hookah) water pipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers
(BMC Public Health, 2011)  

Up in Smoke : The Fallacy of the Harmless Hookah
(Chest, 2011) 

Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States
(American Journal of Health Behavior, 2010) 

Hookah & Health

Hookah use can have an a variety of health implications beyond the immediate risks we usually think of, such as increased heart rate and blood pressure and risks of other tobacco related diseases. An emerging problem with hookah use is carbon monoxide poisoning, with young people requiring emergency treatment and hospitalization.

Acute effects of water pipe tobacco smoking: a double-blind, placebo-control study
(Drug and Alcohol Dependence, 2010)

Anesthesia implications of water pipe use
(Journal of Clinical Anesthesia, 2012)

Carbon Monoxide Levels Among Patrons of Hookah Cafes
(American Journal of Preventive Medicine, 2011)

Carbon monoxide poisoning in narghile (water pipe) tobacco smokers
(Canadian Journal of Emergency Medicine, 2012) 

Comparison of carcinogen, carbon monoxide, and untrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors
(Atmospheric Environment, 2010) 

Does shisha smoking affect blood pressure and heart rate? 
(Journal of Public Health, 2008)

Effects of Water-Pipe Smoking on Lung Function: A Systematic Review and Meta-Analysis
(Chest, 2011) 

Hookahs an Waterpipes: Cultural Tradition or Addictive Trap? 
(Journal of Adolescent Health, 2008)

Inhaling smoke causes smoke inhalation: put that in your hookah pipe!
(Canadian Association of Emergency Physicians, 2011) 

Mainstream smoke of the water pipe: Des this environmental matrix reveal as significant source of toxic compounds? 
(Toxicology Letters, 2011) 

Narghile smoking and its adverse health consequences: a literature review
(British Dental Journal, 2009) 

Nicotine, Carbon Monoxide, and Carcinogen Exposure after a Single Use of a Waterpipe
(American Association for Cancer Research, 2011) 

Scientific Evidence of the Health Risks of Hookah Smoking
(CESAR, 2008)

The Acute Effects of Water-Pipe Smoking on the Cardiorespiratory System
(Chest, 2011) 

Water pipe smoking and human oral cancers
(Medical Hypotheses, 2009) 

Waterpipe smoking: not necessarily less hazardous than cigarette smoking
(Netherlands Heart Journal, 2013)

Waterpipe Tobacco and Cigarette Smoking, Direct Comparison of Toxicant Exposure
(American Journal of Preventive Medicine, 2009) 

Waterpipe Tobacco Smoking and Cigarette Smoking: A Direct Comparison of Toxicant Exposure and Subjective Effects
(Nicotine & Tobacco Research, 2010) 

Hookah & Policy

Comprehensive tobacco-free policies include the prohibition of hookah use, and provide services for hookah education and cessation. Tobacco-free policies are one way to reduce hookah use among youth and young adults.

An Emerging Deadly Trend: Waterpipe Tobacco Use
(American Lung Association, 2007) 

Reducing Hookah Use, a public health challenge for the 21st century
(The BACCHUS Network) 

Regulating Hookah and Waterpipe Smoking
(Tobacco Control Legal Consortium) 

Tobacco smoking using a water pipe: a re-emerging strain in a global epidemic
(Tobacco Control, 2006) 

Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators
(World Health Organization, 2005) 

Hookah Steam Stones and Herbal Shisha Products

Steam stones are a newer product that can be used with a hookah pipe in place of tobacco. Steam stones are heat-treated pours materials soaked in fluid (usually glycerine). They are heated in hookahs where tobacco would normally be placed and release a flavored vapor that is inhaled by the user. Virtually nothing is known about the potential health effects of steam stone use, although concern exists because the stones are heated with charcoal which expose the user to carbon monoxide and carcinogenic materials.

‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free water pipe products and the air quality of the cafes where they are served
(Tobacco Control, 2013) 

Hookah steam stones: smoking vapor expands from electronic cigarettes to waterpipes
(Tobacco Control, 2012)