The prevalence of current cigarette use has declined, according to the 2014 Surgeon General’s report, The Health Consequences of Smoking-50 Years of Progress.
However, there is significant evidence showing an increase in use of alternate tobacco products including hookah, especially among young adults.
As a result, the recommendation in the Surgeon General’s report was to study and address the use of alternative forms of tobacco products, particularly among youth.
In 2012, a research study was conducted at the University of South Florida campus with 478 undergraduate and graduate students to determine the prevalence, knowledge and practices of hookah use among the university students.
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Hookah, also known as a water pipe, is a device in which tobacco containing nicotine or herbal, non-tobacco, tea leaves are placed in the head and covered with a layer of aluminum foil.
Users inhale from the mouthpiece, pulling the heat of the charcoal over the tobacco and burns it, creating smoke. The smoke then travels down the body, bubbles out of the water, through the hose and is inhaled by the user.
USF College of Public Health researchers, Selamawit Hadgu, Drs. Shams Rahman, Lisette Chang, Abraham Salinas-Miranda, and Jamie Corvin found that over half of the students in the study had tried hookah despite knowing that smoking the water pipe was harmful to their health.
The prevalence of hookah use among this population was most likely due to the misperception that smoking hookah was less harmful than smoking cigarettes and a healthier alternative, according to their research.
Ninety-two percent of the students were aware of a hookah lounge in a 10-mile radius of the campus and reported that it has become socially appealing to smoke hookah with friends. Thirty percent of those who reported never smoking hookah said they would consider smoking in the future.
The researchers suggest an intervention addressing both the social aspect of hookah use and the myth that it is a safer alternative may be a better strategy for health education efforts in this student population.
Maureen Guthke, assistant director of the Tobacco Free Florida AHEC Cessation Program at the USF Morsani College of Medicine, took the opportunity to address these two issues with undergraduate students at the USF COPH.
Guthke encouraged the future public health professionals to become informed, use credible sources like the Centers for Disease Control and Prevention, and to challenge friends or supporters of hookah to learn the facts before engaging in the behavior.
“It is understandable how young adults can perceive hookah as a safer alternative to cigarettes,” Guthke said.
The water, which is mistakenly known as the filter, only filters five percent of the nicotine with the remaining 95 percent being inhaled. It is the 90,000 ml of smoke that is inhaled during a one hour session of hookah that is concerning, according to Guthke.
“500 to 600 ml of smoke is inhaled when smoking just one cigarette,” Guthke said. “In comparison, hookah results in 30 times the amount of exposure to carcinogens than that in a cigarette smoker.”
While it is widely accepted that exposure to secondhand cigarette smoke can have significant health consequences, not much is known about the effects of secondhand hookah smoke at this time. One study published in the Journal of Atmosphere Environment found that toxins emitted in the air were in excess of that found from cigarette smoke.
Laws, such as the Florida Clean Indoor Air Act that helps to protect our residents from exposure to tobacco smoke, exclude hookah lounges that are licensed as retail tobacco stores.
Up until recently, the lack of strict regulation on online purchasing of hookah products made the devices easily available even to those under the age of 18, according to Guthke.
On May 5, the FDA announced that the law regulating traditional cigarettes and smokeless tobacco will now include the same regulations on other tobacco products including hookah.
In early 2016, USF joined more than 20 other Florida colleges and universities and more than 1,500 campuses across the country in becoming a tobacco-free campus.
The tobacco-free policy at USF prohibits the use of, selling of and advertising of any tobacco product, including water pipes and hookahs. The tobacco-free policy applies to all faculty, staff, students, vendors and visitors to the campus. The goal of the policy is not to force people to quit tobacco, but rather provide a safe and healthy environment for all.
Guthke and other advocates of the USF tobacco-free policy and the new FDA regulations see this as a step in the right direction to having a consistent message regarding the harmful effects of tobacco use, regardless of the form.
Story by Maureen Guthke, USF AHEC Cessation Program
