Risk Perceptions of Hookah Smoking

Background: The prevalence of hookah (waterpipe) smoking is on the increase among adolescents and adults and appears to be a replacement for regular cigarette smoking. A major concern is that tobacco prevention policies have focused on traditional tobacco products, largely letting hookah smoking fly under the radar. This study focused on risk perceptions of hookah smoking to determine whether hookah smokers viewed hookah as less dangerous than regular cigarette smoking.

Methods: A validated survey was distributed to a random sample of the community in paper format and also electronically. A total of 880 surveys were completed. Respondents represented 156 different ZIP codes in Michigan.

Results: Approximately 19% of respondents were current hookah smokers. 29.6% of hookah smokers were Arab-Americans versus 3.6% of African Americans. Logistic regression revealed that hookah smoking was more likely among those who were Arab-Americans (OR=12.5), Chaldeans (OR=9.2), younger (OR=2.1), male (OR=2.5), and with higher income (OR=1.8). Hookah smokers were more likely than non hookah-smokers to rate hookah as less dangerous than cigarette smoking (OR=2.3). Compared to non-hookah smokers, hookah smokers were more likely to perceive second hand hookah smoke as less dangerous (OR=1.9). Hookah smokers also considered hookah smoking to present less of a health risk than cigars, chewing tobacco, and cigarettes with either filters and/or menthol.

Conclusion: Hookah smokers have a distorted risk perception of hookah and believe it to be safer than a range of other tobacco products. There is a need for targeted anti-hookah consumer information as well as policies.