Understanding reasons for waterpipe (hookah) smoking among youth

BACKGROUND: Despite being declared dangerous by the WHO, the ancient tradition of waterpipe tobacco (hookah) smoking practiced in Eastern Mediterranean, Middle Eastern, and some Asian countries has become popularized in the United States. With the advent of flavoring agents, hookah has proliferated among youth, where 4%-15% of middle and high school students have tried it. However, the largest emergent population of hookah smokers is college-aged youth. PURPOSE: We examined college students' attitudes and beliefs about hookah as well as their perceptions of the benefits received from smoking it. SIGNIFICANCE: Before effective interventions can be implemented, an examination of the consumer's perspective regarding the product's perceived benefit and value is needed. METHODS: We conducted 63 intercept interviews and 3 focus groups with students (hookah smokers and nonsmokers) at an urban university. FINDINGS: Hookah smoking provides a bridge to social engagement for students when they are bored, wish to relax, and want to make new friends. Whereas some students were candid about their fears of health risks from hookah, others disdained them. Students consider frequent hookah smokers and hookah lounge owners to be reliable sources of pertinent information. Smoking hookah does not carry the stigma that characterizes cigarettes; moreover, it is seen as less costly and less habit-forming. Additionally, hookah allows students to add alcohol and other drugs to experience various effects. CONCLUSIONS: Better dissemination of the health consequences of hookah smoking is needed. To be effective, interventions must address the social reasons for smoking hookah and reach pre-college and college-aged populations.