Youth appeal of hookah and hookah lounges, and policy implications

The American Lung Association warns that hookah is the first new tobacco trend of the 21st century. Despite widespread misconceptions to the contrary, hookah smoke contains toxins and is associated with many of the same diseases as cigarette smoke. Youth hookah use in Oregon is on the rise, particularly in counties containing hookah lounges, which operate under a smoke shop exemption in the state's smoke-free workplace law. To inform tobacco control efforts in Oregon, we wanted to know more about the appeal of hookah and hookah lounges to youth and young adults. We conducted focus groups with 16-18 year-olds, college-aged individuals, and parents of 12-18 year-olds. We also assessed hookah lounges in Oregon to describe the lounge environment, customer profiles, and promotional activities. Widespread peer acceptance of hookah use, the flavored, sweet-tasting tobacco smoke, and common perceptions that hookah is not harmful all contribute to hookah's appeal. Parents were largely unaware of hookah. Hookah is accessible to youth, both at lounges and at friends' houses, and is more affordable because it is taxed at a lower rate than cigarettes. Hookah smoking appeals to youth and young adults in Oregon. To reduce hookah smoking a comprehensive approach is required. Public education is needed to inform youth and adults about the dangers of hookah use, including warning labels on hookah tobacco. Flavors in hookah tobacco should be prohibited, and the tax rate on hookah tobacco should be made equivalent to the tax on cigarettes. Smoke-free workplace laws should prohibit smoking lounges.