Teenage hookah smoking rates must be reduced, experts say

While the lion’s share of youth anti-smoking efforts has focused on cigarettes, a new report in the CDC journal Preventing Chronic Disease suggests more needs to be done to reduce the number of teens smoking flavored tobacco from hookahs.

According to a recent survey cited in the report, 18.5% of 12th-grade students admitted to using a hookah in the previous year. And what’s particularly concerning to the study authors, led by Daniel Morris of the Oregon Health Authority’s public health division, is that many young people don’t seem to recognize that hookah use carries serious health risks: Hookah smoke contains many of the same toxins as cigarettes and has been associated with a similar laundry list of diseases such as lung cancer and respiratory illness.

But the news is not all bad. The authors report that the predictors of who will smoke hookah -- including how socially acceptable the practice is, whether a family member does it, and whether the smoker perceives use as harmful or not -- are the same as those for cigarette smoking. This implies that the same interventions that have been so successful in reducing cigarette smoking will work with hookah smoking as well.

What are those interventions? For one, Morris and his team argue that prices for shisha, the flavored tobacco commonly smoked from hookahs, should be higher, calling such an increase “the single most powerful intervention to reduce youth smoking.” Currently, they write, the price for a pound of hookah pipe tobacco is $22 lower than that for cigarette tobacco, a gap they believe must be narrowed.

Other interventions include more persuasive warnings, like the graphic labels used on cigarettes, and the removal of sweet flavorings from shisha -- a ban that already exists for cigarettes. In addition, the authors argue, because shisha is often smoked in designated hookah bars, which tend to be exempt from “no smoking” rules, the rules must be changed to eliminate that exemption.

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