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Hookah Use among California’s Educated Rises despite State Anti-Smoking Efforts

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California has some of the toughest anti-smoking laws in the country and has led the nation on banning public and workplace smoking, tobacco education and cessation programs. This two-decade effort has paid off, state officials say.

California has seen a decline in cigarette smoking across all demographic groups, down 38 percent from 1990 and women consistently continue to smoke less than men, according to a 2010 Public Health report.

The report says Californians buy roughly half the number of cigarettes as residents of other states. From 2005 to 2008, 9 percent fewer packs of cigarettes were sold in the state.

But according to new research from University of California San Diego (UCSD) Californians may be trading one habit for another.

UCSD School of Medicine researchers say between 2005-08, hookah use among California adults rose 40 percent. Use among the college crowd, those aged 18-24, was even higher.

Researchers say the increased popularity of the hookah -- a water pipe used for smoking tobacco -- “may be caused by the social nature of the behavior coupled with the misguided belief that it is less harmful than cigarettes,” according to the study published early online in American Journal of Public Health.

Wael Al-Delaimy, MD, PhD is associate professor and chief of the Division of Global Health in the UCSD Department of Family and Preventive Medicine. He says the rise in hookah use is particularly alarming, precisely because of the state’s anti-tobacco leadership role.

Hookah lounges have sprung up across the California in the past decade. “Though public indoor cigarette smoking is banned throughout California, hookah use is permitted in designated lounges. This may create the impression that hookah is a safer alternative to cigarettes, which is simply not true,” Al-Delaimy, who led the research, said in a written statement.

The Centers for Disease Control and Prevention (CDC) says hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancers, lung cancer, stomach cancer, esophageal cancer, reduced lung function, and decreased fertility. What’s more, a typical one-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette, according to the CDC.

The UCSD team used data from the statewide California Tobacco Surveys, the largest representative sample on hookah use collected at different points in time from the same source population.

Study results showed from 2005 to 2008, hookah use among all adults increased by more than 40 percent. By 2008, hookah use in California was much higher among young adults -- 24.5 percent among men, 10 percent among women -- than it was among all adults -- 11.2 percent among men, 2.8 percent among women.

Unlike cigarette smoking where those with higher education smoke less, hookah use is higher among those who are more educated, particularly among non-Hispanic whites, the research said.

The UCSD team is urging California policymakers to consider laws that would ban hookah lounges. They believe such a policy would “eliminate the implication that hookah smoking is safer and more socially acceptable than cigarette smoking,” Al-Delaimy said.

Lynette Summerill, an award-winning writer and scuba enthusiast lives in San Diego, CA. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.


California Department of Public Health California Tobacco Control Program. Two Decades of the California Tobacco Control Program: California Tobacco Survey, 1990-2008. Dec. 2010.

UCSD Researchers Alarmed at Rise in Hookah Use Among California Youth. Aug. 19, 2011 UCSD Press Release. accessed online: http://health.ucsd.edu/news/2011/08-19-hookah-use-rising?RSS=Health

Center for Disease Control and Prevention. Smoking and Tobacco Use Fact Sheet: Hookahs. Accessed 23 Aug. 2011 online at : http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs

American Journal of Public Health First Look. Increasing Hookah Use in California. Joshua R. Smith, Steven D. Edland, Thomas E. Novotny, C. Richard Hofstetter, Martha M. White, Suzanne P. Lindsay, and Wael K. Al-Delaimy. AJPH published August 18, 2011, 10.2105/AJPH.2011.300196 Accessed online at http://ajph.aphapublications.org/first_look.dtl

Reviewed on August 23, 2011
by Maryann Gromisch
Edited by Jody Smith

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