Hookah Smoking Increases Risk of Subsequent Cigarette Smoking Among Adolescents and Young Adults

A team of researchers at Dartmouth College and University of Pittsburgh found respondents who had smoked water pipe tobacco but not smoked cigarettes were at increased risk of cigarette smoking two years later as recently published online in JAMA Pediatrics. The study followed 2,541 adolescents and young adults for two years.

Samir Soneji, PhD, a tobacco regulatory control researcher at Dartmouth and lead author on the study said, "We found hookah smoking increased the probability of trying cigarette smoking over the next two years by 19%."

This longitudinal study developed at Dartmouth's Norris Cotton Cancer Center followed 2,541 individuals aged 15 to 23 years old for two years, and demonstrated that hookah smoking, which commonly begins as a social custom, and snus use are associated with later cigarette use. Specifically, hookah smoking and snus use among non-cigarette smoking adolescents and young adults were longitudinally associated with subsequent cigarette smoking including initiation of cigarette smoking, cigarette smoking in the past month, and high-intensity cigarette smoking. Snus is a smokeless tobacco product that originated in Sweden and has become popular among young men living in the rural U.S.

Manufacturers of both snus and shisha — the tobaccos smoked in hookahs — increase the appeal of their products by adding appetizing flavors and marketing them in social media. Mass media marketing of cigarette products has been banned in the U.S. since 1971 when the Public Health Smoking Act of 1969 went into effect.

What's more, the volume of carcinogen-containing smoke inhaled by a hookah smoker is 100 times that of a smoker smoking a single cigarette.

Looking forward, Soneji encourages comprehensive Food and Drug Administration regulation of all tobacco products to restrict manufacturers' ability to flavor, package, and market their non-cigarette tobacco products in ways designed specifically to appeal to adolescents and young adults. Doing so may curb the onset of cigarette smoking.

The study was supported by NCI grant R01-CA77026, NCATS grant KL2TR001088, and NCI grant RO1-CA140150. In addition to Soneji, collaborators included James D. Sargent, MD and Suzanne E. Tanski, MD, MPH from Dartmouth's Norris Cotton Cancer Center and Brian Primack, MD, PhD from the School of Medicine at University of Pittsburgh.

About Norris Cotton Cancer Center at Dartmouth-Hitchcock

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.