By: Julian Taylor

Introduction
New research published in the journal Pediatrics indicates youth hookah use is increasing and hookah users are likely to be abusing other substances including alcohol, marijuana, and cigarettes. In addition, the research indicates hookah use increases as socioeconomic status increases. Hookah smoking involves using water pipes to smoke tobacco and tobacco-like products. Adverse health outcomes for hookah use includes the delivery of “tar, nicotine, and carbon monoxide in even higher doses than cigarettes”. Hookah has also been linked to lung and esophageal cancer, respiratory illness, periodontal diseases, decreased pulmonary and cardiovascular functions, low birth weight, chromosomal aberrations, infertility, and the transfer of infectious diseases.

This research is an excellent tool for coalitions and communities who want to explore the issue of hookah use in their localities. The researchers discuss the increase of hookah use by youth, the risk factors associated with hookah use, and the link between hookah use and other substances.

What did they do?
In this study, researchers used the Monitoring the Future (MTF) survey for a random sample of high school seniors throughout 48 states across the United States. Approximately 15,000 seniors take the survey which asks questions relating to 13 different topic areas including demographics, socioeconomic status, and usage of various substances. There are six different forms of the survey which are randomly distributed, but only one form assesses hookah use. Therefore, the sample randomly measured one sixth of hookah usage. Furthermore, MTF didn’t start assessing hookah use until 2010, so this study uses data from 2010 to 2012.

What did they find?
The study shows from 2010-2012 the average annual prevalence of hookah using seniors in high school was 18%. Results suggest cigarette smoking is one the most robust and consistent risk factors for hookah use. Other important risk factors to note were lifetime alcohol use, lifetime marijuana use, lifetime use of other illicit substances, and weekly income from job. These risk factors are reciprocal for hookah, meaning that using hookah increases the likelihood of marijuana, alcohol, and cigarettes. The results indicate that white males were the most at risk, especially if they earned $51 or more per week from a job.

What can coalitions do?

• Collect local data — To determine whether your community has a hookah problem, begin with the collection of quantitative and qualitative data from a variety of sources. Check to see if your community’s student survey has a measurement of hookah use. Additionally, deepen the story around hookah use by following-up with youth through structured interviews and listening sessions. According to the study, there is a positive relationship between hookah use and other substances, including alcohol, tobacco, and marijuana. In communities with student surveys not measuring hookah use, coalitions should explore this relationship with qualitative data collection methods to determine the existence of a youth hookah problem.
   
• Identify local conditions —Coalitions need to use their community assessment data to identify the local conditions of the youth hookah problem in their community. Since this problem will be different for every community, coalitions need to ask the question “but why here?” to better identify and address how youth hookah use manifests itself in the community. For example, the data might reveal a community with numerous hookah outlets located in close proximity to the local high school.
   
• Address the risk factors —Once your coalition identifies the root causes and local conditions associated with youth hookah use in your community, develop a comprehensive strategic plan of strategies and interventions that are logical and data-driven. Coalitions looking to create community-level reductions in youth hookah use should look into interventions that change the environment. For instance, many indoor smoke free air policies exclude commercial hookah venues. Coalitions can inform the community and advocate for policy change relating to hookah use. Other relevant policies include restrictions on purchasing hookah paraphernalia and smoking on school campuses.

To review the original source please refer to:
Palamar, J. J., Zhou, S., Sherman, S., & Weitzman, M. (2014). Hookah use among US high school seniors. Pediatrics, 134(2), 227-234.