Some Hookah Users Got 'Hooked' on Cigarettes

Hookah tobacco and snus use may increase cigarette smoking rate in young adults

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Alternative tobacco products like snus and hookahs may be gaining popularity among teens and young adults — and they may also spark later cigarette use.

A new study found that teens and young adults who smoked water pipe tobacco from hookahs and used snus were more likely to smoke cigarettes.

Some who use hookah and snus may view those products as healthier alternatives to smoking. But those products can still introduce dangerous toxins and chemicals into the body, which highlights the importance of keeping kids from using tobacco in any form.

According to MedlinePlus, "Young people who do not start using tobacco by age 18 will most likely never start."

Samir Soneji, PhD, of the Geisel School of Medicine at Dartmouth College in Lebanon, NH, and colleagues based their research on data from 2,541 people between the ages of 15 and 23.

“Our study contributes to a growing body of evidence on the potential for water pipe tobacco smoking to increase the risk of subsequent cigarette smoking,” Dr. Soneji and team wrote.

Of the study participants, about 39 percent had tried cigarettes, 15 percent were current smokers, 20 percent had smoked water pipe tobacco and 9.4 percent used snus.

Snus, which comes from Sweden, literally means "smokeless tobacco" in Swedish. It is a form of finely ground tobacco, often flavored, and sold in small tea-bag like pouches. Users place it between the upper lip and gum. A hookah is a large pipe with a flexible tube that draws tobacco smoke through a chamber that contains water. Hookah tobacco is often flavored.

A total of 1,596 people filled out surveys at both the start of the study and after two years. At the start of the research, 1,048 (65.7 percent) of these young people had never smoked cigarettes. Of those who declared themselves non-cigarette smokers, 71 (6.8 percent) had smoked water pipe tobacco and 20 (1.9 percent) had used snus.

At the two-year follow-up, 39 percent of those who started as non-cigarette smokers but had smoked water pipe tobacco had started smoking cigarettes. A total of 11 percent of these former nonsmokers declared themselves to be current cigarette smokers (meaning they had smoked cigarettes in the past 30 days).

Of those who had not smoked water pipe tobacco, 20 percent started smoking cigarettes and 5 percent declared themselves current smokers.

Of the non-cigarette smokers who had also used snus at the start of the study, 55 percent started smoking and 25 percent said they were current smokers. Among the nonsmokers who weren’t using snus at the beginning, 20.5 percent started smoking and 5 percent said they were current smokers.

“Our study demonstrates that [water pipe tobacco smoking] and snus use among non-cigarette smoking adolescents and young adults were [tied to] subsequent cigarette smoking,” Dr. Soneji and colleagues wrote.

Statistics from the 2012 National Youth Tobacco Survey (NYTS) revealed that hookah use among young people had gone up. Among high school students, 5.4 percent were using hookah in 2012 — compared to 4.1 percent in 2011.

The Centers for Disease Control and Prevention estimated that 2.5 percent of high school students were using snus in 2012.

Dr. Soneji and team remarked that teens and young adults may use these tobacco products because of their appealing added flavors. They added that water pipe tobacco remains largely unregulated by the FDA, and snus is less regulated than other smokeless tobacco.

“Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking,” Dr. Soneji and colleagues wrote.

This study was published online Dec. 8 in JAMA Pediatrics.

The National Cancer Institute and the National Center for Advancing Translational Sciences funded the research. The authors disclosed no conflicts of interest.

Review Date: 
December 8, 2014
Last Updated:
December 9, 2014