Policy Implications and Research Recommendations: A Review of Hookah Use Among US College Students

Abstract

The rate of Hookah use among college students during the last decade is about 30%. Although college students perceive hookah use as a safer alternative to conventional cigarettes, hookah use increases the risk of disease and nicotine dependence, and therefore remains an area of concern. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. This review attempts to assess empirical literature relating to hookah use while focusing on the consequences for regulatory policy. PubMed (including MEDLINE 2010-2017), PsycINFO, EBSCO, Scopus (Elsevier) databases were examined to pinpoint articles published in English. The following terms were used in the searches: Hookah or Waterpipe or nargile or "arghile" or "shisha" or "hubble bubble" or "alternative tobacco product" or "flavored tobacco". Hookah use may initiate smoking among tobacconaïve college students. College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior. In addition, few public health messages target college-age adults with anti-hookah messages. A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of "safety" which inadvertently may imply a suggestion of no need for safety measures. Hence, a research agenda that would inform about health policy actions has been proposed.

Waterpipe smoking and subsequent cigarette and e-cigarette use: a cohort study

“…Students perceive waterpipe use as a safer alternative to conventional cigarettes [ 21 ]. In addition, few public health messages target the population with anti-waterpipe messages.…”

Nicotine Use During Pregnancy: Cessation and Treatment Strategies

“…21 In addition to nicotine exposure, hookah users are exposed to carbon monoxide, oxidants, heavy metals, and phenols, which can lead to increased heart rate and blood pressure, impaired pulmonary function, nicotine dependence, chronic bronchitis, emphysema, and coronary artery disease. 22,23 The decreased oxygen deliverance has effects that expand more broadly with animal models, suggesting an increased likelihood of low birth weight, neonatal death, and growth restriction. 24 Studies have also demonstrated a greater risk of altered fetal autonomic cardiac regulation and nicotine withdrawal in neonates born to individuals who used electronic nicotine delivery systems during pregnancy.…”

“…Data from animal models have shown that nicotine intake in any form can cross the placenta and adversely affects fetal lung development 21 . In addition to nicotine exposure, hookah users are exposed to carbon monoxide, oxidants, heavy metals, and phenols, which can lead to increased heart rate and blood pressure, impaired pulmonary function, nicotine dependence, chronic bronchitis, emphysema, and coronary artery disease 22,23 …”