NEW YORK - Wealthier high school students may be more likely to try smoking hookah, according to a new study.
The water-pipe device with its series of tubes and mouthpieces looks nothing like a cigarette, but is often used to smoke tobacco, and as such carries many of the dangers inherent in cigarette smoking.
Researchers at New York University Langone Medical Center analysed data from questionnaires given to several thousand high school seniors every year from 130 public and private schools in 48 states.
The survey first added questions about hookah use in 2010. The current results include responses from about 5,500 students in 2010, 2011 and 2012 combined.
About 18 per cent of students reported having tried hookah in the past year, according to results published July 7 online in Pediatrics.
White and Hispanic students were considerably more likely to have tried hookah than their black classmates, as had been found in other studies. Students who lived in urban areas and had parents with higher education levels were also more likely to have tried hookah.
Finally, hookah use was more common among kids with higher weekly incomes and those who smoked cigarettes, drank alcohol or used other illicit substances.
"We have found similar findings for cocaine - students with more money are more likely to use," said lead author Joseph J. Palamar.
"My second answer is that cigarette smoking has become a stigmatised behaviour over the last decade and it now tends to be associated with lower socioeconomic status," Palamar told Reuters Health in an email. "Hookah, however, doesn't appear to have the same 'lower class' stigma that is now being applied to many cigarette smokers."
It is also possible that hookah bars and their advertising, which are often located near college campuses, are aimed at more affluent and educated youth, noted coauthor Dr. Michael Weitzman.
Cigarette use is on the decline among US youth but the decline is offset by a rise in alternative forms of tobacco, including hookah, according to a report from the Centers for Disease Control and Prevention cited in the new study.
In many state legislatures, the definition of smoking does not explicitly include hookah, which leads to some hookah bars being exempt from smoke-free laws and minors allowed in hookah establishments and near smoking paraphernalia.
"Recent work by our group indicates high levels of multiple hazardous chemicals and particulate matter in the indoor air of NYC hookah bars," Weitzman said.
"Evidence suggests that hookah use may actually be more addictive and more harmful than cigarettes," he told Reuters Health in an email. "A single water pipe session can equate to smoking 20 or more cigarettes and yield greater levels of nicotine, tar and (carbon monoxide) than cigarettes."
Other studies have linked hookah smoking to decreased lung function and lung cancer and to lower birth weights among the babies of pregnant smokers, he said.
"Kids understand that cigarettes are really a bad thing for you and contain lots of properties that are dangerous to you," said tobacco researcher Charlie Saunders of Florida State University College of Medicine in Tallahassee. "They switch to tobacco alternatives many times because they think they are less harmful and they also have large concentrations of nicotine."
But the flavorings in "shisha" make it easier to inhale, so hookah can actually be more effective at getting nicotine into the body, Saunders, who was not part of the new study, told Reuters Health.
"No, smoking hookah a couple times or once in a while isn't as dangerous as smoking cigarettes every day," Palamar said. "But it is a habit we need to get our teens to avoid."