Should family physicians question younger patients on hookah, e-cigarettes use?

Physicians need to questions their younger patients not only about if they smoke, but what they smoke. A new report suggests that children as young as middle school-aged are smoking e-cigarettes and hookah, which are often believed to be safer alternatives to regular cigarettes.

The Centers for Disease Control and Prevention (CDC) reports a 30% increase in hookah usage in high school students from 2011 to 2012, and a 50% increase in e-cigarettes usage in middle and high school girls, and middle school boys. In 2012, 6.7% of middle school students reported using a tobacco product, with more than half of them using cigarettes. More than 23% of high school students say they use a tobacco product-14% smoke cigarettes.

“While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes,” the CDC states in its assessment of the 2012 National Youth Tobacco Survey (NYTS).

Hookah smoking is a social activity, and usually occurs in groups at hookah bars and cafes, where people pass around a tube to inhale charcoal-heated tobacco in flavors such as strawberry, cherry, mint, and apple. Studies that measure hookah usage vary, but it is estimated that between 22% and 40% of college students have smoked hookah in the past year. According to the NYTS, adult smokers begin their habit before the age of 18.

A one-hour hookah session involved up to 200 puffs, compared with only 20 puffs of the average cigarette. The high heat of the tobacco mixed with the additional toxins from charcoal can lead to the same risks of oral, lung, stomach, and esophageal cancers, as well as reduced fertility and lung function.

There is also an increase risk of heart disease, low birth weight in pregnant women, and respiratory and dental disease associated with hookah and other types of tobacco use. The communal nature of hookah also increases the spread of infectious disease.

The CDC suggests that hookah products should be subjected to the same type of regulation as tobacco products, and more public education efforts should be made to grow awareness of the dangers of hookah.

Hookah goes by several names, including shisha, waterpipe, goza, and narghile. Many alternative tobacco products, including hookahs and e-cigarettes, are available to for purchase online, and marketed for low prices via social media, so regulating the age of buyers and the safety of the product has been difficult for government agencies.

In 2012, the CDC says 1.78 million middle and high school students tried e-cigarettes, which are battery-powered devices, and often odorless as they dispense nicotine via a heated aerosol. They are often flavored as well, and can contain irritants and carcinogens, though they don’t contain tobacco. Because e-cigarettes are not regulated by the Food and Drug Administration, the exact makeup of the nicotine-dispensing aerosol may vary depending on the manufacturer.