VCU Study Reports Patterns of Use, Beliefs and Attitudes of Waterpipe Smokers

By Sathya Achia Abraham

Smoking tobacco through a waterpipe, also called a hookah, is popular among young, educated Americans, who in addition to using the waterpipe, also use cigarettes and alcohol, according to a new study led by a Virginia Commonwealth University researcher.

The findings offer important preliminary information about patterns of use, beliefs and attitudes related to waterpipe tobacco smokers in the United States, and are reported in the February issue of the journal, Nicotine & Tobacco Research.

"Our results indicate that daily waterpipe tobacco smoking is a concern in the United States. These findings impact our understanding of waterpipe tobacco smoking because they begin to document the spread of waterpipe tobacco smoking among young people in the United States," said principal investigator Thomas Eissenberg, Ph.D., associate professor in the VCU Department of Psychology.

"Our ability to prevent waterpipe tobacco smoking and to educate young people about it is improved when we know who is using it and why," he said.

According to Eissenberg, more than 18 percent of respondents used waterpipe tobacco daily. Additionally, 44 percent of respondents reported waterpipe sessions lasting 60 minutes or more – which is the same time as lengthy waterpipe smoking episodes reported in the Middle East. The team also noted that most waterpipe users believed that this method of smoking tobacco was less harmful and addictive than cigarette smoking.

"Daily waterpipe use is a potential indicator of nicotine dependence," he said. "Relative to a single cigarette, consumed in five minutes, a 45-minute waterpipe smoking episode is associated with as much as 100 times the smoke and up to 50 times the toxins," said Eissenberg.

Approximately 200 waterpipe tobacco smokers in two convenience samples; one from a waterpipe café in Richmond, Va., and the other from an Internet forum devoted to waterpipe tobacco smoking completed an electronic questionnaire. The questionnaire included 56 items regarding demographics, waterpipe use knowledge, attitudes, behaviors and smoking patterns as well as use of other psychoactive substances such as cigarettes, alcohol and marijuana.

Eissenberg and his team hope to conduct a more detailed study that would include a larger, randomly sampled group of waterpipe tobacco smokers in the United States to further understand this behavior and develop appropriate prevention strategies.

Waterpipes originated hundreds of years ago and were popular in Southwest Asia and North Africa, primarily among men who used them to smoke tobacco in cafes, where they gathered and talked. After falling out of favor, the popularity of hookahs started to increase again in the late 1990s and usage has spread to big cities and college towns in the United States.

In a hookah, tobacco is heated by charcoal, and the resulting smoke is passed through a water-filled chamber, cooling the smoke before it reaches the smoker.

This work was supported by grants from the National Cancer Institute, The National Institute on Drug Abuse, and the Fogarty International Center. Nicotine & Tobacco Research is the official journal of the Society for Research on Nicotine and Tobacco.

Eissenberg, who is director of the VCU Clinical Behavioral Pharmacology Laboratory and a researcher with the VCU Institute for Drug and Alcohol Studies, collaborated with Stephanie Smith-Simone from the Center for Health and Wellbeing, Princeton University and Robert Wood Johnson Foundation; Wasim Maziak and Kenneth D. Ward, both from the Department of Health and Sport Sciences and Center for Community Health, University of Memphis; and Syrian Center for Tobacco Studies in Aleppo, Syria. Staff and students with the VCU Clinical Behavioral Pharmacology Laboratory assisted with data collection.