America's Hookah-Smoking Teens Are Wealthy and White

Photograph by Dan Gill/The New York Times via Redux

The rate of teen cigarette use has been declining in the U.S. for two decades, but public health officials have been worried about kids experimenting with additional forms of tobacco smoking. A study (PDF) in the journal Pediatrics underscores a teenage shift to the hookah, a communal water pipe that originated in the Middle East and South Asia. Eighteen percent of high school seniors had smoked a hookah within the past 12 months, according to a survey of 5,540 students.

The bubbling devices can now be found in suburban basements and college dorm rooms, and hookah lounges have proliferated in recent years. Smoking from a hookah carries many of the same risks as cigarettes. With water pipes not as portable, hookah users are unlikely to smoke as frequently as regular cigarette smokers—unless they never leave their dorm rooms.

Who’s puffing? Demographic traits generally linked to higher rates of cigarette smoking were linked to lower rates of hookah use. “Well-known risk factors for cigarette use among adolescents, such as lower socioeconomic status and lower parental education, unexpectedly were associated with lower rates of hookah use,” the authors wrote. Instead, teens whose parents were better-educated and those with cash from jobs or other sources were more likely to be hookah smokers. Whites and Hispanics were far more likely than blacks to have sampled a hookah. Further risk factors are more predictable: Teens already experimenting with cigarettes, pot, and alcohol are more frequent hookah smokers.

Some of the disparity may stem from the expense of going out to smoke a hookah. “Given the cost of frequenting hookah bars, it is not surprising that wealthier students, as indicated by higher weekly income, are more regular visitors, although it remains unknown what proportion of hookah use occurs in hookah bars versus in homes or other noncommercial settings,” the authors wrote.

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