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College students have smoked hookah pipes as much as cigarettes, poll shows

The portion of respondents who have smoked Cigarettes at least once, 39.6 percent, was virtually the same as hookah smokers. The study is the first random sample of U.S. university students to address hookah smoking, long practiced in the Middle East, North Africa and Central and South Asia. Participants were invited by e-mail to complete the online hookah use survey. The results are available online in the Annals of Behavioral Medicine at www.springerlink.com. "I'd say the most surprising (finding) is that the proportion who ever used (hookahs) is every bit as common as cigarette use," said Dr. Brian Primack, lead author of the study and an assistant professor of medicine and pediatrics at Pitt's medical school. Perhaps More troublesome, though, was the finding that 35.4 percent of those who had smoked tobacco in a hookah had never smoked a cigarette. "I think that's a key finding," Primack said. "There's an overlap in a lot of people (who have smoked both) but there were over a third of the people smoking water pipes who would otherwise have never touched a cigarette. ... "(Hookahs) are reaching a group of young people who otherwise would have been nicotine- and tobacco-naive. ... We don't really know what the implication of that is. Some people might say that it wouldn't make a difference: Somebody who is exposed to a few water pipe sessions, that might not change their risk of later using tobacco products. But I think there are a lot of researchers who would be concerned and say that even intermittent exposure at this age to nicotine and tobacco will increase their likelihood of becoming addicted to nicotine and continuing to the same." That is the similar worry of Dr. Steven Shapiro, chairman of the medicine department in the medical school and of the Center for Reduced Smoking and Exposure. "I'm worried that it's going to be an introduction to the tobacco world and they'll become true cigarette smokers," he said. But 78.8 percent of the surveyed group that said it has smoked water pipes in the past year thought the devices were less addictive than Cigarettes. "That addictiveness finding was also surprising, how unconcerned they are about addictiveness," Primack said. Another surprise, he said, was a stated intent to try a water pipe in the future among 92 (20.5 percent) of the 449 students who had not yet smoked from a water pipe. He noted a similar openness would not be expected among non-cigarette and non-marijuana smokers to try those smoking methods. The tobacco smoked in a hookah, called shisha, often is flavored and sweetened with molasses or honey. Perhaps for that reason, 46.7 percent of those students who had smoked hookah in the past year thought it was less harmful than Cigarettes. That sentiment was shared by Manoj Kintali, Abhishek Parikh and Sukriti Grover, Carnegie Mellon University students sharing an afternoon hookah over chess recently in Pittsburgh They said they don't go to hookah bars all that frequently but smoke hookah almost daily at their apartments. Kintali, 19, and Parikh, 20, smoke Cigarettes, though Grover, 21, does not, and all three said they considered hookah less harmful. "Hookah doesn't have tar and all that crap in it," Parikh said. But health organizations disagree. In 2007, the World Health Organization warned that hookah smoking is "not a safe alternative to cigarette smoking." On its Web site, the American Cancer Society says: "(Hookah) is marketed as being a safe alternative to Cigarettes because the percentage of tobacco in the product smoked is low. This claim for safety is false. The water does not filter out many of the toxins. In fact, hookah smoke contains More toxins such as nicotine, carbon monoxide, tar and other hazardous substances than cigarette smoke." "We don't know much about long-term consequences," Primack said. "Some studies from the Middle East have them associated with various cancers and respiratory diseases, but there's been nothing really substantial (yet)."