CDC: Adolescents Curious, Susceptible to Hookah Smoking

January 23, 2019, 06:15 am News Staff – Hookah smoking has increased among young people. And nearly three out of 10 adolescents who have never smoked a hookah or water pipe (6.9 million youth) reported curiosity or susceptibility about using a hookah; these percentages were highest among those who had used other tobacco products.

The end result: There hasn't been an overall change in tobacco product use among middle and high school students.

According to the CDC, "curiosity" refers to an interest in tobacco products, even in the absence of intention to use tobacco; "susceptibility" is the development of beliefs about future tobacco use behaviors, which may inform the likelihood of experimentation or establishment of use.

The presence of curiosity or susceptibility can help identify adolescents who may progress from nonuse to experimentation or established tobacco use, the agency said.

The CDC said few studies previously assessed curiosity about or susceptibility to hookah smoking.

Existing studies that focused on young adults or college-age populations suggested that people susceptible to hookah-smoking are more likely to be male, use other tobacco products, have reduced perceptions of the harmfulness and addictiveness of hookah smoking, and believe that smoking a hookah is socially acceptable.

However, current young adult hookah smokers started earlier than this age group -- at a median initiation age of 17.4 years.

"Because curiosity and susceptibility are precursors to tobacco use, it is important to monitor these constructs among youth," the CDC said in the study.

Curiosity

To assess curiosity, the NYTS asked respondents: "Have you ever been curious about smoking tobacco in a hookah or water pipe?" Response options were "definitely yes," "probably yes," "probably not" and "definitely not."

To be consistent with previous studies, the CDC categorized curiosity as highly curious (definitely yes, probably yes), somewhat curious (probably not) or not curious (definitely not).

The study noted that respondents who answered "probably not" were at greater risk of smoking than those who said "definitely not."

The CDC found that among students who had never used tobacco products, 14.6 percent were curious about hookah smoking; 6.2 percent (1.1 million youth) were highly curious about hookah smoking and 8.4 percent (1.5 million youth) were somewhat curious.

More high school students (7.9 percent) than middle school students (4.7 percent) said they'd been highly curious about hookah smoking. This was also the case with girls (7.9 percent) versus boys (4.4 percent), and Hispanic students (9.1 percent) and non-Hispanic black students (9 percent) compared to non-Hispanic white students (4.3 percent).

Those who responded they were "highly curious" were also more often students who perceived hookah smoking as less addictive than cigarettes (20.6 percent), as causing little or no harm (17.8 percent) or who perceived that more than 20 percent of their peers smoked a hookah (11.1 percent).

Students who disagreed that all tobacco products are dangerous had an increased prevalence of high hookah curiosity (12.8 percent), the CDC said.

The study also found that among students who had ever used other tobacco products, the percentage of those curious about hookah smoking (45.9 percent), highly curious (25.7 percent) and somewhat curious (20.2 percent) were all higher than never-tobacco users.

High curiosity about hookah smoking was more prevalent among current users of other tobacco products (34.6 percent) than among those who currently did not use tobacco products (21.4 percent).

High curiosity also was more prevalent among students who perceived hookah smoking as less addictive than cigarette smoking (41 percent) than those who perceived it as equally addictive (27.6 percent) or more addictive (18.3 percent).

Susceptibility

Susceptibility was assessed in the study using three questions:

• "Do you think you will try smoking tobacco in a hookah or water pipe soon?"
  
• "Do you think you will smoke tobacco in a hookah or water pipe in the next year?" and
  
• "If one of your best friends offered you a hookah or water pipe with tobacco, would you try it?"

These questions were combined into a susceptibility index, which has been validated as a predictor of smoking initiation.

Response options for each question were "definitely yes," "probably yes," "probably not" and "definitely not."

The CDC said tobacco susceptibility measured the lack of a firm commitment not to use tobacco products.

Therefore, the agency defined susceptibility as a response of "definitely yes," "probably yes" or "probably not" to at least one question. Respondents who answered "definitely not" to all questions were defined as "not susceptible."

Susceptibility to hookah smoking was reported by 15.6 percent of students (2.8 million) who had never used tobacco products.

The CDC said the prevalence of susceptibility was higher among high school students (18.5 percent) than among middle school students (13 percent). This was also the case among girls (17.9 percent) compared to boys (13.2 percent); among non-Hispanic black students (19.1 percent) and Hispanic students (22.5 percent) compared to non-Hispanic white students (12.5 percent); and among those reporting any tobacco product use by a household member (19.1 percent) compared to those who did not (14.5 percent).

An increased prevalence of hookah susceptibility also was observed among students with reduced perceptions of hookah smoking as harmful (no/little harm, 37.3 percent; some harm, 19.7 percent) versus those who perceived greater associated harm (8.3 percent).

This increased susceptibility also was present among those who believed hookah smoking was less addictive than cigarette smoking (37.9 percent) versus those who believed it was equally addictive or more addictive (both at 17.8 percent).

Among students who ever used tobacco products, 52.5 percent (3.1 million) reported being susceptible to hookah smoking, the study said.

Susceptibility was greater among high school students (54.4 percent) than among middle school students (47.6 percent); among non-Hispanic white students (53.5 percent) and Hispanic students (56.4 percent) than among non-Hispanic black students (43.2 percent); and among current users of tobacco products (about 65 percent) than among nonusers (46.5 percent).

A higher prevalence of susceptibility to hookah smoking was observed among students with low perceptions of hookah smoking as harmful (no/little harm, 72.2 percent; some harm, 58.7 percent) versus those who perceived it as harmful (a lot of harm, 33.3 percent); among students who perceived hookah smoking as less addictive than cigarette smoking (69.7 percent) versus those who perceived it as equally addictive (57.5 percent) or more addictive (46.7 percent).

The CDC concluded in its study that curiosity and susceptibility may be critical factors that increase the risk of hookah smoking among youth.

"These findings reinforce the importance of campaigns aimed at educating youth about the dangers of all forms of tobacco product use, particularly combustible tobacco products such as hookah," it said. "Additionally, continued surveillance of curiosity about hookah smoking and susceptibility to its use among youth can inform public health policy, planning and practice."

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