Dual cigarette and waterpipe users more likely to develop dependence, tobacco-related diseases

People who smoke both cigarettes and waterpipes - dual users - lack sufficient knowledge about the risks of tobacco smoking and are at considerable risk for dependence and tobacco-related diseases, such as cancer, heart disease and stroke later in life, according to findings of a new study by Virginia Commonwealth University.

The study, the first of its kind to assess trends in cigarette and waterpipe tobacco smoke based on long-term data, reveals few users perceive dangers of waterpipe tobacco. A common misconception about waterpipe smoking is that it is not as harmful as cigarette smoking.

In the past several years, a marked increase in waterpipe tobacco smoking, also known as hookah, has occurred among college students, especially those who did not smoke cigarettes before. While waterpipe smoking also can attract non-cigarette smokers, recent evidence has shown that a significant proportion of current cigarette smokers are using waterpipes, making them dual users of these tobacco products.

In a study, published online this week in the Journal of American College Health, researchers found that dual users - people who smoke both cigarettes and waterpipes - may have an increased exposure to nicotine, increased risk for tobacco dependence and are less likely to quit tobacco use.

"We often assume that everyone, including college students, is knowledgeable about the health risks associated with tobacco smoking," said principal investigator Aashir Nasim, Ph.D., National Institute on Minority Health and Health Disparities scholar and associate professor of psychology and African American studies in the VCU College of Humanities and Sciences.

"This simply isn't true, especially in relation to waterpipe tobacco smoking. Surprisingly, many hold the belief that waterpipe tobacco smoking is less harmful than cigarette smoking because the water filters out the 'bad stuff,'" he said.

According to Nasim, the team observed that although cigarette smoking among college students has declined since 2006, waterpipe tobacco smoking has increased substantially -- by about 20 percent -- among non-cigarette smokers, and waterpipe tobacco smoking prevalence has remained relatively unchanged among current cigarette smokers. About 10 percent of cigarette smokers also use waterpipe, he said.

Secondly, the team found that compared to exclusive cigarette smokers or exclusive waterpipe users, dual cigarette and waterpipe users report being more susceptible to peer influences and perceive the probability of addiction associated with waterpipe tobacco smoking to be relatively low.

The team is now examining other types of dual use - for example, dual cigarette and cigar use - on college campuses. This work is being done in collaboration with Danielle Dick, Ph.D., associate professor of psychiatry, psychology and human and molecular genetics at VCU, and her Spit for Science research team.