Smoking tobacco with a water pipe increasingly popular among women

Smoking tobacco using a water pipe - also called a hookah -- generally is viewed in a more positive light than smoking cigarettes, particularly for women, according to one of the first studies on water pipe and cigarette smoking to look at social attitudes and gender.

The study, published in the April issue of Preventive Medicine, involved two surveys that were given last year to 587 male and female students at Aleppo University in Syria and 268 customers at Aleppo cafes and restaurants that permit customers to smoke using hookahs filled with fruit-flavored tobacco. The surveys found that hookah users, especially women, were particularly enthusiastic about what they viewed as the hookah's positive aspects, including its traditional, familiar, social and attractive look.

The surveys were conducted by the Syrian Center for Tobacco Studies, a National Institutes of Health-funded tobacco-control research center that involves collaboration among researchers from Virginia Commonwealth University, the Aleppo School of Medicine and the University of Memphis. They included four, nine-item questions about participants' views of hookah and cigarette smoking by men and women. The nine items were: "Safe," "Personal decision," Tradition abiding," "Looks familiar," "Looks energetic," "Sign of social status," "Looks balanced," "Looks attractive," "Looks social."

Although this study focused on water pipe smoking in the Eastern Mediterranean region, tobacco-control experts in the United States are interested in the results because of the recent spread of the hookah bar fad across the United States, particularly among college students and young adults, and the potential health effects of the nicotine exposure. Little is known about social attitudes and perceptions related to water pipe use and how those attitudes and perceptions might be influenced by gender.

"Water pipe smoking was declining in the Middle East two decades ago, but it is on the rise again, particularly among Arab-American adolescents," says Thomas Eissenberg, Ph.D., associate professor of psychology and head of VCU's Clinical Behavioral Pharmacology Laboratory. Eissenberg was an author on the study.

"Water pipe smoking may be associated with significant health risks, and we only now are beginning to accumulate information on this issue," Eissenberg said. "There also has been little research on the social attitudes related to water pipe smoking that might help us develop ways to intervene and curb its spread."

Water pipes originated in the Middle East hundreds of years ago and were popular 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 Middle East in the late 1990s and 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. Some water pipe users believe that this method of smoking tobacco delivers less tar and nicotine than regular cigarette smoking and has fewer adverse health effects because of the filtering effect of the water.

Eissenberg, however, says initial research on the health effects of water pipe smoking indicates that it can increase carbon dioxide and nicotine exposure and heart rate and may contribute to coronary heart disease and different cancers.

"The water pipe is another method of tobacco use, one that we should not ignore as we fight the tobacco epidemic," Eissenberg said. "Past experience has taught us that ignoring the epidemiology and health effects of tobacco-use products can lead to a public health disaster that may have been preventable."

The research is supported by a grant from the NIH's Fogarty International Center.

EDITORS' NOTE:  Dr. Eissenberg is available to discuss the potential health implications of water pipe smoking. A copy of the study is available via e-mail in PDF format or by fax. For information, please call VCU News Services at (804) 828-1231.

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