US suffering flavor blur

| April 12, 2018

The findings of two recently-published studies on the emergence of hookah use in the US indicate that public health officials might need to consider broadening their tobacco prevention efforts beyond traditional cigarettes, according to a story by David J. Hill of the University of Buffalo, US, published on

“Taken together, the results from these two studies underscore the important role hookah has played in the tobacco product landscape,” Jessica Kulak, the lead author on both papers, was quoted as saying. Kulak, PhD, is a postdoctoral fellow in the Primary Care Research Institute of the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Kulak published both papers as part of her dissertation through collaborations with colleagues at the Rutgers University School of Public Health and Roswell Park Comprehensive Cancer Center.

The first study, published in March in the American Journal of Health Behavior, examined patterns and trends of hookah use among public high school students in New Jersey.

The findings were said to have shown significant increases in hookah use across three indicators – those who had ever used hookah, those who were currently using hookah and those who smoked hookah frequently.

Overall, 23.6 percent of New Jersey high school students were found to have ever used hookah in 2014, significantly higher than the nearly 18 percent who reported ever using it in 2008, Kulak and her colleagues reported.

In 2014, past 30-day hookah use (11.8 percent) was said to be as high as e-cigarette use (12.1 percent) and higher than other-tobacco-product use. Among all high school students, frequent hookah use increased from 1.6 percent in 2008 to 2.9 percent six years later.

Kulak and her colleagues cited a variety of factors that might be contributing to the popularity of hookah among teens. For example, hookah tobacco was taxed at a lower rate than were cigarettes, and it was sold in a variety of flavors, many of which had been banned in cigarettes.

Many hookah users believed also that it was not as harmful as other tobacco products.

Kulak’s second dissertation-based paper, also published in March in Substance Use & Misuse, looked at hookah’s role in nicotine product initiation among college students.

For this study, Kulak surveyed 832 college students in Western and Central New York. Among study participants who reported having used a nicotine product at some point, 25 percent said hookah was the first product they had tried. Only combustible cigarettes (39.5 percent) were reported more frequently.

Among students who ever smoked cigarettes, most reported these as their introductory product. Nearly half of the students who had never smoked cigarettes reported that hookah was the first tobacco product they smoked.

This study suggested also that hookah users were less likely than were combustible-cigarette smokers to use multiple tobacco products – such as combustible cigarettes, cigars and chewing tobacco.

Based on the findings of the two studies, Kulak said public health agencies might need to consider revising the surveys and other data collection instruments they used to account more accurately for hookah use.

In addition, she said, there were opportunities for further regulation by the US Food and Drug Administration, especially banning flavors in hookah tobacco.

The full story is at:


Category: Breaking News, Flavoring, OTP, Regulation

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