Florida-based Hookah Research Group Completes Major Research Milestone

Study funded by the State of Florida will help protect youth and adults from the dangers of hookah

MIAMI, July 18, 2022 /PRNewswire/ -- A collaborative of tobacco control experts called the Hookah and E-cigarettes Health Communication Group, centered in Florida, is nearing the end of an important first stage in research designed to understand the impact of placing health warning labels on hookah products on reducing hookah use among young adults. The University of Miami in partnership with Florida International University is leading the effort with counsel from experts across the country.

There is considerable misinformation about the dangers of hookah use that the public is not aware of, especially young people. In addition, because for many people hookah use occurs at "hookah lounges" and restaurants, they often don't see warning labels on packages because the employees prepare the hookah for their use.  Hookah lounges also benefit from a lack of regulation and oversight that limits the impact of local policies to deliver important health information to consumers.

The fact is hookah use is dangerous and addictive. Hookah smoking has been shown to be increasingly widespread among young adults in the United States, with the majority of past–30-day smokers reporting intermittent use.¹ In Florida, hookah smoking is increasing particularly among youth and young adults. Data from the Florida Youth Tobacco Survey show that hookah smoking in 2021 exceeded cigarette smoking among high school students (only behind e-cigarettes and cigars).²

Although many users think it is less harmful, studies have shown that hookah smoke contains many of the same harmful components found in cigarette smoke, such as nicotine, tar, and heavy metals.^3,4 Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.^5,6 In a typical one-hour hookah smoking session, users may inhale 100–200 times the amount of smoke they would inhale from a single cigarette.^7,8

Hookah smoke can also be harmful to non-users. Even after it has passed through water, the smoke from a hookah has elevated levels of these toxic agents.[9] Secondhand smoke from hookahs can be a health risk for people who do not smoke. It contains smoke from tobacco, as well as smoke from the heat source (e.g., charcoal) used in the hookah.^10,11,12

"The social appeal of hookah, particularly among teenagers and young adults, cannot be understated. Hookah lounges are very attractive to younger consumers because they can hang out with friends, it is relatively cheap, and is perceived as a low-risk activity that still has an edgy element to it, said Taghrid Asfar, Ph.D., Research Associate Professor of Epidemiology in the Department of Public Health Sciences at the Miller School of Medicine. "It is important that consumers understand the high risk of addiction and health consequences from these products and our research into health warning labels will help to understand how best to communicate those risks."

Health warning labels represent one of the most successful tobacco control strategies to communicate smoking-related risks, and studies have consistently shown that health warning labels are associated with a decrease in smoking rates and smoking-related morbidity and mortality. Given the information that exists, our project highlights the importance of developing new health warning labels for hookah products to increase awareness not only at the local level, but at a national and international level as well. Studying the effects of health warning labels can allow us to advance risk communication and suggest innovative ideas to policymakers.

The first round of research of college students' attitudes and behaviors toward hookah and health warning labels is nearing completion, with a study to be released by September 2022. The first research project, "Developing and testing waterpipe-specific health warning labels targeting young people in Florida", is funded by the Florida Department of Health's James and Esther King Biomedical Research Program. This project aims to develop and test a set of pictorial health warning labels for hookah products. 

"Health warning labels have been tested in focus groups and confirms there is a lack of awareness of the dangers of hookah use," said Wasim Maziak, Ph.D., Professor in the Department of Epidemiology at Florida International University. "More importantly, when health warning labels are seen by hookah users, their behavior changes, specifically, their use of the product decreases, which supports our view that warning labels need to be on the hookah devices themselves."

The Hookah and E-cigarettes Health Communication Group is a collaborative group of tobacco control advocacy specialists and investigators at the University of Miami (Dr. Asfar), Florida International University (Drs. Maziak and Bursac), Florida Tobacco Free Workgroup (Dr. Thurer), tobacco control media and advocacy specialist (Mr. Abrams; Golin), youth-oriented anti-tobacco campaigns expert (Dr. Vallone; Truth Initiative), health communication specialist from the University of Memphis (Dr. Schmidt), FDA legal advisor (Mr. Lindblom), tobacco products regulatory scientist (Dr. Eissenberg), and a national and international authority on health communication for tobacco products, with a focus on e-cigarettes (Dr. Noar). For more information visit: https://www.publichealth.med.miami.edu/research/research-labs/hookah-and-e-cigarette-health-communication-group/index.html 

¹ Gentzke AS, Wang TW, Cornelius M, Park-Lee E, Ren C, Sawdey MD, Cullen KA, Loretan C, Jamal A, Homa DM. Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021. Morbidity and Mortality Weekly Report, 2022; 71(No. SS-5):1–29. [accessed 2022 July 12].

² Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2021. [accessed 2022 July 12].

³ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, 2012 [accessed 2022 July 12].

⁴ Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food and Chemical Toxicology 2003;41(1):143–52 [accessed 2022 July 12].

⁵ Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States.external icon  American Journal of Health Behavior 2010;34(3):275–85. 2012 [accessed 2022 July 12].

⁶ Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review.external icon  International Journal of Epidemiology 2010;39:834–57. [accessed 2022 July 12].

⁷ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, 2012 [accessed 2022 July 12].

⁸ World Health Organization. Tobacco Regulation Advisory Note. Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulatorsexternal icon. Geneva (Switzerland): World Health Organization, Tobacco Free Initiative, 2005. [accessed 2022 July 12].

⁹ Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States.external icon  American Journal of Health Behavior 2010;34(3):275–85. 2012 [accessed 2022 July 12].

¹⁰ American Lung Association. Facts About Hookahexternal icon  Washington: American Lung Association, 2007. [accessed 2022 July 12].

¹¹ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, 2012. [accessed 2022 July 12].

¹² World Health Organization. Tobacco Regulation Advisory Note. Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulatorsexternal icon. Geneva (Switzerland): World Health Organization, Tobacco Free Initiative, 2005. [accessed 2022 July 12].

SOURCE Hookah and E-Cigarette Health Communication Group