1. Among adolescents, frequency of hookah smoking is jointly linked with a) the belief that it is a common peer practice, and b) exposure to household users.
2. In general, adolescents overestimate the true prevalence of hookah smoking among their age cohort.
Evidence Rating Level: 2 (Good)
Study Rundown: Unlike other forms of tobacco consumption, hookah pipes are inherently designed to be shared in a social setting. The ornate devices are typically stationary and require preparation in anticipation of use. Additionally, the wide variety of tobacco flavors appeals to an eclectic market. Although adolescent hookah use has been studied from an epidemiological perspective, little is known about the sociological factors involved. Authors of this study sought to describe the habits and beliefs of teen hookah smokers. Adolescents answered questions in a national tobacco survey with regards to frequency and location of hookah use, beliefs surrounding harm, and the perception of prevalence. Overall, the majority of youth overestimated the prevalence of peer hookah use. Additionally, having a household member who was a hookah smoker was strongly correlated with current frequent smoking. Proving in absolute terms behavioral associations remains difficult by virtue of the cross-sectional nature of the study. However,the data highlights how perceived and actual social acceptability of hookah smoking influences behavior amongst teens. Pediatricians can incorporate these salient points into conversations about smoking during well-child visits with patients and their families.
Relevant Reading: Effects of hookah smoking on indoor air quality in homes
In-Depth [cross-sectional study]: Authors studied data from the 2016 National Youth Tobacco Survey, sampling a total of 20675 students between grades 6 to 12 in both public and private schools. Respondents were clustered by frequency of hookah use, ranging from “never” to “current frequent smoker” (smoking for at least one third of the past 30 days). Participants were asked to estimate the frequency of hookah smoking among their grade cohort, which was then matched with the true prevalence. They were also asked to comment on the location of use and whether there was a history of multi-modal tobacco consumption. For data analysis, the chi-squared test with a significance set at P <0.05 was used. 59.3% of students overestimated the prevalence of use within their particular grade. Prevalence embellishment carried an adjusted odds ratio (aOR) of 9.3 for current occasional use. The true prevalence amongst all participants of ever smoking from a hookah pipe was in fact 10.5%. Hookah smoking was found to most likely occur at a friend’s house (47.7% of the time) and living with a household hookah smoker was strongly correlated with occasional use (aOr = 20.56).
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