More and more Florida high school students are trying hookah - water pipes used for smoking tobacco, according to a new study.
"Hookah smoking is associated with a host of smoking-related health problems including but not limited to cardiovascular disease, oral disease, cancer and decreased (lung) function," said Adrienne J. Heinz, a postdoctoral research fellow at the Stanford University School of Medicine in California.
"Hookah and cigarette smoke contain many of the same toxins," she said.
Heinz studies alcohol and drug use patterns and was not involved in the Florida study.
The Florida Youth Tobacco Survey, given to a random sample of public high school students in the state, showed about one in six teenagers reported ever having tried hookah in 2012. That was up from one in nine in 2007.
A study of the data, published in Nicotine & Tobacco Research, found the proportion of teens that currently use hookah has held steady at about 8 percent, however. The research was led by Tracey E. Barnett from the University of Florida in Gainesville.
Each year between 4,000 and 40,000 students filled out surveys.
Although girls were less likely than boys to have tried hookah in 2007, they seem to have caught up by 2012.
The proportion of boys who ever tried hookah rose from 12 percent to 17 percent over the five-year period. For girls, hookah use increased from 9 percent to almost 17 percent.
Hispanic students were most likely to have tried smoking hookah, with 22 percent reporting having used it when surveyed in 2012. That compares to 19 percent of white students and 5 percent of black students.
Eleven percent of Hispanic students were currently smoking hookah in 2012, also higher than rates among white or black students.
"Since its use can pose significant health risks, hookah smoking is a trend that is of concern not only in Florida but also in communities across the United States," said Kymberle Sterling, from the Georgia State University School of Public Health in Atlanta.
Sterling is a federally funded tobacco control researcher who studies hookah and cigarillo smoking among youth and young adults. She was not part of the new research.
"There is some preliminary evidence to suggest that hookah may serve as a 'gateway' for other forms of tobacco use among individuals who would otherwise remain tobacco naïve," Heinz wrote in an email. But the connection deserves more study.
Flavored tobacco fermented in molasses and fruit extracts called "maassel" is commonly sold in hookah cafes and smoke shops and is far more palatable than other forms of tobacco, she said. That might make hookah appealing to younger consumers who wouldn't otherwise use tobacco products.
"We must never forget that tobacco dependence is a disease with a pediatric age of onset," Thomas Eissenberg, co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond, said. He did not participate in the new research.
"With hookah in particular, we know that the smoke contains many of the same poisons that are in cigarette smoke and that young people are unaware of this fact," Eissenberg told Reuters Health in an email.
"As we see youth hookah use rise, we know to step up our efforts so that, just as many young people avoid cigarettes because they are deadly, they will also avoid hookah use."
Most states require that customers in hookah lounges be 18 or older to enter.
"The most alarming aspect of hookah smoking is that it's commonly perceived as being harmless and even safe - and a far better alternative to cigarette smoking," Heinz said.
"When these positive expectations and cultural norms go uncorrected, teens will of course be more likely to experiment without first considering the health risks."