Young Adult Hookah Smokers Research Articles

Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults.

Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs. This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults. Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment (n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures. There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone. Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco. This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.

Results of a Single Arm Pilot Study of a Mobile Messaging Intervention for Hookah Tobacco Cessation in Young Adults.

Background:Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation.Objectives:This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers.Methods:Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants’ hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention.Results:Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant (P < .05) increases in risk perceptions (d’s = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment.Conclusions:These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.

Development and Pretesting of Risk-Based Mobile Multimedia Message Content for Young Adult Hookah Use.

Background. Hookah is one of the most commonly used tobacco products among U.S. young adults due in part to widespread misperceptions that it is not harmful or addictive. There is growing evidence that hookah tobacco is associated with health harms and can lead to addiction. Research on interventions to address these misperceptions by communicating the harms and addictiveness of hookah use is needed. Aims. This study developed and pretested mobile multimedia message service (MMS) message content communicating the risks of hookah tobacco use to young adult hookah smokers. Method. Message content, delivery, and pretesting were tailored to participants' risk beliefs, hookah use frequency, and responses to simulated text message prompts. Participants viewed 4 of 12 core MMS messages randomized within-subjects and completed postexposure measures of message receptivity and emotional response (e.g., worry). Results. The sample included 156 young adult (age 18-30 years) hookah smokers; 31% smoked hookah monthly and 69% weekly/daily. Prior to viewing messages, a majority endorsed beliefs reflecting misperceptions about the risks of hookah tobacco. Postexposure measures showed participants were receptive to the messages and the messages evoked emotional response. As anticipated, messages produced similar receptivity and there were few differences in emotional response between the messages tested. Discussion. Young adult hookah tobacco smokers were receptive to tailored mobile MMS messages and messages evoked emotional response, two critical precursors to behavior change. Conclusion. Findings indicate that research testing the efficacy of tailored MMS messaging as a strategy for reducing hookah tobacco use in young adults is warranted.

Acute Effect of Hookah Smoking on Arterial Stiffness and Wave Reflections in Adults Aged 18 to 34 Years of Age

Hookah (waterpipe) smoking is rapidly increasing in popularity worldwide. Despite being heavily advertised in the media as a healthier alternative to cigarettes, the toxicology of hookah smoke suggest otherwise. Cigarette smoking unequivocally causes an acute increase in arterial stiffness, but whether hookah does the same is unknown. In 48 young healthy habitual hookah but not cigarette smokers, we measured heart rate, peripheral and central blood pressure, carotid-femoral pulse wave velocity (measure of arterial stiffness), aortic augmentation index (measure of wave reflection), plasma nicotine, and exhaled carbon monoxide before and after ad lib hookah smoking. Hookah smoking increased heart rate by +16 ± 1 beats/min and mean brachial arterial pressure by +6 ± 1 mm Hg (both p <0.05, mean ± SE). Most importantly, it increased carotid-femoral pulse wave velocity and aortic augmentation index by +0.66 ± 0.09 m/s-1 and +8.76 ± 3.99%, respectively (p <0.05, mean ± SE), denoting increased acute arterial stiffness. These vascular effects were accompanied by increases in plasma nicotine concentration (+5.8 ± 1.2 ng/ml, p <0.05) and expired carbon monoxide (+25.44 ± 1.68 ppm, p <0.05). All these parameters were unchanged during time-control studies (n = 14). Thus, in contrast to effective media marketing of hookah as a safer alternative to cigarettes, the present study shows for the first time that in young adult hookah smokers, a single hookah smoking session causes an acute increase in arterial stiffness of comparable magnitude to what has been previously reported for cigarettes. Further research is warranted to determine whether habitual hookah smoking accelerates the age-dependent development of hypertension and its cardiovascular complications.

Hookah Smoking Causes an Acute Adverse Effect on Arterial Stiffness and Wave Reflections in Young Adults

Hookah (waterpipe) smoking is a centuries‐old, revived yet understudied epidemic of tobacco use. Despite being heavily advertised and glamorized in the media as a healthier alternative to cigarettes, the toxicology of hookah smoke suggest otherwise. Cigarette smoking unequivocally causes an acute increase in arterial stiffness, but whether hookah does the same is unknown. In 48 young healthy habitual hookah but not cigarette smokers, we measured heart rate, peripheral and central blood pressure, carotid‐femoral pulse wave velocity (measure of arterial stiffness), aortic augmentation index (measure of wave reflection), plasma nicotine, and exhaled carbon monoxide (CO) before and after 30 minutes of ad lib hookah smoking. Hookah smoking increased heart rate by +16 ± 1 beats/min and mean brachial arterial pressure by +6 ± 1 mmHg (both p &lt; 0.05, mean ± SE). Most importantly, it increased carotid‐femoral pulse wave velocity and aortic augmentation index by +0.66 ± 0.09 m/s−1and +8.76 ± 3.99%, respectively (p &lt;0.05, mean ± SE), denoting increased acute arterial stiffness. These vascular effects were accompanied by increases in plasma nicotine concentration (+5.8 ± 1.2 ng/ml, p&lt;0.05) and expired CO (+25.44 ± 1.68 ppm, p&lt; 0.05). All these parameters were unchanged during time‐control studies (n=14). Thus, in contrast to effective media marketing of hookah as a safer alternative to cigarettes, the present study shows for the first time that in young adult hookah smokers, a single hookah smoking session causes an acute increase in arterial stiffness of comparable magnitude to what has been previously reported for cigarettes. Further research is warranted to determine whether habitual hookah smoking accelerates the age‐dependent development of hypertension and its cardiovascular complications.Support or Funding InformationThis study was funded by the Tobacco‐Related Disease Research Program to Dr. Mary Rezk‐ Hanna (#23DT‐0102) and Dr. Ronald Victor (#22XT‐0017).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Hookah Smoking Does Not Constrict Human Coronary Microvessels

Hookah (water pipe) smoking has reached epidemic proportions due to unregulated social media marketing to young adults as a safer avant‐garde alternative to cigarettes. In contrast, much is suspected by tobacco researchers—yet little is proven—about hookah's putative health risks. What distinguishes hookah from all other tobacco products is that burning charcoal is used to heat the tobacco. As a result, hookah smoke delivers a large acute exposure not only to carbon monoxide (CO) but also to fine and ultrafine particles, charcoal combustion products that have been suggested—but unproven—by the air pollution and tobacco literature to constitute putative coronary vasoconstrictor stimuli. To test if hookah smoking constricts human coronary microvessels, in 28 young adult hookah smokers (age 27±5 years, mean±SD, 8 women, 20 men) we used myocardial contrast echocardiography (MCE) perfusion imaging with intravenous lipid shelled microbubbles to measure myocardial blood flow and its two components, microvascular flux rate (β) and functional capillary blood volume (A), and measured myocardial oxygen consumption (MVO2 = (7.2 × 10−4) x (heart rate x systolic blood pressure) + 1.42) as well as exhaled CO and plasma nicotine before and immediately after 30 minutes of ad lib hookah smoking in a custom‐built smoking chamber. With hookah smoking, exhaled CO increased from 3.0±0.4 to 25±2.2 ppm (mean ±SE, p&lt;0.001 pre‐vs. post‐hookah), which approximates the CO boost of a typical ad lib hookah smoking session in hookah bars and indicates an exposure to fine and ultrafine particles that is 10 times greater (and to total particles that is 250 times greater) than that with cigarette smoking. On MCE, myocardial blood flow (A x β) did not decrease but rather increased acutely with hookah smoking (88±10 to 120±19 a.u.·s−1, p=0.02). The increased perfusion matched the mild hookah‐induced increase in MVO2 (6.5±0.3 to 7.6±0.4 ml·min−1, p&lt;0.001), indicating physiologic vasodilation, and was manifested primarily by increased microvascular flux rate (0.7±0.1 to 0.9±0.1 s−1, p=0.01) with unchanged capillary blood volume (133±7 to 137±7 a.u., p=ns), a pattern of coronary microvascular response seen previously with a mild b‐adrenergic agonist. Moreover, the increased MVO2 and accompanying decrease in heart rate variability were accompanied by increased plasma nicotine (0.9±0.1 to 7.8±1.3 mg/mL, p&lt;0.001) and almost completely eliminated by intravenous propranolol, documenting b‐adrenergic mediation. Thus, under these experimental conditions, mainstream hookah smoke either is not an acute coronary vasoconstrictor stimulus or one that is too weak to overcome the physiologic dilation of coronary microvessels caused by mild nicotine‐induced cardiac b‐adrenergic stimulation and/or pharmacologic dilation caused by carbon monoxide.

Acute Effect of Hookah Smoking on the Human Coronary Microcirculation

Hookah (water pipe) smoking is a major new understudied epidemic affecting youth. Because burning charcoal is used to heat the tobacco product, hookah smoke delivers not only nicotine but also large amounts of charcoal combustion products, including carbon-rich nanoparticles that constitute putative coronary vasoconstrictor stimuli and carbon monoxide, a known coronary vasodilator. We used myocardial contrast echocardiography perfusion imaging with intravenous lipid shelled microbubbles in young adult hookah smokers to determine the net effect of smoking hookah on myocardial blood flow. In 9hookah smokers (age 27 ± 5years, mean ± SD), we measured myocardial blood flow velocity (β), myocardial blood volume (A), myocardial blood flow (A× β) as well as myocardial oxygen consumption (MVO2) before and immediately after 30minutes of ad lib hookah smoking. Myocardial blood flow did not decrease with hookah smoking but rather increased acutely (88 ± 10 to 120 ± 19 a.u./s, mean ± SE, p=0.02), matching a mild increase in MVO2 (6.5 ± 0.3 to 7.6 ± 0.4ml·minute(-1), p <0.001). This was manifested primarily by increased myocardial blood flow velocity (0.7 ± 0.1 to 0.9 ± 0.1second(-1), p=0.01) with unchanged myocardial blood volume (133 ± 7 to 137 ± 7 a.u., p=ns), the same pattern of coronary microvascular response seen with a low-dose β-adrenergic agonist. Indeed, with hookah, the increased MVO2 was accompanied by decreased heart rate variability, an indirect index of adrenergic overactivity, and eliminated by β-adrenergic blockade (i.v. propranolol). In conclusion, nanoparticle-enriched hookah smoke either is not an acute coronary vasoconstrictor stimulus or its vasoconstrictor effect is too weak to overcome the physiologic dilation of coronary microvessels matching mild cardiac β-adrenergic stimulation.

Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study.

Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults. Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah. Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors. For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.

Hookah smoking among young adults in southern California.

Hookah (water pipe) smoking is a form of tobacco use, historically from the Middle East and India that is fueling a contemporary epidemic of tobacco abuse and a nationwide public health crisis, particularly among young adults. There is little information on factors influencing hookah smoking and health beliefs of hookah smokers. Guided by the health belief model, the purpose of this study was to assess young adult hookah smokers' perceptions, attitudes, beliefs, and preferences toward hookah smoking and identify factors that may influence heavy (>3 times per week) versus light hookah smoking. A cross-sectional design was used for this study. Participants were recruited at hookah lounges in southern California. A sample of participants who smoke hookah and were between 18 and 30 years of age completed a short survey about their perceptions, attitudes, beliefs, initiation, and frequency of hookah smoking. Characteristics of light and heavy hookah smokers were compared using t tests and chi-square tests. Content analysis was used to analyze qualitative data. Participants (N = 91) had a mean age of 24 (SD = 2.7), and 65% were men; 24% reported smoking before the age of 18, and 73.6% of participants smoked more than once a week. Men were heavier smokers in comparison to women (p = .006), 57% believed that hookah was not harmful to their health, and 60% reported socialization as the main reason why they smoked hookah. It is critical to advocate for greater research on the health effects of hookah smoking and dissemination of these findings to the public, particularly to young adults.