Florida-based hookah research group achieves 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 collaboration of tobacco control experts called Hookah and E-cigarette Health Communication Groupfocused on Florida, nearing the end of an important first step in research to understand the impact of placing health warning labels on hookah products on reducing hookah consumption among young people adults. The University of Miami in partnership with Florida International University leads the effort with expert advice from across the country.

There is considerable misinformation about the dangers of hookah use that the public is unaware of, especially young people. Also, since many people use the hookah in “hookah lounges” and restaurants, they often do not see warning labels on the packages as 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 provide important health information to consumers.

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

Although many users believe it to be 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 Tobacco and hookah smoke contain several toxic agents known to cause lung, bladder and mouth cancer.5.6 During a typical hour-long hookah smoking session, users can inhale 100 to 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 passing through water, hookah smoke contains high levels of these toxic agents.[9] Second-hand smoke from hookahs can be a health risk for people who don’t smoke. It contains tobacco smoke, as well as smoke from the heat source (eg, charcoal) used in the hookah.10,11,12

“The social appeal of hookah, especially among teenagers and young adults, cannot be underestimated. Hookah lounges are very attractive to young consumers because they can hang out with friends, it’s relatively cheap and is perceived as a low-risk activity that still has an edgy element, 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 of these products and our research on health warning labels will help to understand how best to communicate these risks.”

Health warning labels are one of the most effective tobacco control strategies for communicating the risks of smoking, and studies have consistently shown that health warning labels are associated with decreased smoking rates. and tobacco-related morbidity and mortality. Given the existing information, our project emphasizes the importance of developing new health warning labels for hookah products to increase awareness not only locally, but also nationally and internationally. Studying the effects of health warning labels can allow us to advance risk communication and suggest innovative ideas to policy makers.

The first round of research on students’ attitudes and behaviors towards hookah and health warning labels is nearing completion, with a study to be published by September 2022. The first research project, “Developing and testing water pipe-specific health warning labels targeting youth in Florida“, is funded by the James and Esther King Biomedical Research Program of the Florida Department of Health. This project aims to develop and test a set of illustrated health warning labels for hookah products.

“The health warning labels have been tested in focus groups and confirm that there is a lack of awareness of the dangers of hookah use,” said Wasim MaziakPh.D., Professor in the Department of Epidemiology at Florida International University. “More importantly, when hookah users see health warning labels, their behavior changes, especially their use of the product decreases, which supports our view that warning labels should be on hookahs themselves.”

About Hookah and E-Cigarette Health Communication Group

The Hookah and E-cigarettes Health Communication Group is a collaborative group of tobacco control specialists and investigators from 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 (M. Abrams; Golin), youth anti-tobacco campaign expert (Dr Vallone; Truth Initiative), health communications specialist University of Memphis (Dr. Schmidt), legal counsel to the FDA (Mr. Lindblom), tobacco product regulatory scientist (Dr. Eissenberg), and national and international authority on health communications for tobacco products, with a focus on on electronic 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


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

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

4 Shihadeh A. Main smoke aerosol investigation of clay 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].

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

8 World Health Organization. Tobacco Regulatory Advisory Note. Waterpipe: health effects, research needs and recommended actions by regulators external icon. Geneva (Swiss): 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].

ten American Lung Association. Hookah factsexternal icon Washington: American Lung Association, 2007. [accessed 2022 July 12].

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

12 World Health Organization. Tobacco Regulatory Advisory Note. Waterpipe: health effects, research needs and recommended actions by regulators external icon. Geneva (Swiss): World Health Organization, Tobacco Free Initiative, 2005. [accessed 2022 July 12].

SOURCE Hookah and E-Cigarette Health Communication Group

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