Waterpipes are popular, especially with young men

An Iranian man smokes in a coffeehouse in central Tehran March 1, 2007.

NEW YORK (Reuters Health) - Waterpipe smoking may be gaining in popularity, particularly among young men with some time and money to burn, a study of Canadian college-age adults suggests.

Waterpipes, or hookahs, have long been used for smoking tobacco in the Middle East, North Africa and parts of Asia, and "hookah lounges" have been increasingly popping up in the U.S. and other Western countries in recent years. Studies suggest they are particularly popular with college students.

In the new study, reported in the journal Pediatrics, researchers found that among 871 Montreal residents between the ages of 18 and 24, 23 percent said they had used a waterpipe in the past year.

That rate is three times that found in an earlier survey of Canadian adults in the same age group, the researchers say.

It is also similar to what some recent studies in the U.S., Australia and Europe have shown. A 2008 study of students at one U.S. university, for example, found that nearly half had ever used a waterpipe, while 20 percent had done so in the past month.

The current study adds to the picture by showing which young adults may be most attracted to waterpipe smoking: 18- to 20-year old English-speaking men from higher-income homes.

"Water-pipe users may represent a more-privileged group of young people with the leisure time, resources, and opportunities to use water-pipes," write the researchers, led by Dr. Jennifer O'Loughlin of the University of Montreal.

Waterpipe users in the study were also more likely than non-users to smoke cigarettes, binge-drink or use other drugs, particularly marijuana. Three-quarters of waterpipe users said they had smoked marijuana in the past year, versus 35 percent of non-users.

According to O'Loughlin, many of these waterpipe users may mistakenly view the habit as a "safe" way to smoke.

"The popularity of waterpipes may be due in part to perceptions that they are safer than cigarettes," she said in a written statement. "However, waterpipe smoke contains nicotine, carbon monoxide, carcinogens and may contain greater amounts of tar and heavy metals than cigarette smoke."

Waterpipes consist of a long tube attached to a glass or plastic container that holds water in its base. The tobacco, which is flavored with fruits and sugar syrup, is burned using charcoal. Because the smoke passes through the water before inhalation, waterpipe smokers commonly -- but mistakenly -- believe that the harmful substances in tobacco smoke are filtered out.

Past studies have shown that waterpipe smoking can increase heart rate and blood pressure, as well as impair lung function -- though it is still unclear how the habit might affect the long-term risks of heart disease and cancer.

While the potential public-health impact of waterpipe smoking is not yet known, O'Loughlin's team writes, "more in-depth surveillance of apparently increasing use is required."

Greater efforts to dispel the perception that waterpipes are safe may also be needed, according to the researchers.

SOURCE: Pediatrics, June 2010.