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  1. Health

USF study shows college students believe hookah smoking safer than cigarettes

TAMPA — He never drinks alcohol or smokes cigarettes, but Wathik Bouslimi makes an exception to his otherwise moderate lifestyle: hookah smoking.

Bouslimi, a 32-year-old software engineering student at Strayer University, was smoking apple-flavored tobacco through a hookah — a traditional metal water pipe with a mouthpiece at the end of a flexible hose — as he studied at Kahwa Hookah Lounge near Busch Gardens one recent afternoon. He enjoys hookah smoking but has few illusions about its risks.

"Oh, it's not healthy," he said with a chuckle.

He's right. But not everyone knows it.

A recent University of South Florida study found numerous misconceptions about the risks of hookah smoking. More than half of the nearly 500 undergraduate and graduate students surveyed said they believed it was less harmful than cigarette smoking. More than a quarter either thought hookah smoking was not harmful or didn't know for sure.

The long-term health risks of hookah use are not clear. But existing research shows that hookahs deliver tar, nicotine and carbon monoxide in even higher doses than cigarettes.

One session of hookah use exposes smokers to as much as six times the levels of carbon monoxide in a single cigarette, the USF study notes. A study last month found high levels of benzene — a chemical in crude oil and gasoline — are present in hookah smokers and nonsmokers after they attend social events where the water pipes are used, according to a journal of the American Association for Cancer Research.

"This isn't a safe alternative to smoking," said Jaime Corvin, a USF public health professor and an author of the report, published this month by a journal of the U.S. Centers for Disease Control and Prevention.

The USF study is more evidence that we still don't have a good handle on so-called alternatives to cigarette smoking. This month, another survey found that American teenagers are now more likely to use electronic cigarettes than traditional cigarettes, a trend driven by the belief that e-cigarettes are less harmful.

E-cigarettes have exploded in popularity partly because they're marketed as being safer than regular cigarettes. They usually contain nicotine, solvents and flavoring. But because little research has been done on these battery-operated devices, many public health advocates say consumers can't be entirely sure what they're inhaling.

Hookah smoking is an ancient practice common in Middle Eastern cultures. Globally, more than 100 million people do it regularly. In the past decade, an estimated 3,000 hookah cafes opened just in the United States, the USF study says.

University students are a prime target for hookah cafes. More than 90 percent of the USF students surveyed reported having a hookah bar within 10 miles of their homes. Nearly 55 percent said they had used a hookah at least once.

Corvin said the precise reasons for the misconceptions aren't clear, but researchers have some ideas after talking with students.

For one, hookah smoking is seen as a social activity. More than 30 percent of the USF students who had not smoked using a hookah reported that they might try it one day. Among their reasons: socializing with friends. Hookah smoking is often done in groups, with the same mouthpiece passed from person to person.

That presents a significant challenge for public health advocates trying to curb hookah smoking. "It's a really fun activity, unfortunately," Corvin said.

Other factors suggest, incorrectly, that hookah smoking is healthier than cigarettes. Many hookah lounges are licensed as retail tobacco stores, exempting them from Florida's smoking regulations, Corvin noted. So seeing people smoke hookah in public places where cigarettes would be off-limits may imply that hookah smoking is safe for the public.

Some hookah smokers acknowledge that their practice isn't healthy, but say they don't smoke hookah as often as people smoke cigarettes. "I see people who smoke cigarettes and they get hooked," said Bouslimi, who says he routinely goes a month without smoking with a hookah. "With this (hookah), you don't get addicted."

Though the survey suggests students who don't smoke cigarettes may feel okay about indulging in hookah smoking, the study also contains an almost contradictory finding: Students who smoke cigarettes were likely to also practice hookah smoking. Alcohol and hookah smoking, by contrast, were not strongly associated. Many hookah bars serve coffee and tea instead of alcohol.

The USF study was unfunded. Corvin's students in a global health course came up with the idea of looking at hookah use and helped conduct the research.

Contact Jodie Tillman at or (813) 226-3374. Follow @jtillmantimes.