The study appears in the "First Look" online version of American Journal of Public Health.

Researchers say the increased popularity of the hookah -- a water pipe used for smoking tobacco -- may be caused by the social nature of the behavior coupled with the misguided belief that it is less harmful than cigarettes.

"This rise is particularly alarming because it's happening in California, a state that leads the nation in tobacco control," said Wael Al-Delaimy, MD, PhD, associate professor and chief of the Division of Global Health in the UCSD Department of Family and Preventive Medicine. "While cigarette smoking has decreased nationwide and in California, reports of ever using hookah have increased, especially among adolescent and young adults."

Most users report smoking hookah with many friends, according to Al-Delaimy. "Though public indoor cigarette smoking is banned throughout California, hookah use is permitted in designated lounges. This may create the impression that hookah is a safer alternative to cigarettes, which is simply not true."

The UCSD research team used data from the state-wide California Tobacco Surveys that are led and directed by Al-Delaimy. This data on hookah is the largest representative sample on hookah use collected at different points in time from the same source population.

Study results showed that from 2005 to 2008, hookah use among all adults increased by more than 40 percent; and by 2008, hookah use in California was much higher among young adults -- 24.5 percent among men, 10 percent among women -- than it was among all adults -- 11.2 percent among men, 2.8 percent among women.

Al-Delaimy's team also found that hookah smoking among men and women was more common among non-Hispanic Whites, with at least some college education. Unlike cigarette smoking -- where those with higher education smoke less -- hookah use is higher among those who are more educated.

"More specific studies are warranted but we urge policymakers to consider laws that would ban hookah lounges, thus eliminating the implication that hookah smoking is safer and more socially acceptable than cigarette smoking," said Al-Delaimy.

In addition to Al-Delaimy, the research team includes Joshua Smith, PhD, MPH, UCSD Department of Family and Preventive Medicine; Tomas E. Novotny, MD, MPH, San Diego State University; Steven D. Edland, PhD, UCSD Department of Family and Preventive Medicine; Richard Hostetter, PhD, San Diego State University; and Suzanne P. Lindsay, PhD, MSW, MPH, San Diego State University. Data collection for the California Tobacco Survey was funded through a contract with the California Department of Health Services.

Note: If no author is given, the source is cited instead.

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