More and more U.S. college students are smoking tobacco using waterpipes – or hookahs – and it's becoming a growing public health issue, according to a new study led by a Virginia Commonwealth University researcher.

The findings offer important insight into the prevalence and perceptions related to waterpipe tobacco smokers and are reported in the May issue of the Journal of Adolescent Health.

"These results should serve as an alarm bell to anyone interested in public health in the United States. Preventing tobacco-caused death and disease means remaining alert to new forms of tobacco smoking and then understanding the health risks of these new forms and communicating these risks to public health workers, policy makers, and to smokers themselves," said principal investigator Thomas Eissenberg, Ph.D., associate professor in the VCU Department of Psychology.

In a hookah, tobacco is heated by charcoal, and the resulting smoke is passed through a water-filled chamber, cooling the smoke before it reaches the smoker. Some waterpipe users perceive this method of smoking tobacco as less harmful and addictive than cigarette smoking.

According to Eissenberg, current and prospective waterpipe tobacco smokers should be made aware that waterpipe tobacco smoking is not as benign as they might think. Waterpipe and cigarette smoke contains some of the same toxins -- disease-causing tar and carbon monoxide, as well as dependence-producing nicotine. Additionally, the exposure to these toxins through waterpipe smoking may be greater due to longer periods of use.

Further, smokers take more and larger puffs with waterpipes, leading to inhalation of 100 times more smoke from a single waterpipe use episode relative to a single cigarette.

Through a cross-sectional study, approximately 744 students, mostly between the ages of 18 and 21, completed an Internet survey that included questions about demographics, tobacco use, risk perceptions and perceived social acceptability.

The research team found that approximately 43 percent of those surveyed had smoked tobacco using a waterpipe in the past year; and 20 percent of them had smoked tobacco using a waterpipe in the past month. Users were more likely to perceive waterpipes as less harmful than cigarettes compared to those who had never used a waterpipe before.

"The data we report, along with data from other schools, show that waterpipe tobacco smoking is common on college campuses across the country. Thus, prevention messages, especially those that communicate the potential risks of waterpipe tobacco smoking, should focus on college campuses."

In future studies, Eissenberg and his team hope to examine the prevalence of this method of tobacco use in a large, national sample of waterpipe tobacco smokers in the United States, and assess potential health risks and dependence-producing effects. In the future, researchers may be able to determine the role that waterpipe use among youth may serve as a 'gateway' for use of other tobacco products or psychoactive substances.

This work was supported by grants from the National Cancer Institute, The National Institute on Drug Abuse, and the Fogarty International Center.

The Journal of Adolescent Health is the official journal of The Society of Adolescent Medicine.