University at Buffalo Study Shows Increases in Hookah Use Across Three Indicators

Jessica Kulak

Published April 27, 2018

“It may indicate the demographics of those who use hookah are shifting.”
Jessica Kulak, PhD, Postdoctoral Fellow
Department of Community Health and Health Behavior

A paper published in March by researchers at the University at Buffalo and Rutgers shows significant increases in hookah use across three indicators – those who have never used hookah, those who currently do, and those smoke hookah frequently.

The study, published in the American Journal of Health Behavior, was led by Dr. Jessica Kulak. Dr. Kulak is a postdoctoral fellow in the Primary Care Research Institute in the Jacobs School of Medicine and Biomedical Sciences and an alumna of the University at Buffalo School of Public Health and Health Professions. She published the paper with co-authors from the Rutgers University School of Public Health and Roswell Park Comprehensive Cancer Center in Buffalo.

The findings, Dr. Kulak says, indicate that public health officials may need to consider broadening their tobacco prevention efforts beyond traditional cigarettes.

The study examined patterns and trends of hookah use among public high school students in New Jersey. The Rutgers School of Public Health has collected the New Jersey Youth Tobacco Survey (NJYTS) biennially since 1998. Questions about hookah use were introduced in 2008; Dr. Kulak analyzed four waves of NJYTS from 2008 to 2014.

Overall, 23.6 percent of New Jersey high school students had ever used hookah in 2014, significantly higher than the nearly 18 percent who reported ever using it in 2008, Dr. Kulak and her colleagues reported.

In 2014, past 30 day hookah use (11.8 percent) was as high as e-cigarettes (12.1 percent) and higher than other tobacco products. Among all high school students, frequent hookah use increased from 1.6 percent in 2008 to 2.9 percent six years later.

Researchers noted significant increases among girls and Hispanics, which is inconsistent with some previous studies that report data on ‘current’ hookah use among youth. “It may indicate the demographics of those who use hookah are shifting,” Dr. Kulak said. “However, previous reports on findings by demographics do show mixed results.”

“Whereas previous work exists examining trends in current product use, this is the first study to provide an assessment of the patterns and trends of hookah products, in a representative sample, across three different indicators – ever, current and frequent use,” adds Dr. Cristine Delnevo, director of the Center for Tobacco Studies at Rutgers School of Public Health. “Most surveillance data do not include enough detail to look at trends in ever or frequent product use, but these are important indices to consider.”

Dr. Kulak and her colleagues cite a variety of factors that may be contributing to the popularity of hookah among teens. For example, hookah tobacco is taxed at a lower rate than cigarettes, and it’s sold in a variety of flavors, many of which have been banned in cigarettes. Many hookah users also believe that it’s not as harmful as other tobacco products.