The offset of traditional tobacco use has been supplanted by the rise of the hookah. A new study is out confirming earlier results that white males who have used tobacco in the past are likely to use the device. It also confirmed that hookah use is correlated with kids of higher socioeconomic status. That means, living in a bigger city, better educated parents and higher incomes.

Study author Joseph Palamar talked about the new association of traditional smoking and alternative tobacco products such as the hookah. “When it comes to cigarette smoking, at least now, we tend to think of it as more associated with lower socioeconomic status and lower parental education.”

With a hookah, the use becomes cost prohibitive for many. Though that begs the question, aren’t cigarettes nearly cost prohibitive in this age of excise taxes? “Given the cost of frequenting hookah bars, it is not surprising that wealthier students, as indicated by higher weekly income, are more regular visitors, although it remains unknown what proportion of hookah use occurs in hookah bars versus in homes or other noncommercial settings.”

Smoking as a whole is on the decline. While 40% admitted to trying cigarettes in 2012, the number dropped to 38% in 2013. This issue with alternative tobacco products is the perception they are safer than regular cigarettes. The FDA is already rushing studies on e-cigarettes, and evidence already exists on both e-cigarettes and hookahs that shows it is a complete misconception.

The CDC has released reports that show the tobacco used in hookahs, known as shisha, can deliver nicotine, tar and carbon monoxide in higher doses than cigarettes. That pretty much shatters any notion that is a safe alternative to cigarettes. Even non-tobacco products used in hookahs have been shown to carry toxic agents that increase a user’s risk of developing smoking-related cancers, lung disease and heart disease.

It doesn’t help that the entire basis of hookah is set up as a gathering of friends. The whole process has become a trend to have hookah parties. The industry is capitalizing on the new base of customers and are developing fashionable hookah sticks, or e-hookahs.

Public health advocates are pushing for greater awareness in schools and elsewhere to show the dangers of using alternative tobacco products.

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