Parents, Teach Your Children Well.

Hookah smoking is rapidly increasing in popularity in the United States, particularly among urban youth, college students, and young professionals. The most common prevalence is among ages 18–24 y. Alarmingly, some studies suggest there is significant use among middle and high school students as well.1 Hookahs are water pipes that are used to smoke tobacco heated by charcoal. Hookah tobacco comes in many different enticing flavors and is also known as narghile, arghileh, shisha, hubble-bubble, and goza. Hookah smoking is a social event, typically done in small groups among people who share the mouthpiece. New forms of hookah smoking recently introduced to the marketplace include steam stones and hookah pens. These devices use battery power to turn liquid containing nicotine, flavorings, and other chemicals into a vapor that is inhaled. The health risks of charcoal-heated tobacco during hookah smoking are well known, but very little is known about the risks of electronic hookah smoking.2 The study reported in this issue of RESPIRATORY CARE by Calvanese et al3 reveals disturbing facts about the lack of parental understanding of the dangerous health effects of hookah use among their college-age children attending a private college in the Southeast United States. Although hookah smokers are likely to heed their parents’ message, these parents misunderstand hookah smoking, making them ill-prepared to advise their children of the health dangers. Regrettably, most national and state surveys of tobacco use do not include hookah use as a data point, so information and public awareness are limited. Adding to the lack of understanding is the rapidly changing marketplace that provides consumers with a wide assortment of increasingly diverse products that deliver nicotine with or without combustible tobacco. As the investigators suggest, increased awareness among parents and children—and I would add, the general public—is desperately needed. Many misconceptions exist about hookah-smoking health risks. Targeted education must be provided to stop the dramatic rise in hookah use in the United States. It is imperative that parents have appropriate information to teach their children about these hazards. First, parents should teach their children that hookah smoking has the same health risks as cigarette smoking, plus additional risks that smoking does not have. The perception of safety and harm reduction has been disproven by studies that documented the presence of toxicants and carcinogens in water-pipe smoke.4 An hour-long hookahsmoking session involves 200 puffs of burned tobacco, compared with 20 puffs when smoking one cigarette. The amount of smoke inhaled during a typical hookah session is 90,000 mL, compared with 500–600 mL inhaled when smoking one cigarette.1 Thus, the occurrence of adverse health effects primarily on the respiratory and cardiovascular systems noted by documented cases of coronary artery disease, obstructive pulmonary disease, and increased