Kymberle Sterling, DrPhil MPH

Waterpipe, or hookah, smoking, has become increasingly popular among young people. In 2010, the nationwide Monitoring the Future study found that 17 percent of 12th graders said they had used hookahs in the past year. The hookah heats specially-made tobacco, which comes in a variety of sweet flavors, and then passes the smoke through a bowl of water. The smoker then draws this tobacco smoke through a mouthpiece connected to the pipe by a rubber hose. Because of the way a hookah is used, smokers may absorb higher concentrations of the same toxins found in cigarette smoke. In fact, a person smoking a hookah for one hour inhales 100 to 200 times the volume of smoke inhaled from one cigarette. Dr. Kymberle Sterling is using an American Lung Association Social Behavioral Research Grant to study college students' perceptions of hookah smoking and the effect of hookah advertising on those perceptions. She is also exploring the prevalence of hookah use in this group.

"Unbeknownst to most of the general public, hookah smoking carries many of the same health risks as cigarettes."

People who use hookahs are also at risk for the same diseases caused by cigarettes, including cancer of the lung, mouth and esophagus. "Some people incorrectly believe that the water filtration process in hookah smoking makes it less harmful, and that toxins are removed as the smoke passes through the water," she says. "Because the sweetened tobacco used is less irritating and provides a more pleasant smoking experience than cigarettes that adds to the perception that it's safer to smoke."

Dr. Sterling's two-year study will be broken into three phases. In the first phase, she will analyze ads about hookah use to see what types of messages are being promoted; followed by holding eight focus groups of six to eight students to decipher beliefs about hookah use and advertising. For those who are hookah smokers, she will ask why they started using hookahs, why they continue to use them and if they use other tobacco products, to see if there appears to be a relationship between hookah smoking and use of other tobacco products. In the final phase of the project, Dr. Sterling will use the information gained to develop survey measures to help estimate the prevalence of hookah use, attitudes and beliefs about hookah smoking, and college students' exposure to hookah ads and promotions.

"We hope results from this study will inform the public health community about the prevalence of hookah use among college students, and the impact hookah ads have on rates of use," she says. "This information can be used to develop evidence-based public health interventions to reduce hookah use among young people."