Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users

We surveyed hookah users in all cafes that provided hookah to its customers in downtown San Diego, California and nearby areas. A total of 235 hookah users participated in this study.Average age of study participants was 22 years, 57% were males, and 72% were not cigarette smokers. Whites were more likely to use hookah than the other ethnic groups (33%), older hookah users (26-35 years) were mostly males, and mint flavor of hookah tobacco was the most popular among a wide variety of flavors (23%). There was no significant difference in gender in relation to the wrong perception that hookah is less harmful than cigarettes, but those of Asian ethnicity were much less likely than other ethnic groups to believe that hookah is less harmful than cigarettes. More frequent users of hookah were more likely to believe that hookah is less harmful than cigarettes. The majority of hookah users (58.3%) believe hookah is less harmful than cigarette smoking.Compared to cigarettes, there appears to be a lack of knowledge about the harmfulness of smoking hookah among users regardless of their demographic background. Education about the harmfulness of smoking hookah and policies to limit its use should be implemented to prevent the spread of this new form of tobacco use.Lung cancer is the leading cause of cancer mortality in the world [1]. Cigarette smoking cause up to 87% of lung cancer deaths worldwide and is estimated to cause up to 90% of lung cancers in the United States [2-4]. Smoking is also responsible for cancers of larynx, oral cavity, pharynx, esophagus, and bladder [4,5]. Moreover, continued smoking increases resistance to cancer therapy in lung cancer patients [6,7]. The smoke from tobacco contains more than 60 carcinogens of both radioisotopes and chemicals [8] that in additional to cancer can cause several respiratory ailments and increase in respiratory infections. Nicotine contained in cigarette smoke causes a depression in the immune response to malignant growths in