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    Hookah Smoking Popular Among Well-Heeled Teens

    Survey found one in five high school seniors had tried it; being affluent, well-educated raised risk

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    Teens who smoked cigarettes (or used to) also were more likely to have tried hookahs, as were those who drank alcohol or used illicit drugs.

    The investigators noted that hookah smoking often requires that users pay to enter a "hookah bar," a financial barrier that might explain its greater popularity among those with more disposable income.

    That said, the team stressed that the larger concerns are twofold: that hookah smoking is often mistakenly perceived as safer and less addictive than cigarettes, and that hookah use may ultimately serve as a "gateway" to cigarette smoking.

    "What I find risky about hookah," said Palamar, "is [the] perception of it being safer than cigarettes."

    "More research is needed, but right now it appears that a lot of hookah use is more ritualistic. A lot of users appear to use only occasionally with friends, for example, in hookah bars. And not everyone inhales," Palamar noted. "Cigarette use tends to be much different. For example, we generally don't have employees stepping out of work to take quick hookah breaks."

    But Palamar stressed that, regardless, "adolescents need to be educated about the potential harms associated with [hookah] use, so they will be able to make informed decisions about use."

    Dr. Norman Edelman, a senior medical consultant for the American Lung Association and a professor of medicine at the State University of New York at Stony Brook, said the bottom line is that "hookah smoking is not safe."

    "It is dangerous," he noted. "The big myth is that because the smoke bubbles up through water it's somehow purified and safe. But lots and lots of studies have shown that the smoke users inhale contain all the toxic compounds that are inhaled smoking a cigarette. And the other thing is that when people smoke they often do it for a long time, for like an hour or so. So they get a lot of it. And that means that just one session with a hookah appears to be equivalent to smoking a whole pack of cigarettes."

    "So it's not surprising that this is becoming more popular among urban kids who have the money for this and are looking for new ways to get a thrill or act out," Edelman added. "But it's a popularity based on delusion."

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