Cigarette smoking among teenagers and young adults has dropped, but e-cigarettes and a rise in hookah smoking pose a threat to these health gains. UC San Diego professor of epidemiology Wael Al-Delaimy is examining trends in e-cigarette and hookah use, aiming to increase public education about their dangers and urging lawmakers to regulate their sales.
Al-Delaimy directs the California Tobacco Surveys, a statewide project, ongoing since 1990, that studies California residents' behaviors, attitudes and beliefs relative to tobacco. The data are used by policy makers, public health officials and community organizations to further tobacco control.
E-cigarette use now exceeds traditional cigarette smoking among teenagers, according to a 2014 survey funded by the National Institute on Drug Abuse. Al-Delaimy is concerned that e-cigarette smokers believe that these products are better than other tobacco products because they will help them quit. That isn't necessarily true, according to his research.
Safe to vape?
E-cigarette fans say that e-smoking can help smokers kick the habit. But Al-Delaimy has published research that concludes the opposite. His 2014 study published in the American Journal of Public Health followed 1,000 California smokers for more than a year. The results revealed that smokers who used e-cigarettes were 49% less likely to decrease cigarette use and 59% less likely to quit altogether than were smokers who never used e-cigarettes.
"We should be very cautious about e-cigarettes and not propagate their use," Al-Delaimy said.
The Center for Environmental Health, an Oakland-based health watchdog group, cited Al-Delaimy's study on e-cigarettes and reduced likelihood of quitting tobacco in its September report, "A Smoking Gun," which calls out the e-cigarette industry for deceptive labeling and marketing practices. The report showed that the majority of 97 e-cigarettes and other "vaping" products tested produce high levels of the cancer-causing chemicals formaldehyde and acetaldehyde.
"Our results show conclusively that it's not safe to vape," said Charles Margulis, the center's media director. Even nicotine-free e-cigarettes produce high levels of formaldehyde and acetaldehyde, according to the report.
Not happy about hookah
Al-Delaimy is extending his tobacco research to hookah use, a trend he said is serious and harmful and one that merits more attention from researchers and legislators. Hookah smokers use a water pipe to inhale sweetened or flavored tobacco that is heated with charcoal and filtered through water.
A hookah-smoking session typically lasts 45 to 60 minutes, much longer than smoking one cigarette or a few cigarettes a day, according to Al-Delaimy. This prolonged, concentrated exposure to hookah tobacco smoke delivers high levels of chemicals linked to lung disease, heart disease and cancer, he said.
Al-Delaimy and colleagues from UC San Diego and San Diego State University surveyed 689 San Diego high school students about hookah use. A quarter of the students surveyed said they had smoked hookah. Of those, 10% said they were currently using hookah. Half of the students learned about hookah from a friend, and 20% of the students said they learned about hookah from seeing a hookah lounge. In this and another earlier study on hookah, Al-Delaimy found that hookah users believed hookah is safer than cigarettes.
Hookah bars and lounges are legal in California, and using a loophole in the laws, they're exempt from state laws that forbid smoking in public places because these lounges claim they operate as tobacco shops and private smokers' lounges.
This feeds into a false impression that hookah smoking is less harmful than cigarettes or other tobacco products, Al-Delaimy said. Casual acceptance of hookah smoking potentially dismantles more than two decades of progress in lowering tobacco-related disease and death in California. Al-Delaimy advocates stricter regulation of hookah bars and lounges as part of an aggressive continuation of tobacco control in California.
Increase costs to decrease use
A bill to raise the cigarette tax in California by $2 a pack would include e-cigarettes in the hike, a move Al-Delaimy supports. Introduced by state Sen. Richard Pan (D-Sacramento), SB 13 is expected to produce $1.5 billion in revenue the first year if passed, money slated for smoking cessation programs, health services for low-income families and tobacco-related medical research.
"Tax is consistently associated with decreased consumption, especially among the younger population," Al-Delaimy said.
He predicted that the measure will face well-funded opposition from the tobacco industry. California is poised to make history as the first state where less than 5% of the population smokes, he said, but the rise in other forms of tobacco use may derail that goal.
"The battle with tobacco and its addictive components is far from over," he said.