Water-Pipe Tobacco Smoking: An Emerging Health Risk Behavior in Adolescents in the United States

Walid Abuhammour1, 2, Nida Yousef3, Joyvina Evans4, Rudayna Zureikat4, Mutaz Abuhammour4, Rashed A. Hasan5, *
1 Department of Pediatric Infectious Disease, Hurley Medical Center, Michigan State University, Flint, MI, USA
2 Pediatric Infectious Diseases, Hurley Medical Center, Flint, MI, USA
3 Hurley Medical Center – Michigan State University, College of Human Medicine, Flint, MI, USA
4 Hurley Medical Center, Flint, MI, USA
5 University of Toledo Medical School, St. Vincent Mercy Children’s Hospital, Toledo, OH, USA

© 2009 Abuhammour et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University of Toledo Medical School, St. Vincent Mercy Children’s Hospital, 2213 Cherry St., Toledo, OH 43608, USA; Tel: 419-251-4855; Fax: 419-251-3264; E-mail:



To assess the attitude and practices of adolescents regarding water-pipe smoking (WPS) in a predefined ‘perceived’ high risk group of youth 12-18 years of age in the Detroit metropolitan area.


This was a cross-sectional survey (conducted March1st through June 30th, 2008) in which participants completed a self-reported questionnaire, which included demographics, WPS, other types of smoking, and their perception about the hazards of WPS.


A total of 272 [85% response rate (272/320] surveys were completed. One hundred and sixty seven (61%) were WPS “users”. Fifty-six (22%) used WPS at home, 34 (13%) at coffee shops, 74 (29%) at both locations, and 3 (1%) at other locations. Relative to non-users, WPS users were more likely to be cigarette smokers (OR = 1.7, unadjusted OR = 2.5, p < 0.05), to have someone else in the household who uses WPS (OR = 2.2), to believe that WPS is safe (OR = 1.4, unadjusted OR = 2.0) and that WPS is less harmful than cigarettes (OR = 1.2 unadjusted OR = 1.6, p<0.05). In addition WPS use was associated with less likelihood of believing that one may acquire an infection (OR = 0.9) and that the toxicity of the inhalants was equivalent to cigarette smoking (OR = 0.8).


WPS represents a growing public health issue for adolescents in the US. Aggressive education of adolescents is essential in combating the misperception associated this form of smoking.

Keywords: Water-pipe smoking, argile, shisha, hoka.