Converging lines of evidence show that waterpipe (hookah) smoking has been increasing dramatically among U.S. youth. Although waterpipe smoking can lead to nicotine dependence, no study to date has documented the development and course of nicotine dependence among waterpipe smokers. A team of researchers led by Dr. Wasim Maziak of the Robert Stempel College of Public Health & Social Work at Florida International University has just published a study, Early symptoms of nicotine dependence among adolescent waterpipe smokers that tackles this issue. According to this study funded by the National Institute on Drug Abuse and conducted among a cohort of adolescents (eighth and ninth graders) in Beirut, Lebanon, symptoms of nicotine dependence such as craving, feeling addicted and failed quitting attempts develop at low levels of waterpipe use. The median tobacco usage when the first symptom emerged was 7.5 waterpipes/month, and at reaching full ICD-10 diagnosis of nicotine dependence 15 waterpipes/month. Nicotine dependence can also appear within a relatively short time after the initiation; first symptom at 10.9 months, while the full syndrome at 13.9 months of initiation.
“Our data show that symptoms of nicotine dependence among adolescent waterpipe smokers are not contingent on intensive and frequent use and can appear fairly early after initiation” said Dr. Maziak, professor and chair of the department of epidemiology at the College, adding, “While limited accessibility and intermittent use may hinder the development of nicotine dependence, the larger amounts of inhaled smoke, length of smoking session and strong social cues may facilitate nicotine dependence in waterpipe smokers.
The multi-institutional team working with Dr. Maziak on the study includes FIU Stempel College PhD student Dr. Raed Bahelah, Dr. Joseph R. DiFranza (University of Massachusetts), Dr. Fouad M. Fouad (American University of Beirut), Dr. Kenneth D. Ward (University of Memphis) and Dr. Thomas Eissenberg (Virginia Commonwealth University).