College students who participate in intramural or club sports are less likely to smoke cigarettes than non-athletes, but are more likely than non-athletes to smoke from a hookah, according to a University of Pittsburgh study online now in the Journal of Adolescent Health.

“This study demonstrates that many athletes clearly perceive hookah smoking as less of a concern than cigarette smoking,” said Brian Primack, M.D., Ed.M., M.S., assistant professor of medicine and pediatrics at Pitt’s School of Medicine and lead author of the study. “What they don’t realize, however, is that they are exposing themselves to many of the same toxic chemicals contained in cigarettes.”

A hookah, or waterpipe, is used to inhale tobacco that usually is flavored or sweetened. The opening of hundreds of hookah cafes in the U.S. over the past decade demonstrates the increasing popularity of hookah smoking. Although the aesthetic appeal of the practice suggests that it is not harmful, studies show that hookah tobacco smoke is just as toxic as cigarette smoke and is associated with substantial harm and addictiveness. For example, one average hookah smoking session exposes the user to 40 times the tar of a single cigarette.

Researchers at Pitt examined survey data from 8,745 college-age individuals who participated in the National College Health Assessment administered by the American College Health Association in 2008, and found that 33 percent of the respondents reported participating in varsity, club and intramural sport in the preceding 12 months. Overall, 29.5 percent of the total sample reported having smoked from a hookah. Consistent with what has been reported in the past, all types of athletes were less likely than non-athletes to smoke cigarettes. Similarly, varsity athletes were 22 percent less likely than non-athletes to have smoked tobacco from a hookah. However, club and intramural participants were each 15 percent more likely than non-athletes to have smoked tobacco from a hookah.

“Varsity athletes may be particularly cautious with any type of substance use because of the demands of their sport and the seriousness of their athletic commitment,” said Dr. Primack. “But club and intramural athletes clearly perceive this as a safer form of tobacco use. We in public health need to impress upon them that it is not.”

Co-authors of the study were Carl Fertman, Ph.D., M.B.A., Kristin Rice, M.P.H., and Michael Fine, M.D., M.Sc., all from the University of Pittsburgh; and Anna Adachi-Mejia, Ph.D., Dartmouth University.

Dr. Primack is supported with funding from the Robert Wood Johnson Foundation, the National Cancer Institute and the Maurice Falk Foundation.