According to a survey, hookah smokers were more than twice as likely to try cigarettes than nonsmokers.

About 40% of regular or sometime hookah users with little to no previous history of cigarette smoking were deemed “susceptible” to such smoking in the future, on the basis of their responses to questions about future smoking, said Ramzi G. Salloum, PhD, of the University of Florida College of Medicine in Gainesville, and colleagues, writing in the CDC’s Preventing Chronic Disease.

In contrast, only 16% of hookah non-users gave signs of being susceptible to cigarette smoking, the researchers found. Susceptibility was determined by responses to two questions: “Do you think you will smoke a cigarette soon?” and “Do you think you will smoke a cigarette in the next year?”

Anyone who didn’t answer “definitely no” to both questions was considered susceptible to future smoking. But a sensitivity analysis, in which susceptibility was more narrowly defined as answers of “definitely yes” or “probably yes” to one of the questions, yielded a similar pattern of results, the researchers said.

“To our knowledge, ours is the first US study to assess the relationship between current waterpipe smoking and susceptibility to cigarette smoking among young adults who had never established cigarette smoking,” Salloum and colleagues wrote. “Understanding the association between waterpipe smoking and susceptibility to cigarette smoking is the first step in exploring whether the appeal of waterpipes among young people could lead to initiation of cigarette smoking.”

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