The increasing use of alternative tobacco products, such as water pipes and e-cigarettes, by children under the age of 18 is a burgeoning public health crisis, according researchers from NYU Langone Medical Center.

"Alternative tobacco products represent a new challenge in the 75-year-old war against tobacco," says co-author Michael Weitzman, MD, a professor of Paediatrics and of Environmental Medicine at NYU Langone.

"With the increasing numbers of young adults using alternative tobacco products, we have every reason to be concerned."

The new study highlights research on the use of alternative tobacco products by young adults published earlier this year by Brian A. Primack, MD, PhD, and colleagues at the University of Pittsburgh School of Medicine.

That paper reported the results of a longitudinal study of 1596 young adults ranging in age from 15 to 23, including 1048 who had never smoked prior to the study. The results showed that use of water pipes, also known as hookahs, and other alternative tobacco products is associated with a 2.5 times increase in later cigarette use.

Public health specialists consider cigarette smoking to be a paediatric disease, since nine out of 10 adult smokers started smoking as children.

Although cigarette use overall has decreased by 33 percent in the past decade in the United States, the use of alternative tobacco products such as hookahs has increased an alarming 123 percent, with nearly 20 percent of high school seniors smoking hookahs.

Dr. Weitzman says this increase can be attributed, in part, to a general unawareness of the dangers of alternative tobacco products by the public, the medical community, and the media.

There is a misperception that alternative tobacco products are safer than cigarettes, but the evidence says otherwise.

"Other researchers have demonstrated that a typical 45 minute hookah session is equivalent to smoking as many as five packs of cigarettes," Dr. Weitzman says.

In a study published last year in the journal Tobacco Control, Dr. Weitzman and colleagues discovered potentially hazardous levels of secondhand smoke and other air pollutants, as well as evidence of nicotine, in New York City hookah bars.

The increasing popularity of alternative tobacco products threatens to undermine the gains seen in the last several years with the decline in cigarette use. 

"Nicotine is the most addictive substance," Dr. Weitzman says. "The use of alternative tobacco products by children can be the beginning of an addiction that can lead to later cigarette use. Tobacco use is the leading preventable cause of death worldwide, causing more deaths than HIV, tuberculosis and malaria combined."

Source: New York University School of Medicine