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Hookah and snus users more likely to start on cigarettes, study says

The ancient Middle Eastern practice of smoking flavored tobaccos through a tall, ornate water pipe, or hookah, has become increasingly popular throughout the United States. Hookah lounges are becoming trendy in college towns. Justin Sullivan/Getty Images

Young people who have smoked hookahs and used powdered tobacco are more likely to start smoking cigarettes, according to a study published Monday in JAMA Pediatrics.

The researchers found that people aged 15 to 23 who try a water pipe and snus - a moist powdered tobacco similar to chewing tobacco - are more likely to graduate to cigarettes than those who haven’t tried those products. 

Those who make the leap are chasing a better nicotine hit, according to the study, led by Samir Soneji of the Geisel School of Medicine at Dartmouth College. Researchers surveyed about 1,000 young people over a two year period.

The researchers said theirs is not the first study to find a connection between water pipe usage and cigarettes smoking, especially among young people. They pointed to "a longitudinal study of first-year college women" published last year in the journal Addictive Behaviors which found that use of water pipe tobacco before college "predicted the initiation and resumption of cigarette smoking." 

The FDA does not regulate the manufacturing, distribution or marketing of water pipe tobacco products.

The study said the exposure to nicotine in the smokeless products leads to the increase in smoking.  Hookahs in particular also introduce youth to inhaling flavored smoke and doing so in a social setting, the researchers wrote.

Unlike traditional chewing tobacco, snus is spitless. A Swedish snus manufacturer has asked the FDA for permission to soften its warning label to say that the product is less harmful than cigarettes.