title: Review of hookah tobacco smoking among college students: policy implications and research recommendations.
abstract: BACKGROUND
  About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco.
  
  
  OBJECTIVE
  Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy.
  
  
  METHODS
  PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy".
  
  
  RESULTS
  Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking.
  
  
  CONCLUSIONS
  Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.
authors.affiliation: School of Pharmacy and.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Gathuru
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Tarter
authors.forename: Michele
authors.initials: M
authors.lastname: Klein-Fedyshin
mesh_terms: D035843:Biomedical Research; D006291:Health Policy; D006801:Humans; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014495:Universities / Q000706:statistics & numerical data
keywords: Advertising; college; health effects; health policy; hookah tobacco