Hookah tobacco smoking among US youth and young adults: regulatory gaps and equity implications for African American communities

Although hookah (ie, waterpipe) has been used for centuries globally, its contemporary expansion in the USA has been driven largely by flavoured tobacco, lounge-based social smoking and regulatory exemptions that distinguish hookah from other combustible tobacco products. These regulatory gaps affect US youth and young adults broadly, but their consequences are unlikely to be distributed equally. National data show elevated hookah use among African American (AA) youth1 2 and increased initiation and progression among non-Hispanic Black young adults,3 while longstanding tobacco-industry targeting and social marketing may further amplify risk in AA communities.4 This commentary therefore examines hookah as a broader youth and young adult regulatory blind spot with distinct equity implications for AA communities and outlines pragmatic policy and practice steps to close that gap.

An under-recognised disparity

National surveillance data show a persistent disparity in hookah use among AA youth.1…

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