As college students have made their way back to campus this month, many also return to the habits, some good, some bad, that dorm-life promotes. A new survey finds that adults under 25, including high school graduates and college students, are more likely to rate hookah and e-cigarettes as safer than cigarettes, when compared to 25 to 34-year-olds, according to a paper in Health Education&Behavior.

Well, they are. E-cigarettes have no smoke, just some nicotine, so every study has found them to be 95% less harmful than cigarettes. A hookah is not great but still far less harmful than cigarettes. 

Using survey data from 2,871 smoking and nonsmoking young adults, ages 18-34, Dr. Olivia A. Wackowski and Dr. Cristine D. Delnevo found that a quarter of young adults believed hookah to be less risky than cigarettes - a belief shared by current cigarette smokers and those who had never smoked cigarettes before.

"This is concerning as it suggests that even a substantial proportion of non-smokers may view hookah as being a relatively safer and acceptable way to use tobacco," the researchers wrote. 

The researchers also found the following:

• 62.1% of young adults ages 18 to 24 believed that e-cigarettes were less risky than cigarettes, while 54.6% of 25 to 34-year-olds believed e-cigarettes to be less risky. Additionally, 32.7% of 18 to 24-year-olds believed hookah to be less risky than cigarettes, while 18.5% of 25 to 34-year-olds believed hookah to be less risky.

• 57.8% of respondents believed e-cigarettes to be less risky than cigarettes and 11.4% said they were unsure.

• 50% of respondents said that methanol cigarettes, hookah, cigars, smokeless tobacco, and snus were about as risky as cigarettes.

• 30% of all respondents believed that smokeless tobacco, menthol cigarettes, and cigars were more risky than cigarettes.

• 24.5% of respondents reported that hookah is less risky than cigarettes, which was equally prevalent for both cigarette smokers and nonsmokers.

• 31.2% of respondents reported that they had smoked at least 100 cigarettes before and smoked regularly at the time of the survey.

If 62 percent of e-cigarettes smokers believe they are less harmful than cigarettes that should be a good thing. E-cigarettes are not tobacco and never have been. Are nicotine patches considered less harmful than cigarettes? Gum? They are all nicotine substitutes to reduce desire for smoking, which is what causes the harm.

"This might be associated with differences in advertising messages these groups are exposed to, the variety of flavors these different products are offered in, and in the case of e-cigarettes, possibly an inclination for younger people to attribute more positive feelings toward newer products that are seen as new and 'techy'," commented the study authors, clearly showing their lack of understanding of what motivates 25-year-olds.

That some tobacco products were riskier than cigarettes did not stop people from using them, also no surprise. Young people take more risks. When actor/director Rob Reiner tried to get smoking banned from movies he made it cool and rebellious for young people who obviously know better. The authors speculate that promoting other tobacco products, such as snus, as safer may not encourage smokers to switch products but instead encourage new product uptake for both smokers and nonsmokers. There are Americans who take up chewing tobacco and don't smoke cigarettes, just as there are snus users in Sweden who never smoked, but they are rather rare today. And if we are talking about harm, banning alternatives is making the perfect the enemy of the good. The rest of Europe, which bans snus, has 400% more tobacco-related deaths than Sweden, where people use snus instead of smoking.

Published in Health Education & Behavior.