Hookah

Hookahs, or waterpipes, have given mainstream popularity to a cultural and historical form of tobacco. Hookah use is most common among 18 to 24 year-olds and college students, who believe it to be safe. However, misconceptions about hookah smoking are widespread and need to be addressed.

History of Hookah

The hookah is used to smoke specially made tobacco through a waterpipe. Tobacco is indirectly heated with burning embers or charcoal which filters the smoke through a bowl of water. The smoke is then drawn through a rubber hose to a mouthpiece, where it is inhaled by the user.

Hookahs generally consist of four parts:

1. The bowl where the tobacco is heated.

2. The base filled with water or other liquids.

3. The pipe, which connects the bowl to the base.

4. The hose and mouthpiece through which smoke is drawn.

Hookah smoking began in ancient Persia and India and spread throughout the Middle East and Asia during the 15th century. In the late 20th century, new flavors were added to the mixture to make the hookah more appealing to women. As people moved from the Middle East and Africa, hookah cafes began appearing in European cities and the U.S.

Hookahs have become especially popular among urban youth, young professionals, and college students. Additionally, new forms of electronic hookah smoking (e-hookah) are now available. These products are battery powered and turn liquid containing nicotine, flavorings, and other chemicals into an aerosol, which is inhaled, much like e-cigarettes.

Health Effects of Hookah Smoking

The research on hookah use shows that smoking through a hookah carries the same or similar health risks as cigarette smoking. These negative health effects include increased risk of heart disease, lung, oral, and bladder cancer.

While studies of smoke from hookahs found that it has similar amounts of nicotine, tar, and heavy metals as other tobacco products, some experts believe hookah smoking actually increases exposure to dangerous substances over other products. Because hookah smokers smoke over a much longer period of time – often 40 to 45 minutes, versus 5 or 10 minutes for a traditional cigarette – a hookah smoker could possibly breathe in as much smoke in a single session as smoking 100 or more cigarettes.

The wood cinders or charcoal used to burn hookah tobacco creates additional health consequences for smokers as well. When burned, these substances release high levels of dangerous chemicals, including carbon monoxide. Some research shows that hookah smoke is actually more dangerous than cigarette smoke, because it includes smoke from the tobacco as well as the heat source used to burn the tobacco.

Although more research needs to be done on the long-term health effects of hookah smoking, existing studies show that it carries many of the same risks as cigarette smoking and is not a safe alternative. Additionally, secondhand smoke from hookahs can be a health risk for nonsmokers.

Perception and Awareness

Hookahs are thought to be more enjoyable for smokers because the smell, taste, and smoothness of the sweetened tobacco provides a much less irritating smoking experience than cigarette smoking.

Experienced smokers sometimes add other liquids, such as fruit juice or wine, to change the taste of the smoke. Hookah smoking is also usually less expensive than cigarette smoking.

Hookah Use in the U.S.

In 2010, the Monitoring the Future survey found that among high school seniors in the United States, about 1 in 5 boys (17%) and 1 in 6 girls (15%) had used a hookah in the past year.

A 2010 study at the University of Nevada, Las Vegas (UNLV) found that 15.2% of college students there had smoked hookah in the last 30 days.

Hookah Bars and Cafes

The rise in hookah smoking in the U.S. may be the result of marketing efforts targeted towards college students. Hookah bars and cafes are commonly found in cities and towns near large colleges or universities, like UNLV, despite state smoke-free air laws. Based on U.S. business listings, more than two-thirds of the states currently have hookah bars or cafes.

State Regulations, Legislation, and Policies

Although many states have laws banning smoking in almost all public places and workplaces, hookah bars and cafes are exempt from these laws in some states.

Hookah bars can qualify for exemptions by identifying as a “retail tobacco establishment,” “tobacco bar or cigar lounge,” or a business that sells only tobacco products, whether for use onsite or elsewhere.

Smoke-free air laws seem to have contributed to the popularity of hookah bars by making them one of the few indoor places where smoking is still allowed.