Hookah Bars
Hookah bars are emerging as an important consideration for smokefree air efforts in many communities. As more municipalities and states go 100% smokefree in workplaces, restaurants, bars, and casinos, establishments seeking to violate the law look for loopholes wherever they can. Most frequently, establishments claim to be "retail tobacco shops", by transforming themselves into hookah bars. If this tactic to skirt your smokefree law appears in your community, contact ANR for lessons learned and tips.
What is a hookah?
A hookah, also known as a narghile, shisha or hubble-bubble, is a waterpipe of Middle Eastern origin that is used to smoke sweet, often flavored, tobacco. The smoke is filtered through water in the base of the hookah's pipe. There is a common misconception that hookah smoke is less harmful than cigarette smoke, or not at all harmful, since the smoke passes through water before being inhaled or emitted as secondhand smoke. This is not true. The science shows that smoke from a hookah contains many of the same harmful and carcinogenic components as cigarette smoke. Hookahs should not be considered a safer alternative to cigarette smoking. Secondhand hookah smoke is not less harmful than secondhand cigarette smoke.
In 2005, the World Health Organization (WHO) issued an Advisory Note on Waterpipe Tobacco Smoking. This Advisory Note states:
- "waterpipe smokers and second-hand smokers [are] at risks for the same kinds of disease as are caused by cigarette smoking, including cancer, heart disease, respiratory disease, and adverse effects during pregnancy."
- And recommends that "waterpipes should be prohibited in public places consistent with bans on cigarette and other forms of tobacco smoking," and that "education…is urgently needed about the risks of waterpipe smoking, including high potential levels of secondhand exposure."
This chart lists chemicals found in hookah smoke versus cigarette smoke. Click on the image to enlarge.
How did the hookah fad start?
Hookah bars or cafes have been in the U.S. for many years, primarily in communities with Middle Eastern populations, and serve as social centers for many people. Traditional hookah establishments are not bars in the typical sense, as they primarily serve hookah-smoking and not alcohol-drinking patrons. In fact, most traditional hookah establishments do not serve alcohol at all, in keeping with Muslim practice.
However, hookah bars are gaining popularity around the U.S., particularly among college age individuals. Eighteen to 22-year-olds often find these establishments appealing for social reasons and because of the widespread misconception that there are reduced health risks associated with both active hookah smoking and secondhand hookah smoke. Hookah bars targeting the college age population often serve alcohol and can serve as an introduction to smoking among people who may not otherwise smoke.
| Hookah News |
| Hope for hookah bars in Davis County goes up in smoke FARMINGTON Before any hookah bars open in the county, the Davis County Board of Health plans on halting them at the border by using the state’s Clean Air Act. The board gave a directive to health department director Lewis Garrett to put together a policy which would ban such establishments because of the effects of second-hand smoke hookahs would generate. . . . Sam North, a health educator with the county, told board members that for many, smoking a hookah is a social event. Hookah bars are gaining in popularity in the United States, especially among college-age students. Here in Utah there are such bars in Salt Lake County and elsewhere. Utah County is looking at its first. North told board members that statistics from studies conducted in 2005 and 2006 for a national Tobacco-Related Disease Program, show that those smoking hookahs get 72 times the tar, four times the nicotine and 11 times the carbon monoxide of those smoking cigarettes. ... Raad, D.; Gaddam, S.; Schunemann, H.J.; Irani, J.; Abou Jaoude, P.; Honeine, R.; Akl, E.A., "Effects of waterpipe tobacco smoking on lung function: a systematic review and meta-analysis," Chest [Epub ahead of print], July 29, 2010. This study examined existing literature into the effect of hookah smoking on lung function. The authors concluded that, "Waterpipe tobacco smoking negatively affects lung function and may be as harmful as cigarette smoking. Waterpipe smoking, therefore, is likely to be a cause of COPD." Dugas, E.; Tremblay, M.; Low, N.C.; Cournoyer, D.; O'Loughlin, J., "Water-pipe smoking among North American youths," Pediatrics [Epub ahead of print], May 10, 2010. This study analyzed the sociodemographic characteristics of hookah smokers aged 18 to 24 by surveying residents of Montreal, Canada. The authors found that, "Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year." Jamil, H.; Elsouhag, D.; Hiller, S.; Arnetz, J.E.; Arnetz, B.B., "Sociodemographic risk indicators of hookah smoking among white Americans: a pilot study," Nicotine and Tobacco Research [Epub ahead of print], March 22, 2010. This study from Michigan assessed hookah use among whites and concluded that, "The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco." Daher, N.; Saleh, R.; Jaroudi, E.; Sheheitli, H.; Badr, T.; Sepetdjian, E.; Al Rashidi, M.; Saliba, N.; Shihadeh, A., "Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: sidestream smoke measurements and assessment of second-hand smoke emission factors," Atmospheric Environment 44(1): 8-14, January 1, 2010. This study compared some components of cigarette secondhand smoke with hookah secondhand smoke, including ultrafine particles (UFP), carcinogenic polyaromatic hydrocarbons (PAH), volatile aldehydes, and carbon monoxide (CO). The authors wrote that, "We found that a single waterpipe use session emits in the sidestream smoke approximately four times the carcinogenic PAH, four times the volatile aldehydes, and 30 times the CO of a single cigarette. Accounting for exhaled mainstream smoke, and given a habitual smoker smoking rate of 2 cigarettes per hour, during a typical one-hour waterpipe use session a waterpipe smoker likely generates ambient carcinogens and toxicants equivalent to 2-10 cigarette smokers, depending on the compound in question. There is therefore good reason to include waterpipe tobacco smoking in public smoking bans."
This study surveyed hookah users in the San Diego, California, area to determine their perceptions of the health hazards of hookah smoking. A majority of those surveyed (58.3 percent) believed that hookah smoking was less harmful than smoking cigarettes. The study analyzed the characteristic of hookah users and their beliefs. Exemptions for Hookah Bars in Clean Indoor Air Legislation: A Public Health Concern Popularity of waterpipe smoking or hookah smoking in the United States has been growing for some time now among youth and young adults. Currently, many cities and states have exemptions that allow hookah bars to remain in operation despite the passage of clean indoor air legislation. From a public health perspective this is concerning for many reasons. One public health concern with the increase in popularity of this type of tobacco use is the associated health effects. Another concern is that hookah smoke produces a sweet smelling aroma making it less obvious that patrons and employees of hookah bars are inhaling noxious fumes from mainstream smoke, as well as the toxins from the charcoal that is used to heat the tobacco. The purpose of this paper is to discuss smoke-free air legislation in relation to hookah use, the public health implications of exempting hookah bars from current smoke-free legislation, and implications for the public health nurse in protecting the public from the dangers of second-hand smoke, and limiting this new form of tobacco use. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. OBJECTIVE: To examine the prevalence and potential health risks of waterpipe tobacco smoking. METHODS: A literature review was performed to compile information relating to waterpipe tobacco smoking. RESULTS: Waterpipe tobacco smoking is increasing in prevalence worldwide; in the United States, 10-20% of some young adult populations are current waterpipe users. Depending on the toxicant measured, a single waterpipe session produces the equivalent of at least 1 and as many as 50 cigarettes. Misconceptions about waterpipe smoke content may lead users to underestimate health risks. ... ESCONDIDO: City rejects proposal to allow hookah lounges The move comes in response to at least four inquiries the city has received this fall from entrepreneurs seeking to fill North County's void of hookah lounges, where customers smoke flavored tobacco through communal pipes. Area residents have been forced to travel to Sorrento Valley or San Diego's Gaslamp District to smoke hookah pipes in a public setting since the only lounge in North County, Hubbly Bubbly in San Marcos, closed about a year ago. Proponents have said that allowing such lounges in Escondido could reduce the growing number of downtown vacancies, help fill the city's void of activities for young people, bring new energy to Grand Avenue and possibly bolster nearby restaurants and retail shops. Councilman Sam Abed and Councilwoman Olga Diaz said they were open to allowing hookah lounges if the city adopted significantly tougher restrictions than other cities have ... Eissenberg, T.; Shihadeh, A., "Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure," American Journal of Preventive Medicine 37(6): 518-523, December 2009. Conclusions Waterpipe tobacco smokers inhale same toxicants as cigarette smokers Smoking tobacco through a waterpipe exposes the user to the same toxicants -- carbon monoxide and nicotine -- as puffing on a cigarette, which could lead to nicotine addiction and heart disease, according to a study led by a Virginia Commonwealth University researcher published in the December issue of the American Journal of Preventive Medicine. "The results are important because they provide concrete, scientific evidence that contradicts the oft-repeated myth that waterpipe tobacco smoking does not involve users inhaling the same harmful chemicals that cigarette smokers do," said principal investigator Thomas Eissenberg, Ph.D., professor in the VCU Department of Psychology. "We hope that these results will be used by physicians and public health officials to inform waterpipe tobacco smokers that they risk tobacco-induced nicotine addiction and cardiovascular disease," he said. Toback: Smoking hookah not worth the health risk - Feature Smokers who think that trying hookah as a healthier alternative to cigarettes are way off base. Hookah smokers inhale a greater volume of smoke, worsening the effects of the chemicals in the tobacco. "Data from several different countries reveals that “a single hookah-use episode lasts for about 45 minutes and can easily involve over 100 puffs," said Thomas Eissenberg, professor of psychology at Virginia Commonwealth University, whose research is funded by a grant for the National Cancer Institute. "Each puff is about 500 ml in volume, while a single cigarette-use episode lasts about 5 minutes and can involve about 10-12 puffs of about 30-50 ml each. We are talking 100 times the smoke inhalation for a hookah-use episode, 50,000 ml total volume relative to a “single cigarette-use episode, 500 ml total volume." . . While it is widely known that cigarette smoking is bad for your health, hookah is possibly even worse. Hookah smoking is becoming popular across the country with hookah cafes opening up in many cities. Last semester, a hookah bar opened on Marshall Street but closed after just a few months. I guess the cost to expose one's self to cancer must have not worked well in this economy. ... Bay Area hooked on hookah Across the Bay Area and nation in recent years, hookah lounges have become increasingly popular gathering places for college students too young to drink legally, transplanted Middle Easterners looking to indulge in a familiar pastime and even for veterans of the Iraq war, who learned to enjoy hookahs while overseas. The practice is believed to have originated in India and spread to the Middle East hundreds of years ago. "It's more fun to be in the social atmosphere here," he said at Da Hookah Spot. "I don't smoke cigarettes, but I smoke from a hookah pipe once or twice a week." The lounges are often classified as tobacco shops, allowing them to get around California's 1998 statewide ban on smoking in bars. Most cities prohibit the sale of food in such establishments. The sale of nonalcoholic beverages, however, is typically allowed as long as they do not make up a significant portion of revenues, and alcohol is prohibited, according to officials at the city attorney's offices in Palo Alto, Hayward and San Francisco. Worth waves goodbye to hookah bars Sorry, hookah bar, no smoking The College Station City Council decided Thursday not to make an exception to the city's smoking ordinance for a hookah bar. Hookah Station in the Northgate district had requested an exclusion from the city ordinance that was revised early this year ... Sheesha smokers at high risk of catching virus Sheesha smokers could be contributing to the spread of the swine flu, it has been claimed. According to the Bahrain Anti-Smoking Society, sheesha pipes are an ideal tool for users to catch the virus since they are often passed from person to person. 'This is a real threat and all sheesha users should be careful,' said society vice-president Dr Kadhem Al Halwachi. 'We have already been told smokers are at an increased risk of getting complications from the swine flu because a smoker's lungs are already compromised.' Health officials last week added smokers to a list of 'high risk' individuals who could contract the H1N1 virus. ... It's no to hookah bars, yes to tattoos in Menifee The Menifee Planning Commission started tackling the question on Tuesday of how to regulate hookah lounges, tattoo parlors and cell phone towers, all of which are temporarily banned in the city. After recommending a ban on hookah lounges, most commissioners leaned in favor of allowing but tightly regulating, tattoo and body piercing parlors. Four of the five commissioners expressed reservations about hookah lounges, saying they could promote smoking or encourage crime or "smoking other things," as Commissioner Marc Miller put it. Commissioner Bill Zimmerman supported allowing hookah lounges "in the interest of being fiscally sound." "If Menifee wants to send a message to the public that we are business friendly, an outright ban on certain businesses might not send the right message," he said. ... Shisha 'as harmful as cigarettes' Smoking a shisha pipe is as bad for people as smoking tobacco, the Department of Health and the Tobacco Control Collaborating Centre has found. People who smoke shisha, or herbal tobacco, can suffer from high carbon monoxide levels, its research revealed. It found one session of smoking shisha resulted in carbon monoxide levels at least four to five times higher than the amount produced by one cigarette. High levels of carbon monoxide can lead to brain damage and unconsciousness. . . . The study found shisha smokers had 40-70 ppm of CO in their breath - affecting 8-12% of their blood. Dr Hilary Wareing, director of the Tobacco Control Collaborating Centre, told the BBC's Asian Network she was shocked by the results of the research. . . . "You never see it in the news - 'that is terrible, don't do it' - there's no shock tactics like (there is with) cigarettes," said one young woman. It was this misconception - and finding dangerous levels of carbon monoxide in a pregnant woman who had stopped smoking tobacco, but continued to smoke shisha - which prompted the research. "We found one session of smoking shisha - that's 10 milligrams (of fruit tobacco) for 30 minutes - gave carbon monoxide levels that were at the lowest four and five times higher than having a cigarette," said Dr Wareing. ... No Exemption for Hookah Bars A bill to exempt hookah bars from the North Carolina smoking ban was withdrawn from the House at the request of hookah bar owners. "I tried to make it very clear that our window of opportunity was now, which was last week, and once the decision was made not to go forward with the bill, that killed it for this session." Tarleton says the owners asked him to withdraw the bill because of amendments that would greatly restrict their businesses. ... Survey of Hookah Establishments in North Carolina After the successful passage of a statewide law to prohibit smoking in all NC restaurants and bars, discussion of the law’s impact on hookah bars was brought up by legislators and hookah establishment owners. This report provides a description of hookah, the health impact of hookah use, and results of a survey of hookah establishments in North Carolina. ... New law may put flames out at Wilmington Hookah Bars Wilmington is home to about one-fifth of all hookah bars in North Carolina, but the state smoking ban would effectively put them all out of business. A bill approved Tuesday by a judiciary committee could change the rules for hookah bars like Wilmington's Juggling Gypsy on Castle Street. Exception for hookah bars OK'd by NC House panel Establishments where patrons smoke tobacoo using a water pipe could remain open in North Carolina in legislation heading to the full House. Maziak, W.; Rastam, S.; Ibrahim, I.; Ward, K.D.; Shihadeh, A.; Eissenberg, T., "CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers," Nicotine and Tobacco Research [Epub ahead of print], May 6, 2009. This study examined hookah smokers who had abstained from smoking for a 24 hour period before and after they once again smoked a hookah. The authors noted that exhaled carbon monoxide increased after smoking and that the smokers who abstained showed symptoms of nicotine withdrawal similar to those experienced by cigarette smokers attempting to quit. Santa Cruz bans hookah lounges near kid hot spots City leaders cracked down on hookah lounges Tuesday night, saying the couch-filled shops that sell sessions with flavored tobacco and a water pipe need to stay away from schools, and that only one more will be allowed within city limits. "It occurred to us that this was really more of a public health issue," said City Attorney John Barisone. "This particular type of business appeals to young people." Right now only one hookah lounge, Smoke This! Hookah Lounge next to the Teen Center on Laurel Street, is open in Santa Cruz. That's down from a height of three in 2007. While Smoke This! will be grandfathered in until the year 2014, new rules will not allow lounges within 1,000 feet of schools, parks or recreation centers. ... Water Pipe Smoking and Health-related Quality of Life: A Population-based Study Background: Water pipe smoking is increasing in Eastern Mediterranean Region. The objective of this study was to investigate any relationship between water pipe smoking and healthrelated quality of life in the general population of Bandar Abbas, Iran. Methods: Using a multistage sampling method, a random sample of 1675 individuals aged 15 years and over was studied from June through July 2007. All eligible participants were interviewed using the Short Form Health Survey (SF-36) questionnaire and a short questionnaire containing items regarding socio-demographic characteristics and water pipe smoking status. To compare SF-36 scores between water pipe smokers and nonsmokers, t-test was performed. In addition, Results: In all, 1675 individuals were studied. The mean age of the respondents was 42.1 (SD=16.5) years. One hundred and seventy-two participants (10.4%) were water pipe smokers. There were statistically significant differences between water pipe smokers and nonsmokers on all scales except for role emotional (P<0.001). Logistic regression analysis showed that using water pipe was a risk factor for decreasing Physical Component Summary and Mental Component Summary scores [OR (95% CI): 2.15 (1.56 – 2.96), P<0.01; and OR (95% CI): 1.88 (1.36 – 2.60), P<0.01, respectively]. Conclusion: The study findings indicated that people who smoked water pipe carried a highe rrisk for poorer health-related quality of life. Heights leader hopes to curb hookah use among minors Hookah, chillum smoking more toxic than cigarette: Study JAIPUR: Traditional hookah and chillum are more injurious to health than cigarette, a study has said. The study underlines that the old mode of smoking is much more toxic than cigarette smoke as carbon monoxide (CO) level is higher in it, the study conducted by a group of pulmonary doctors of the SMS Hospital Medical College and the Asthma Bhawan here said. The study assumes significance in the wake of ongoing debates on the ill effects of smoking and the countrywide ban on lighting up the rolled tobacco at public places, which came into force on Thursday. Professor of medicine Virendra Singh, who was a part of the study claims that the traditional smoking ways can be fatal. Grekin, E.R.; Ayna, D., "Argileh use among college students in the United States: an emerging trend," Journal of Studies on Alcohol and Drugs 69(3): 472-475, May 2008. This survey of college students regarding their use of hookahs found that, "More than 15% of the sample reported having used argileh [hookah] at least once in their lifetime, exceeding the percentage of students who had tried stimulants, barbiturates, cocaine, Ecstasy, heroin, or psychedelics. Arab ethnicity and cigarette smoking were the strongest predictors of argileh use; however, a substantial percentage of non-Arabs and nonsmokers also had tried argileh." The study also discussed the health implications of hookah smoking. Waterpipe Smoking on College Campuses May Contribute to Growing Public Health Problem More and more U.S. college students are smoking tobacco using waterpipes – or hookahs – and it’s becoming a growing public health issue, according to a new study led by a Virginia Commonwealth University researcher. The findings offer important insight into the prevalence and perceptions related to waterpipe tobacco smokers and are reported in the May issue of the Journal of Adolescent Health. The article is also featured in an editorial in the same issue. “These results should serve as an alarm bell to anyone interested in public health in the United States. Preventing tobacco-caused death and disease means remaining alert to new forms of tobacco smoking and then understanding the health risks of these new forms and communicating these risks to public health workers, policy makers, and to smokers themselves,” said principal investigator Thomas Eissenberg, Ph.D., associate professor in the VCU Department of Psychology. . . . Maziak, W.; Rastam, S.; Ibrahim, I.; Ward, K.D.; Eissenberg, T., "Waterpipe-associated particulate matter emissions," Nicotine & Tobacco Research 10(3): 519523, March 2008. This study examined potential secondhand hookah smoke exposure in nonsmokers by measuring the particulate matter emissions from hookahs as compared to that of cigarettes. The authors wrote that, "This study provides the first information relevant to understanding the potential waterpipe-associated secondhand smoke. Hazardous PM emission can build up gradually during waterpipe use to reach high levels, whereas comparable levels are reached faster during cigarette smoking. The clear implication of these findings is that clean air policies should include waterpipe tobacco smoking, as it can be responsible for the buildup of toxic levels of indoor air pollutants similar to what occurs with cigarettes." EGYPT: Water pipe smoking a significant TB risk The smoking of the traditional `shisha' water pipe is increasingly emerging as a significant health risk in Egypt, due to air-borne tuberculosis (TB) transmission from pipe sharing and uncontrolled, manual preparation of the pipe. Rania Siam, professor of microbiology at the American University in Cairo (AUC), said the most important risk factor for TB infection was close household contact with a TB case, but she said water pipe smoking (WPS) and the sharing of the pipe with someone with pulmonary TB led to a great risk of TB transmission, especially among young adolescents. "`Shisha' [smoking] is Egyptian culture, where people smoke tobacco and inhale directly from this device. If I smoke `shisha', some bacteria may reside in it. Health officials warn of hookah-smoking hazard: Two CSU students contracted oral herpes Cases of two Colorado State University students who might have contracted oral herpes from recent trips to a hookah bar are prompting health officials to remind people of the dangers of sharing saliva. Anything from mononucleosis to an infectious cold sore can be passed through sharing soft drinks or passing around a mouthpiece at a hookah smoking session. "People shouldn't share spit," said Paul Poduska, infections control coordinator at Poudre Valley Hospital. |
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