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Hookah bars heat up, lead to cigarette smoking

Posted at 6:23 PM, Dec 12, 2014

This holiday, talk to your kids about smoking — and not just cigarettes.

A new study shows that young people who smoke hookah, or water pipe tobacco, are twice as likely to pick up a cigarette habit.

“The tobacco smoked in hookah is sold in different flavors. All of these are well known to appeal to youth,” said Dartmouth researcherSamir Soneji. “One of our concerns is that adolescents and adults may try hookah because it’s very social.”

Cigarette use has been declining for decades, in part because smokers have been cast out into the street. But hookah bars are considered by some to be cool, free from high taxes and often skirt indoor air laws.

The study, which examined 1,500 young adults over two years, was published Monday in the journal JAMA Pediatrics.

In a hookah, tobacco is heated over a coal and the smoke is filtered through water, which emerges as vapor at the end of a hose. Many young people believe that hookah is safer than cigarettes because the smoke is filtered through water.

But Soneji said that’s a misconception.

“The chief concern is inhaling combusted smoke. That’s where the thousands of chemicals are, the carcinogens,” Soneji said.

Matt Davis, Chief Medical Executive for the State of Michigan and public health professor at the University of Michigan, said the results of the study were not a surprise.

“The levels of nicotine are higher in hookah, which is likely to lead to a faster and more severe addiction to nicotine,” Davis said. “The core challenge here to human health is the nicotine habit and how that habit keeps the user coming back.”

Hookah is not a safe alternative to smoking cigarettes,according to the Centers for Disease Control and Prevention. A one-hour chill session at a hookah barexposes each smoker to 150 times the smoke, 1.7 times the nicotine, 8.4 times the carbon monoxide and 36 times the tar of a cigarette.

Hookah bars have exploded in popularity in the past decade. The American Lung Association estimated there were200 to 300 hookah bars in the U.S. in 2007, mostly centered around college campuses.

Today, there are more than 900 hookah bars listed in the Yellow Pages across the country.

Nevada is the nation’s hookah capital, with one bar for every 85,000 residents. That’s nearly twice as many per capita as the runner up, Florida, which has 133 bars.

The state with the most hookah bars overall? California, with 142.

While all but 10 states have some sort of clean indoor air law, hookah bars get by because water pipe tobacco wasn’t popular when the laws were written. Hookah isn’t specifically mentioned in the text of these laws, Davis said, and therefore more open to interpretation.

If loopholes aren’t closed at the local, state or federal level, the historic reduction in tobacco use might be reversed. In 1965, about 42 percent of American adults smoked cigarettes. Today, it’s closer to 15 percent.

“It has to be cool and it has to be allowable. If I smoked in a bar I’d be asked to leave now or get dirty looks because of clean indoor air laws,” Soneji said.

Soneji encouraged parents to re-educate themselves and speak with their kids about the full range of tobacco products, not just cigarettes.

Even though cigarette smoking has been on the decline, it’s still the leading cause of preventable death in the U.S., with 480,000 attributable deaths each year.

Gavin Stern is a national digital producer for the Scripps National Desk. Follow him on twitter at @GavinStern or email him at