Hookah Bars Research Articles

Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States

Preventing youth smoking initiation is a priority for tobacco control programs, because most adult tobacco smokers become addicted during adolescence. Interventions that restrict the affordability, accessibility, and marketing of cigarettes have been effective in reducing youth cigarette smoking. However, increasing numbers of youth are smoking tobacco using hookahs. Predictors of smoking tobacco with hookahs are the same as those for smoking cigarettes. Established interventions that curb youth cigarette smoking should therefore be effective in reducing hookah use. Potential policy interventions include equalizing tobacco tax rates for all tobacco types, requiring warning labels on hookah tobacco and accurate labeling of product contents, extending the cigarette flavoring ban to hookah tobacco, enacting smoke-free air laws and removing exemptions for hookah lounges, and expanding shipping restrictions on tobacco products.

Examining Hookah Smoking Among a Cohort of Adolescent Ever Smokers

Evidence suggests that hookah smoking is growing among adolescents, particularly among those with a history of cigarette smoking, and is an emerging public health concern. We examined hookah use and its correlates among a sample of adolescents who have ever smoked and may be considered high risk for hookah use. We examined differences between hookah users and nonusers among a cohort of 951 adolescents (75.3% of the baseline sample, mean age 17.6 years at 24 months), consisting exclusively of youth who reported ever smoking cigarettes who were participating in a longitudinal study of adolescent smoking predictors and patterns. Ever and 30-day hookah use were assessed at 24 months. Of the 951 participants, 58.5% reported ever use and 30.2% reported smoking hookah at least 1 day in the past 30 days. Multivariate logistic regression analyses found that 30-day hookah use was associated with sex (p < .05); race (p < .001); current cigarette (p < .0001), cigar (p < .01), kretek (p < .05), and alcohol use (p < .01); and attending a hookah bar, lounge, or restaurant (p < .001). Participants who were male, White, and were concurrent users of multiple tobacco products and other substances had increased odds of 30-day hookah use. Prevalence of hookah use is high among youth who have already tried cigarette smoking and is associated with a variety of tobacco and other substance use behaviors. Evidence-based programs may be needed to prevent initiation of or reduce Hookah smoking, as well as address cooccurring problem behaviors, to lessen the health risks associated with use among adolescents.

Hookahs: Hot and Hazardous

Vol. 119, No. 8 News | ForumOpen AccessHookahs: Hot and Hazardous Carol Potera Carol Potera Search for more papers by this author Published:1 August 2011https://doi.org/10.1289/ehp.119-a339AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Hookah cafes are an increasingly popular venue for socializing. In addition to beverages, appetizers, and desserts, habitués can order different flavors of tobacco that they smoke through waterpipes. Many patrons of hookah cafes believe smoking a waterpipe is safer than smoking cigarettes—an unsubstantiated belief “as old as the waterpipe itself,” according to the World Health Organization.1 A new field trial shows that carbon monoxide (CO) levels were 3 times higher in people visiting hookah cafes than in people who visited traditional bars.2Tracey Barnett, a social and behavioral scientist at the University of Florida, Gainesville, and colleagues measured CO levels of 173 patrons leaving three local hookah cafes and 198 patrons leaving five traditional bars that allow smoking. Hookah cafe patrons had an average CO level of 30.8 ppm compared with 8.9 ppm for traditional bar patrons. Even hookah cafe patrons who did not smoke from the waterpipe had average elevated CO levels of 11.5 ppm, similar to cigarette smokers.2The Occupational Safety and Health Administration established a cutoff of 50 ppm for CO exposure over an 8-hour period;3 18% of hookah cafe patrons had CO levels exceeding this level, and 5% tested above 90 ppm.2 Symptoms of CO poisoning such as lightheadedness and nausea start at about 70 ppm.4 Some hookah smokers claim they experience a “high,” but “they’re probably in the early stages of CO poisoning,” Barnett says. Emergency rooms have reported visits for CO poisoning after hookah smoking.5,6,7Hookah smoke contains toxicants not only from burning tobacco but also from the charcoal used to heat the tobacco in the pipe’s bowl, including CO, heavy metals, and polycyclic aromatic hydrocarbons.8 Shared hookahs also can raise the risk for communicable diseases.9 The water in a waterpipe does absorb some nicotine, so hookah smokers may inhale more smoke seeking a satisfying amount of the drug.1 A hookah session typically lasts 20–80 minutes, and the number and depth of puffs taken means a patron may inhale the smoke equivalent of 100 or more cigarettes.1Hookah cafes are popular in university towns and large cities. By one 2005 estimate, up to 20% of some U.S. populations of young adults engage in hookah smoking.10 Norman Edelman, chief medical officer at the American Lung Association, says his organization is working with states to pass laws to ban hookah smoking. “People realize more and more that this is a dangerous practice,” Edelman says.References1 WHO Study Group on Tobacco Product Regulation (TobReg). Advisory Note. Waterpipe Tobacco Smoking: Health Effects, Research Needs, and Recommended Actions by Regulators. Geneva, Switzerland:World Health Organization (2005). Available: http://tinyurl.com/g27zw[accessed 14 Jul 2011]. Google Scholar2 Barnett TEet al.Carbon monoxide levels among patrons of hookah cafes.Am J Prev Med 40(3):324-3282011. http://dx.doi.org/10.1016/j.amepre.2010.11.00421335264. Crossref, Medline, Google Scholar3 OSHA. Occupational Safety and Health Guidelines for Carbon Monoxide [website]. Washington, DC:Occupational Safety & Health Administration, U.S. Department of Labor. Available: http://tinyurl.com/4pbzg4z[accessed 14 Jul 2011]. Google Scholar4 CPSC. Carbon Monoxide Questions and Answers, CPSC Document #466 [website]. Bethesda, MD:U.S. Consumer Product Safety Commission (updated 13 Jul 2011). Available: http://tinyurl.com/338p85[accessed 14 Jul 2011]. Google Scholar5 Cavus UYet al.Carbon monoxide poisoning associated with narghile use.Emerg Med J 27(5):4062010. http://dx.doi.org/10.1136/emj.2009.07721420442182. Crossref, Medline, Google Scholar6 Lim BL, et al. Case of carbon monoxide poisoning after smoking shisha. Int J Emerg Med 2(2):121-122 (2009); http://dx.doi.org/10.1007/s12245-009-0097-8. Google Scholar7 Uyanik Bet al.Narghile (hookah) smoking and carboxyhemoglobin levels.J Emerg Med 40(6):6792011. http://dx.doi.org/10.1016/j.jemermed2009.05.03219576713. Crossref, Medline, Google Scholar8 Shihadeh A, Saleh R.Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe.Food Chem Toxicol 43(5):655-6612005. http://dx.doi.org/10.1016/j.fct.2004.12.01315778004. Crossref, Medline, Google Scholar9 Knishkowy B, Amitai Y.Water-pipe (narghile) smoking: an emerging health risk behavior.Pediatrics 116(1):e113-e1192005. http://dx.doi.org/10.1542/peds.2004-217315995011. Crossref, Medline, Google Scholar10 Cobb Cet al.Waterpipe tobacco smoking: an emerging health crisis in the United States.Am J Health Behav 34(3):275-2852010.20001185. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Vol. 119, No. 8 August 2011Metrics About Article Metrics Publication History Originally published1 August 2011Published in print1 August 2011 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Hubble Bubble Trouble: The Need for Education about and Regulation of Hookah Smoking

A Middle Eastern tradition, hookah smoking involves burning flavored tobacco heated by charcoal, creating smoke that is filtered through water and ingested through the mouth using a hose. Hookah lounges are increasingly locating around college campuses in the United States, and websites offering hookah paraphernalia target U.S. high school and college students. In two studies involving interviews with college-age hookah smokers and analysis of website marketing practices, the authors investigate consumer beliefs and attitudes toward hookah smoking and the way it is portrayed online. The findings indicate that it is a social phenomenon, with young people introducing peers to the practice and websites promoting shared consumption experiences. Contrary to medical evidence, young people believe smoking sweetened tobacco through a hookah is nonaddictive and safer than cigarettes. Hookah lounges often are exempt from age restriction laws because many double as cafés and other eating establishments. Traditional tobacco warnings are not present in lounges or on websites. The findings highlight potential health dangers of hookah smoking and the need for education regarding this practice and demonstrate that regulatory oversight is needed.

Determinants of Hookah Use among High School Students

Hookah use is increasing among young people, but there are limited data on its use among high school-age populations. We examined hookah use initiation, prevalence, cessation, and psychosocial risk factors of hookah use among high school students. A cross-sectional survey of 689 students from three high schools in San Diego County was used to compare characteristics of hookah ever-users to nonusers and factors associated with current and former hookah use. Hookah ever-use in the study population was 26.1%, previous month hookah use was 10.9%, and current hookah use was 10.3%. Most students first learned about hookah from friends (50.3%) or saw a hookah lounge (20.9%). Students believed hookah to be more socially acceptable than cigarettes and less harmful than cigarettes, cigars, and smokeless tobacco. Hookah ever-users were significantly more likely than nonusers to have smoked cigarettes, to know of a hookah lounge in their community, and to believe hookah is safer and more socially acceptable than cigarettes. In comparison to former users, current users were more likely to have recently smoked a cigarette, to know of a hookah lounge in their community, and to believe hookah is more socially acceptable than cigarettes. Hookah use is becoming a commonly acceptable behavior among adolescents, and risk perception is a significant factor. Presence of hookah lounges are associated with increased hookah use among high school students and should be a target of further regulation.

Carbon Monoxide Levels Among Patrons of Hookah Cafes

Individuals who use a hookah (water pipe) as a method of tobacco smoking are exposed to high levels of carbon monoxide (CO). Assessing hookah use in one of the venues of its use (hookah bars) will aid the understanding of the toxins and exposure for the user. In Florida, smoking is prohibited in public places under the Florida Clean Indoor Act but permitted in establishments that have less than 10% gross revenue from food. To assess the CO level of hookah cafe patrons, using traditional bar patrons as a comparison. After IRB approval, a nighttime field study of patrons (aged >18 years) exiting hookah cafes and traditional bars in 2009 was conducted, using sidewalk locations immediately outside these establishments in a campus community. As hookah cafes and bars are typically entered and exited in groups, every other group of people exiting the establishment was approached. For comparison purposes, the sample collected was similar in number, 173 hookah cafe and 198 traditional bar participants. Results from analysis conducted in 2010 indicate that patrons of hookah cafes had significantly higher CO levels (mean=30.8 parts per million [ppm]) compared to patrons of traditional bars (mean=8.9 ppm). Respondents who indicate no cigarette use in the past month but had visited a hookah cafe still demonstrated significantly higher CO values (mean=28.5 ppm) compared to those exiting traditional bars (mean=8.0 ppm). Current cigarette smokers also produced significantly more CO if exiting a hookah cafe (mean=34.7 ppm) compared to a traditional bar (mean=13.3 ppm). CO levels are higher for patrons of hookah cafes, for both current and non-cigarette smokers. Although users report that they perceive hookah to be less harmful than cigarettes, the greater CO exposure for hookah users that was observed in this study is not consistent with that perception.

Study of secondhand smoke levels pre and post implementation of the comprehensive smoking ban in Mumbai

Objectives:This research was undertaken with the aim of assessing the indoor air quality in popular hospitality venues, as also to evaluate the effectiveness of the nationwide comprehensive public smoking ban. The analysis was split into two halves – baseline study taken up prior to implementation of the said ban on 2nd October 2008, and the follow-up study after it came into effect.Materials and Methods:Twenty-five venues including five restaurants, fourteen resto-bars, two hookah (smoking water-pipe) cafes and four pubs were selected using a mix of random, convenience and purposeful sampling. Particulate matter (PM2.5) measurements at these venues were made using TSI SidePak AM510 Personal Aerosol Monitor.Results:The average PM2.5 level in venues where smoking was permitted prior to implementation of ban was found to be 669.95 μg/m3 in the baseline study. Post ban, the average PM2.5 level in same test venues reduced to 240.8 μg/m3. The hookah cafes were an exception as the average PM2.5 levels exceeded the permissible limits before as well as post ban.Conclusion:The baseline study showed that the hospitality venues had hazardous levels of PM2.5 particles arising from second-hand smoke prior to smoking ban. These decreased by a maximum of 64% after the law took effect. A substantial improvement in air quality at these venues post implementation of the smoking ban indicated the effectiveness of the law.

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.

The medical consequences of narghile (hookah, shisha) use in the world

Background Hookah (narghile, shisha) smoking is growing worldwide and particularly in France. The main reasons for this are: first, the arrival on the market of new highly flavored tobacco-based mixtures; second, a new type of charcoal used as a quick heating source; third, the pleasure to experiment with an exotic orientalist practice or the desire to return to the corresponding tradition; fourth, the belief that water filtration would lower the risk of smoking. Methods and results Long-term epidemiological data on complications are scarce. Little is known about qualitative and quantitative transformations occurring when hookah is smoked (in particular regarding carcinogenic agents). Such information will be difficult to collect due to the lack of standardization for this mode of tobacco use. The only current consensus on this issue is that a significant amount of carbon monoxide is produced by the charcoal used to heat and distil the tobacco–molasses mixture. Apart from direct inhalation, concentrations measured in some fashionable hookah lounges and bars are particularly high. Moreover, the additives contained in the widely used quick-lighting charcoals and their harmlessness remain unknown. Conclusion This study sets out the available scientific knowledge regarding the real medical consequences related to the growing use of hookah and focuses on the best known and urgent issue, i.e. concern related to carbon monoxide intoxication in a very peculiar context.