The air inside Prince Cafe of the Harbor, in Washington, D.C.'s tony Georgetown neighborhood, is heavy with the smell of berries. About 50 young adults, lit by the glow of flickering candles, take deep drags from bubbling water pipes. Thick clouds of fruity smoke waft from their mouths and nostrils. Among them sits James Lee Adams, 18, an aspiring R&B singer who won't smoke cigarettes, he says, because they "gross him out" and he wants to protect his voice.
"Even though there's water in these pipes, the smoke that comes out of the mouthpiece still contains carbon monoxide, tar, nicotine, and heavy metals," says Thomas Eissenberg of Virginia Commonwealth University, whose research on smoking and addiction is funded by the National Institutes of Health. "So where's the filtering?"
Hookah lounges have been sprouting up across the country in recent years, catering to a predominately young clientele and often stationed near college campuses. Since 2000, at least 200 to 300 new hookah cafes have opened for business, according to the trade journal Smokeshop in 2004. Hookah lounges appeal to youth in part because they offer those too young to bar-hop a hip meeting ground.
Their growing popularity as social hangouts for 18-to-24-year-olds prompted the American Lung Association to issue a report this year identifying hookah smoking as a major health risk. The World Health Organization previously issued a similar statement. According to the ALA report, hookah bars have appeared in more than two thirds of the nation's states, in some cases operating through exemptions in new smoking bans. In Illinois, for example, a statewide law that went into effect January 1 bars smoking in indoor public places and workplaces. However, smoking—including hookah smoking—will still be allowed in those businesses that don't serve food or liquor and that derive more than 80 percent of their revenue from tobacco-related sales. What's more, most states aren't adequately funding smoking-prevention and cessation programs, according to a report released jointly last month by several prominent organizations. In all, state governments' annual spending is less than half of the roughly $1.6 billion that the Centers for Disease Control and Prevention has advised, says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, one of the groups behind the report.
Hookah smoke contains some of the same hazardous components found in cigarette smoke, which have been linked to heart disease, cancer, and addiction, Eissenberg says. What's more, he says, a water pipe smoker may inhale as much smoke during a single hookah session as a cigarette smoker would inhale by blazing through 100 cigarettes. Cigarette smokers typically take eight to 12 puffs and inhale a total of about half a liter of smoke during a five-to-seven-minute smoking session, whereas hookah smokers may take 50 to 200 puffs and inhale up to 50 liters of smoke over a period that can exceed an hour. But the volume of smoke isn't everything, says Paris-based medical anthropologist Kamal Chaouachi. The charcoal that's often burned to heat hookah tobacco creates abundant carbon monoxide as well as potentially hazardous chemicals that aren't in cigarette smoke, he noted in an E-mail. On the other hand, he says, hookah tobacco is heated to a lower temperature, which may make it less carcinogenic than cigarette tobacco.