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.
What Adams will smoke are hookahs, tall water pipes that have been used for centuries in the Middle East and South Asia. Hookah tobacco is often soaked in molasses and mixed with fruit pulp—mint, mango, rose, or apple, to name some popular blends. Each hookah lets numerous friends smoke communally via disposable mouthpieces. Adams and his high school pals frequent sultry lounges, like Prince's, where for roughly $13 a person they can puff in a manner they may feel is harmless. "Hookahs are safer than cigarettes because the water definitely cleans the smoke," he says. In fact, this notion comes straight off the menu: "Smokers say shishas (hookahs) are smoother than cigarettes, and the water filter makes the smoke less harmful." To experts, these are myths that badly need busting.
"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.
According to Eissenberg, studies suggest that smoke from a single hookah session contains approximately 36 times the tar, 1.7 times the nicotine, and 8.3 times the carbon monoxide as the smoke produced by one cigarette. What fraction of those chemicals a hookah smoker actually absorbs isn't known, he adds, because some of these studies involved machines that simulate how people smoke, not actual smokers. "I'm concerned youngsters will go to these hookah bars and get addicted to the nicotine in the smoke," says Norman Edelman, chief medical officer of the American Lung Association. Research shows that hookah smokers have lower levels of nicotine and cotinine, a chemical the body makes from nicotine, than cigarette smokers, but the dose is still ample enough to lead to dependence, experts say. In fact, a survey of Syrians linked frequent hookah use to their belief it would be difficult to quit.
But Adams doesn't think he's in danger of addiction: "I've never woken up in the morning, breaking out in cold sweats, saying 'Ah! I want hookah!' " However, he did recently lose a 19-year-old friend, a longtime cigarette smoker, to lung cancer, which has made him more health conscious. "If I knew hookahs could put me at the same risk as cigarettes," he says, "that would definitely stop me from smoking them."
Most people who are addicted to tobacco get addicted as teens or younger, Edelman says. Since hookahs, which can stand 3 feet tall, can't be carted around in pants pockets, he worries cigarettes might be the next step. Overcoming a hookah addiction would require the same steps as quitting cigarettes, he says. And the mouthpieces attached to hookahs may pose a separate health risk, says Samira Asma, an epidemiologist at the CDC. Although every hookah smoker can get his or her own at the beginning of a session, many groups opt to simplify the hookah hose-passing ritual by sharing a single mouthpiece. This creates opportunities for the spread of infectious diseases such as herpes or tuberculosis, says Asma.
"It's a fad," Edelman says. "The good thing is these trends usually run their course and die, like oxygen bars. I'm hoping the same will happen with this."