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Public Health - Seattle & King County

Tobacco Prevention Program Newsletter, Fall 2009
By John Bennett

Hookahs: No safe alternative

Hookah 101

A hookah is a glass pipe filled with water used for smoking tobacco, marijuana, and other substances such as a tobacco and molasses mixture commonly referred to as shisha. Hookah is often smoked in a social setting where a group of friends gather around a single pipe. Hookah bars or lounges are designed to create a social area where groups can rent hookahs and purchase tobacco.

People who smoke from a hookah often claim that the pipe is less dangerous than cigarettes because the water "cleans" the smoke. In fact, hookah smoking carries all of the health risks associated with cigarettes and other tobacco products. Additionally, because multiple people share the mouthpiece of a hookah, this type of smoking raises concerns about spreading communicable disease. In particular, studies have suggested an increased risk of contracting tuberculosis with hookah use.

Yet the risk of hookahs has not yet stopped their growing popularity, especially among young adults under the legal drinking age looking for an alternative to a bar for an evening out. In the United States, hookah lounges are springing up in urban areas and around colleges. A recent survey of college students in the U.S. found that over 30% reported using hookah within the last year.

Unfortunately, in the last year at least three new hookah bars have opened in King County. Public Health has also received over a dozen inquiries from people interested in opening their own hookah bar.

As the popularity of hookah spreads, business owners are becoming more creative in their attempt to find a loophole in the Washington State Smoking in Public Places Law (RCW 70.160).

Despite these efforts, Public Health is not aware of any businesses in King County that are legally allowing smoking.

The bottom line is that hookah use is a serious public health issue and use is becoming more common in King County. Public Health is working to bring existing hookah bars into compliance with the law while preventing new ones from opening.

If you know of a hookah bar and want to file a complaint please fill out the online form on our website.

Common misconceptions about hookahs

Myth: The water in the hookah pipe filters out most of the harmful chemicals in the tobacco.

Fact: The World Health Organization reports that a typical one-hour hookah session exposes the smoker to 100 to 200 times the volume of smoke that is inhaled from a cigarette. Hookah smoke contains high levels of nicotine, heavy metals, and carbon monoxide in addition to the hundreds of other chemicals found in cigarette smoke.

Myth: Shisha contains little or no tobacco so it is not as addictive as cigarettes.

Fact: Because hookah smoke is heavily flavored with molasses, fruit, and other ingredients and because it is cooled as it passes through water, users tend to inhale deeper and keep the smoke in their lungs longer- providing more time for nicotine to be absorbed into the system. Nicotine is the addictive chemical in tobacco. Studies have also shown that hookah smoking may serve as a gateway to cigarette smoking and other forms of tobacco use.

Myth: It is legal to have a hookah bar.

Fact: The smoking ban (RCW 70.160) does not make any exceptions for hookah smoking. All places that are open to the public or that have employees are prohibited from allowing smoking of any kind. Public Health views smoking in hookah bars as a violation of the law and will actively enforce the smoking ban in hookah bars just as the law is enforced in any other bar or restaurant.