Hookah trend is puffing along

"It's something I grew up with," she says of the Middle Eastern custom known as hookah. Cheaib, 26, a Lebanese-born American and Georgetown graduate, doesn't smoke cigarettes and goes weeks without a pipe, but she likes the flavors, especially the mint-rose mixture, and the socializing. "When we meet for hookah, it's sort of our way of picking up where we left off," she says. She passes the pipe, more than 3 feet tall, to a fellow graduate while an Egyptian movie plays on a big screen.

In hundreds of bars and cafes nationwide — from Fresno to Ames, Iowa, to Raleigh, N.C. — Americans are inhaling fruit-flavored tobacco through water pipes as Arab and Indian men have done for centuries.

This tradition is posing a new challenge to the anti-tobacco movement in the USA, which has helped pass more than 2,000 smoke-free laws.

The smoking rate in the USA has been cut almost in half in the past 40 years, according to the Centers for Disease Control and Prevention. In 1965, about 42% of U.S. adults smoked; by 2003, that was down to about 22%, CDC says.

The health risks

The popularity of hookah, also known as shisha and narghile, runs against the anti-tobacco trend, partly because it appeals to teens and young adults. Water pipes also are exempted from some smoke-free laws and enjoy a mystique of being a more cultural and safer alternative to cigarettes.

"There's a myth that the smoke is filtered by the water," says Thomas Eissenberg, a psychology professor at Virginia Commonwealth University and co-author of a hookah study. The smoke passes through gurgling water before the user inhales it, but, he says, "Every risk of cigarette smoking is also associated with water pipes." Examples:

• Eissenberg says a hookah, which is smoked for about 45 minutes, delivers 36 times more tar than a cigarette, 15 times more carbon monoxide and 70% more nicotine.

• A study in the Journal of Periodontology found that water pipes smokers were five times more likely than non-smokers to show signs of gum disease.

• In a June 2004 study, Jane Henley, an epidemiologist at the American Cancer Society, found that men who smoked water pipes had five times the risk of lung cancer as non-smokers.

Eissenberg says he understands hookah's allure. "The first time I ordered one, it smelled like cherry cough drops," he says. He's concerned it may introduce young people to the addictive nature of nicotine.

Cheaib and Brian Wood, a Georgetown student, say they don't worry about the risks because they smoke infrequently. Wood, who says he doesn't smoke cigarettes, says hookahs have a smoother taste and don't leave a smell on clothes.

Qaiys Barak, manager of Maanjri Lounge in Raleigh, near North Carolina State University, says his customers are mostly American college students or young professionals. "It's a very young crowd," he says.

"It's different, unique," says Brennan Appel, director of Southsmoke.com, which sells hookah pipes and tobacco. He says sales have tripled in the past three years after hookah emerged in California and swept east.

He says it's now offered in about 1,000 bars, cafes or restaurants nationwide, many of which feature Middle Eastern food, Arab music videos or belly dancing. Smoking a hookah typically costs $7 to $15.

Despite its rising popularity, hookah is running afoul of some anti-smoking laws, including the one enacted this month in Washington state. It bans smoking inside all public facilities and workplaces and outside within 25 feet of doors, windows and vents.

Last month in Anaheim, Calif., the City Council approved restrictions on the city's 11 hookah venues after receiving complaints about rowdiness. It forbade live entertainment, alcohol, cover charges and patrons younger than 18.

Exceptions elsewhere

In other areas, including Columbus, Ohio, hookah venues are getting a pass. Like tobacconists and cigar bars, they qualify for exemptions under smoke-free laws because a sizable share of their sales comes from tobacco. In California, some hookah lounges have bypassed smoking bans meant to protect workers by making employees co-owners.

In New York City, which has about 20 hookah venues, there's tension, says City Councilman Peter Vallone Jr. When the city passed its smoke-free law three years ago, it exempted cigar bars and tobacco stores. Since hookah lounges were relatively new and not politically connected, they weren't exempted, and because few serve alcohol, they don't qualify as bars.

At times, the city has looked the other way and not issued fines. But Vallone, who favors a hookah waiver, has also received complaints from residents about the smoke and noise near these lounges.

Washington, D.C., faces a similar quandary. This month in a first vote, the city approved an indoor smoking ban but exempted cigar bars and tobacconists. Councilman Jim Graham wants to add a hookah exemption to the final law. "This smoke-free bill is not about prohibition," he says. "That's what we would do if we included hookahs."

Smoking an apple-flavored pipe at lunchtime at Prince Cafe, Saudi diplomat Saud Albalawi says he's not happy that hookah may get a waiver. Because it's so readily available in the nation's capital, he's smoking every day. Before he came to the USA three months ago, he was planning to quit.