Bars in East Lansing are starting to open their doors to students that are only 18, but these bars do not serve alcohol. Instead, they offer a relaxing atmosphere where students can smoke flavored tobacco through a hookah. Students who would never touch a cigarette feel comfortable heading down to the Blue Midnight Hookah Lounge just off campus to enjoy an hour of smoking hookah with their friends. Hookah has become one of the trendiest social activities among college students, many of whom see no harm in participating. It is a common belief that hookah smoking is not hazardous, or at least a better alternative to cigarettes. In truth, hookah smokers are putting themselves at risk for harmful health effects.
Over the last few years, hookah bars have popped up in college towns across the country as more and more students gather with friends to smoke the flavored tobacco. Jeff Wareck, manager of Silver Streak and Krazy Katz, a tobacco head shop in East Lansing, said he has definitely seen an increase in hookah sales over the last two or three years. This popular trend has become a way for students to relax and hang out. Sophomore finance major Jack Burke said he smokes hookah about once a month because it is social and fun. “You feel like part of a group. There’s good conversation and showing off with smoke tricks is fun,” Burke said. [Hookah2]
To use a hookah, charcoal is placed on top of tobacco in the bowl. The charcoal heats the tobacco, producing smoke. When inhaling, the smoke travels through the hookah’s body tube, which extends through a glass jar at the base of the hookah. The jar contains water, which cools the smoke before it enters the hose. The hose attaches to the mouthpiece through which the smoke is inhaled.
This modern hookah design was developed in Turkey hundreds of years ago. It was modeled after the original version of a water pipe, which was first invented in India. Hookah, or nargile as it is called in Turkey, became popular part of Turkish culture after it was incorporated into their coffee shops. Today, smoking hookah is one of Turkey’s oldest cultural traditions.
Hookah as a cultural tradition spread to many other countries such as Egypt, Morocco and Israel where it remains popular today. In the Arab world, the hookah is commonly known as shisha. Most cafes in the Middle East and American cities with large Middle-Eastern communities offer hookah and are a popular place for social gatherings.
Though celebrating friends and culture, hookah smokers around the world are also putting their health at risk. The inhalation of smoke raises major health concerns about smoking hookah. Many people believe that the water in the base of the hookah helps filter out harmful byproducts. But Rebecca Allen, alcohol and drugs health educator at Olin Health Center, said that this is a myth; the water does not filter out toxins. In fact, she said smoking hookah is “equally as harmful” as smoking cigarettes.
It may even be worse. Allen said that with hookah, smokers take in more smoke all together and for longer periods of time. According to the World Health Organization, a person can inhale more than 100 times more smoke in a one-hour hookah session than in a single cigarette.
“Since you inhale much longer and much deeper you get a lot more of the byproducts – more tar, more carcinogens,” Allen said. Hookah smokers, like cigarette smokers, inhale carbon monoxide. Exposure to these toxins in cigarettes has been known to cause heart disease and lung cancer.
Donald McGrath, a co-owner of Blue Midnight Hookah Lounge, said that students do sometimes ask about health risks. “We tell them that no smoking is good for you, obviously,” McGrath said. But he also pointed out one plus of smoking hookah rather than cigarettes. “Hookah is 100 percent pure tobacco, so there are no additives like rat poison that are found in cigarettes,” McGrath said. Yet, customers at Blue Midnight are not misled into thinking hookah is completely harmless. “Of course, we never tell people that it is good for them,” McGrath said.
While research on the health effects of cigarettes is extensive, there are few studies on hookah. Further research needs to be done to determine how much and how often hookah smoke needs to be inhaled to cause long term affects and diseases. Since hookah smoking in generally a social activity, people usually smoke it a lot less often than they would smoke a cigarette. McGrath said that most of their customers come into Blue Midnight about once or twice a week to smoke. “Moderation is important not just with hookah but with a lot of things,” McGrath said. Comparing it to cigarettes he said, “Two packs a day would be bad, but with hookah it’s not every day.”
[Allen]Although unsure of how great of a difference it makes, health experts are keeping in mind the tendency for hookah usage to be infrequent when determining its health effects. “If you don’t smoke hookah a lot, in some ways, over the long haul, it can be less harmful [than cigarettes]. But it is still equally addictive,” Allen said.
Nicotine intake and addiction is another primary health concern of smoking hookah. Just like cigarettes, the tobacco used to smoke hookah contains nicotine, which makes smokers feel more relaxed. “Nicotine is unusual in that it releases a chemical cascade, unlike other drugs, releasing eight different types of brain chemicals, some of which act as a stimulant,” Allen said. Nicotine causes changes in the brain that make users crave it more and more. It can also cause unpleasant withdrawal symptoms.
Though many people know that cigarettes are addicting, many are unaware of the risk of becoming addicted to smoking hookah. “There is a great potential for addiction or abuse,” Allen said. “It’s critical to understand that nicotine is one of the most addictive substances we know of.” Not only are the smoke and nicotine harmful, but the very mouthpiece of the hookah can also raise health concerns. Allen said that it is possible to spread viruses or even herpes by sharing a mouthpiece, but most are preventable with cleaning. “A lot depends on where you’re going to smoke,” Allen said.
Many hookah bars offer disposable plastic mouthpieces to prevent the spread of germs. Each person has their own, which can easily be put on the hose and taken off. But a lot of students who use their own hookahs do not take such precautions when sharing with their friends, possibly subjecting them to the spread of colds or worse.[hookahsmoke]
In March, the Michigan House of Representatives introduced a bill that would regulate hookah sanitation in bars and restaurants. The bill mandates the use of disposable mouthpieces and single use hoses, in addition to proper cleaning of the bowl and body. McGrath said that they already sanitize well at Blue Midnight. “We sanitize the whole thing – the base, the pipe – for obvious reasons,” McGrath said. While some hookah bars may choose to sanitize on their own, further action has yet to be taken on the bill; so for now, proper sanitation is not law.
So with so many health effects involved with hookah, why does it seem that nobody knows about them? The law does have a few restrictions on hookah. You must be 18 to buy tobacco or to smoke hookah at a bar. Additionally, Wareck said that there are typical hazard warnings, like those found on cigarette packs, on tobacco boxes. Yet, many hookah smokers are unaware of the potential health risks.
Junior economics major Jeremy Procopio said that he does not worry about his health when smoking hookah. “It’s interesting because when you smoke hookah, you don’t wheeze or cough at all,” Procopio said. Although he knows that smoking is probably bad for him, he doesn’t feel any obvious effects.
Like many students, Procopio only smokes once in while with his friends, which can make it seem even less serious. Gathering once every month or two may discourage smokers from seeing hookah as addictive or dangerous; they may see it as just something to do with friends. “It’s social. That’s why people aren’t concerned too much with the health risk,” McGrath said.
Though Procopio is unaware of the specific health hazards of smoking hookah, he speculates that many people are misled into thinking that hookah is safer than cigarettes. “It’s probably one of the worst things high school and college students can do besides smoking [cigarettes] and drinking. But it’s hard to know because there is no advertising against it,” Procopio said.
Indeed, while health education in schools and TV commercials do their best to stop kids from smoking cigarettes, almost nothing is said about hookah. But members of the Michigan legislature are making an effort to increase awareness of the health effects of smoking hookah, in addition to regulating sanitation. In March, the Michigan Senate introduced a bill that would require businesses that sell hookah tobacco, including hookah bars, to post health hazard warnings in English, Arabic and Spanish. The Senate also introduced a similar bill in March that would create a health awareness campaign explaining the risks of smoking hookah. Both of these bills await further action.
But will these bills make a difference? McGrath does not think increasing knowledge of health concerns would deter many students from smoking hookah. “I assume that most people who smoke know that it’s not good for you because it’s common sense,” McGrath said. Many students may already have some idea that hookah is bad for them, and might not stop smoking once they hear the specifics.
“I am aware of the health problems related to hookah, but it does not affect my behavior,” Burke said. The law and health professionals can try to warn students of the health risks, but that does not mean that they will listen.
College is full of risky decisions from binge drinking to casual sex. While nicotine addiction and toxic smoke may harm hookah smokers, the social atmosphere and nicotine buzz provide a good time. Hookah smokers will have to decide for themselves if the benefits outweigh the risks.

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