June 1, 2011 -- Jeff Burt has always enjoyed the smoothness and fruity flavors of a hookah's smoke. The 28-year-old has smoked shisha -- a flavored tobacco -- for several years in social settings with friends, but it's only in recent months that Burt has worried that his hookah consumption, usually combined with cigarettes and alcohol during a night out, is taking a toll on his body.
"I have been feeling worse and worse after I go out, drink a lot and smoke cigarettes and hookah, so I've been trying to cut down on the amount of that type of stuff I've been doing," said Burt.
Now, other hookah lovers may have to cut back on their shisha consumption, too, whether they want to or not. State lawmakers in Oregon, Connecticut and California are proposing to ban or limit hookah bars because of the health hazards associated with the smoking.
Reps. Carolyn Tomei, an Oregon state representative who sponsored a bill to limit new hookah lounges in Oregon, said her biggest concern is the health risk to young people.
"It's mostly very young people in hookah bars and that's who they appeal to," said Tomei. "Someone middle-aged doesn't start smoking; new smokers are young people. And most young people aren't aware of how dangerous it is."
Jack Henningfield, a drug and tobacco addiction expert at Johns Hopkins Medical Institution and a member of the World Health Organization Tobacco Product Regulation Study Group, agreed with Tomei, and said that even recreational use could turn into addiction.
"Proponents tend to describe infrequent use, but then that is how cigarette addiction and other disease typically start," said Henningfield. "Similar to cigarette smoking, many people escalate to more frequent use and higher levels of intake."
The Eastern Mediterranean device, which has been used in the region for several hundred years, has become a rising trend in the United States, particularly among young adults. Many people smoke shisha, because they believe it is a milder and safer alternative to smoking cigarettes, but experts say the truth is that it's as dangerous-- maybe even more -- than lighting up a cigarette.
A 2009 study conducted by Thomas Eissenberg, a professor of biopsychology and health psychology at Virginia Commonwealth University, found that relative to cigarette smoking, hookah use is associated with greater carbon monoxide, nicotine and smoke exposure.
"People are inhaling charcoal smoke and the combustion product of sugar and flavoring, along with tobacco smoke," said Eissenberg. "Smoke from a hookah and cigarettes have the same poisons."
The tobacco is heated by charcoal. The water in the hookah then cools the smoke before it hits one's mouth, so inhaling theusually fruity-flavored smoke is much smoother than a cigarette. Because of this, many people who partake in the hookah believe that the water acts as a filter to the tobacco toxins, but experts say this is untrue.
Smoking from a hookah during a typical 45-minute session is equivalent to smoking about 100 cigarettes, Eissenberg said.
Moreover, hookah tobacco packages are usually labeled to contain.05 percent of nicotine and 0 percent tar.
"Many hookah lounge owners will say, 'Look, it doesn't have tar' and they'll point to the tobacco package," said Eissenberg. "The box is right, just as a cigarette does not contain tar. You have to burn tobacco to produce tar."
45-Minute Hookah Session Equals 100 Cigarettes
"There is a great deal of tar in hookah smoke," continued Eissenberg. "A person gets about 36 times the amount of tar in a hookah session compared to a cigarette."
So why, in an age of billion-dollar anti-smoking campaigns, are these lounges still publicly accepted?
Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, said that hookah lounges serve as a mechanism to preserve culture and express identity, "thus lacking the social stigma of smoking cigarettes for these communities."
But as smoking shisha becomes more popular, experts say it's imperative to expose the dangers of it.
"Globally, they should be subject to the same regulations as cigarettes and other tobacco products," said Henningfield. "The products, including the tobacco material and charcoal, should include strong warnings and honest information about contents and emissions."
"Their use should be prohibited wherever cigarette smoking and other types of tobacco smoking are prohibited because second hand exposure to their fumes is hazardous, particularly to children and pregnant women," said Henningfield.
Akhil, owner of La Sheesh Hookah Lounge in New Haven, Conn., declined to give his last name, but said he is happy to oblige any regulation that Connecticut lawmakers put into place. But Akhil did note that banning hookah lounges is different than the ban on smoking in public places.
"It's different in a hookah lounge, because a person's intentions are to go to smoke, which is different going to a bar or restaurant, where you could be exposed unfairly to a health hazard," said Akhil. "It's different if you know you're going to a place to smoke out of a hookah."
And as for frequenters of hookah lounges, the sudden ban or limitation to the popular bars may cause protest.
"The public can make their own decision about if they would like to smoke a hookah at a lounge," said Burt. "Hookah lounges are designated bars specifically targeted to people who like to smoke hookah. If you don't like smoking hookah, why would you enter a hookah bar?"