This summer, the New York City health department embarked on a public awareness campaign that departed from its usual reminders to use sunscreen and stay hydrated. For the first time, the department began warning New Yorkers about the health risks of smoking hookah.
The public service announcements followed a February report by the Centers for Disease Control and Prevention that found hookah use increasing among the city’s teenagers, rising from 9 percent who reported smoking hookah at least once in the previous 30 days in 2008 to 13 percent in 2014. The city’s ad campaign warns that one hour of hookah use exposes the smoker to as much carbon monoxide and tar as smoking 10 cigarettes.
Hookah bars, where lounging patrons puff on long-stemmed water pipes that burn tobacco or an herbal blend called shisha, have been popping up all over the country, raising increasing concerns in the public health community not only that they foul indoor air with harmful substances but also that they are a gateway to use of cigarettes and other forms of tobacco. “People have this misconception that hookah is healthier, so we saw the need to have greater awareness around it and its risks,” says Kim Kessler, New York City’s assistant commissioner for chronic disease prevention. “While we’ve made great progress in cigarette use in recent years, rates of smoking are going up in other areas like e-cigarettes and hookah, particularly among young people.”
Hookah bars are often able to circumvent indoor smoking laws because of cities’ loopholes allowing tobacco-free shisha. New York City has such a loophole, but when researchers from the New York University School of Medicine visited eight hookah bars in the city in 2014, they found tobacco at all of them.
Other concerns about hookah bars have led to new regulations. In Charlotte, N.C., they faced scrutiny in 2015 after the air in one bar was found to have four times the permissible level of carbon monoxide. In response, the city required better ventilation and had its firefighters start carrying carbon monoxide detectors.
That same year, then-Seattle Mayor Ed Murray went on a campaign against his city’s hookah bars, linking them to neighborhood crime and vowing to close all of them. Murray backed off after the East African community that frequents the hookah bars protested, calling the shutdowns racist. But the mayor ordered hookah bars to operate more like members-only private clubs and work with the city to ensure that their hookahs were tobacco-free.
That issue -- what is actually being smoked in the pipes -- is a big concern just about everywhere. “We rely for the most part on public complaints or public reports,” along with “voluntary enforcement and social enforcement,” Marcus Plescia, who was Mecklenburg County’s health director in 2015, told The Charlotte Observer.
Even before this summer’s public awareness campaign, New York City was moving far beyond voluntary enforcement. A package of bills passed in 2017 clamping down on tobacco and e-cigarette retailing also carried several regulations aimed at hookah bars, including requiring them to obtain yearly permits, post health warnings and get better ventilation systems; prohibiting them from expanding or moving locations; and ordering them to bar anyone under 21.
More than any other factor, the regulatory moves were motivated by fear of losing ground in the city’s campaign against teenage tobacco use. “Hookah,” says Kessler, “does pose a threat to the progress we’ve made in cigarette use in youth.”