Hookah Smoking Increases in Gainesville, ‘Deadly trend’ Underreported

Natasha Alvarez had enough. She threw away the cigarettes and began a new life.

As part of her plan to quit smoking, she started smoking hookah to help with her addiction.

She didn’t realize she was probably harming herself even more with this decision.

Alvarez, 21, a Santa Fe College graphic design major, used to smoke one pack of cigarettes a day, every day.

“I couldn’t even walk fast because I would get tired, or I couldn’t go up a flight of stairs because I would almost pass out,” Alvarez said. “The bad smell, bad skin, bad teeth, all of it – I got fed up.”

She then started smoking about two hookahs per day.

“I thought I could smoke 1,000 hookahs and it would even be better for me,” she said.

Alvarez is not alone.

According to the Tobacco-Related Disease Research Program, one study found that 91 percent of weekly hookah smokers and 51 percent of daily smokers said they could not quit, “which highlights the addictive nature of hookah smoking among myriad factors.”

People can develop an addiction for hookah as severe as the one for cigarettes and can develop cancer just as easily as well, said Dr. Jane Emmerée, Health Promotion Specialist for GatorWell Health Promotion Services at the University of Florida Student Health Care Center.

Emmerée provides smoking cessation coaching for students enrolled at U.F. She also provides help quitting any type of tobacco product.

Almost 13 percent of U.F. students reported using hookah pipes within the 30 days preceding the Healthy Gators Student Survey Report conducted on the spring of 2008.

People are not aware of the apparent higher rate of cigarette smoking within hookah smokers, Emmerée said.

“Some students can just smoke socially, and you can’t predict who will become nicotine dependent,” Emmerée said. “But we do know people are at risk of dependency whether it is from nicotine in cigarettes, smokeless tobacco, hookahs, etc.”

People who smoke hookah are exposed to more smoke and nicotine because of longer exposure time, according to the American Lung Association Tobacco Policy Trend Alert February 2007 issue, An Emerging Deadly Trend: Waterpipe Tobacco Use.

One hookah lasts a minimum of 45 minutes, which is the amount of time it takes for the tobacco to burn out.

But a more typical one-hour long waterpipe smoking session involves inhaling 100 to 200 times the volume of smoke inhaled with a single cigarette, according to the World Health Organization Advisory Note “Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators” (2005).

The WHO Advisory Note urges waterpipes and waterpipe tobacco products to be “subjected to the same regulations as cigarettes and other tobacco products,” to “include strong health warnings,” and to prohibit misleading labels that imply safety.

One approach to solving this public health problem is to regulate the establishments that provide access to hookahs, Emmerée said, a task that is left up to the states.

In Florida, for example, restaurants have to be smoke free, but bars don’t, she said.

Whether a business is deemed a restaurant or not, depends on percentage of food sales versus percentage of alcohol sales. So hookah bars can avoid the strict regulations surrounding smoking in-doors if they don’t sell or allow cigarettes and their food sale percentage is high.

With limited regulation and an exotic and increasingly popular trend, hookah businesses have blossomed.

Gainesville, for example, had no hookah bars until two and a half years ago.

Now, there are four.

“But they are not competition,” said Sharvee Mia, 22, professional pilot, and owner and manager of Hookah Hutt, 1029 W University Ave., who after the publication of an earlier version of this article on a blog, asked for his quotes to be changed or removed.

The previous location on University Avenue and Sixth Street was too small, he said, so they moved in December to their new location on University Avenue and Tenth Street.

“It is definitely more popular now than when we started,” Mia said. “Now it is closer to campus, so we get a lot of foot traffic.”

Mia said an average of 60 customers visit his hookah bar on a busy night. They usually stay from 45 minutes to one hour and a half.

One of the reasons students like to go to hookah bars is the atmosphere.

Mia said his customers enjoy the hip-hop music he plays, unlike other hookah bars that play Arab music and Arab TV programs.

And this is precisely why Alvarez enjoys going to Hookah Nite Café, 2614 SW 34th St.

For the past month, she has been smoking hookah there three times a week, for up to two hours. She stays there hours at a time watching Arab soap operas, Arab music videos and Arab music contests American Idol-style – though she doesn't speak a word of Arabic. She knows the owner of the place – they know her favorite hookah flavor and when to bring in the baklava.

“Even though I know hookah is bad, I keep doing it,” Alvarez said. “Probably out of boredom, because it’s cheap, and you can talk with friends, relax and have a good time.”

This social aspect may be another underreported health risk factor in hookah smoking.

Infectious diseases like H1N1, hepatitis, tuberculosis or herpes can be transmitted by sharing mouthpieces –a problem cigarette smoking does not have, Emmerée said.

"In general, people underestimate the harm of things,” she said.

Students have shared with Emmerée that they feel hookah establishments are sending the message – which marketing perpetuates – that hookah is not as harmful as cigarettes, she said.

When questioned about it, the owner of Hookah Nite Café, who after the interview asked for his name and comments not to be used, said hookah is not as harmful as cigarettes because it uses natural tobacco, contains no tar, no chemicals and has a small amount of nicotine.

All of these statements were later dismissed by Emmerée. Both the WHO Advisory Note and the American Lung Association Tobacco Policy Trend Alert report that hookah smoke actually contains about 100 times the amount of tar and up to 70 times the amount of nicotine in cigarette smoke.

It is also a myth that the water in hookah pipes cleans any toxins or impurities out, Emmerée said, although both the owner of Hookah Nite Café and of Hookah Hut expressed this to be true.

Even after it has passed through water, the hookah smoke contains high levels of cancer-causing chemicals, more than 4,000 harmful toxic compounds such as ammonia, mercury and carbon monoxide, and heavy metals such as arsenic, lead and nickel, according to the WHO Advisory. The wood cinders and charcoals used to burn the tobacco produce these as well, which are likely to increase health risks.

These cancer-causing chemicals go deeper into the lungs and stay there longer because compared to cigarettes, a single puff of shisha, as hookah is also called, lasts about twice as long, and the suction pressure required to inhale the smoke is about four times stronger, according to a Tobacco-Related Disease Research Program 2006 newsletter.

So contrary to belief, there is nothing healthy about hookah smoking. The fruit used to flavor hookah tobacco is no more healthy than the cherry in Cherry Coke or the fruit in Fruit Roll-Ups.

For decades, fruit flavorings have been added to tobacco in order to sell more products, until Oct. 22 this year, when the Food and Drug Administration banned the sale of flavored cigarettes.

The ban intended to end the sale of tobacco products with chocolate, vanilla, clove and other flavorings that lure children and teenagers into smoking.

According to the ALA, a 2004 survey found that 20 percent of 17 to 19 year-old smokers had tried flavored cigarettes in a 30-day period, compared to the 6 percent of smokers over age 25 who had done so.

Even though candy-flavored tobacco products such as hookah are mainly aimed at them, Emmerée always tells her students to think about what they want to accomplish, their goals and dreams – and then to think about tobacco, she said.

“The idea of putting something harmful into your body may be not be best idea because it won’t allow you to be all you want to be,” Emmerée said.

Though there is a lot of misinformation in the public, she said, more research is being conducted on the subject.

“I expect GatorWell and U.F. to do more in the near future to educate students about this issue,” Emmerée said. “It is important for all U.F. students to make choices about U.F. and beyond, and using any kind of tobacco product, including hookah, may not fit with that.”