Clouds of sickly sweet blackberry smoke are billowing out of Isaac Doss' mouth. He takes a long draw from the bubbling hookah and passes the pipe to Kara Brick.
They are sprawled on cushioned wicker chairs on the patio at Kush, a hookah bar on Greenville Avenue in Dallas. It's a muggy Thursday and the two are celebrating the return of Kara's sister, Savannah Brick, from an au pair job in Europe.
"This is kind of cheating," Kara Brick, 28, says. "We are all ex-smokers. With cigarettes, you really have to push through smoking it the first time. They taste terrible and smell terrible. Hookah is actually enjoyable. This has a social feel and is something we can do together."
Hookah bars are a relaxed gathering place for customers to socialize as they smoke tobacco through water pipes. It's a hot trend among young adults. Nearly one in five U.S. students smoked hookah in the last year, according to a study published in the journal Pediatrics. About 10 businesses sell hookah within a five-mile radius of the University of Texas at Dallas.
But hookah, which comes with few warning labels or health notices, can be more dangerous than smoking cigarettes. A study funded by the National Institutes of Health notes that a single hookah session delivers 1.7 times the nicotine, 6.5 times the carbon monoxide and 46.4 times the tar of a single cigarette.
"There is no reason to believe that a water pipe is less dangerous than a cigarette," says Dr. Thomas Eissenberg, a Virginia Commonwealth University professor who has conducted numerous studies on water pipe smoking. "In fact, depending on some of the toxins, there is reason to believe it is more dangerous."
Doss, 25, smoked hookah regularly at the University of the Ozarks in Clarksville, Ark., without realizing the health risks.
"I was 18 the first time I smoked," he says. "I smoked every weekend. I never considered how bad it would be for me. Now I smoke occasionally enough that it really can't affect me. It's something I consider before I go to the hookah bar."
State law prohibits the sale and smoking of hookahs to anyone younger than 18. Kevin Perlich, a spokesman at the Richardson, Tex., Police Department, says that anyone caught smoking under 18 will be issued a citation for the use of tobacco, a Class C misdemeanor similar to a speeding ticket.
Richardson has adopted ordinances that ban the use of tobacco products, including water pipes, in most public places. But the law does not restrict young patrons from entering the lounge, so teenagers are legally able to be in the environment.
"Hookah seems like it is on the upswing," says Dr. Gary Weinstein, a pulmonologist at Texas Health Presbyterian Dallas. "There are hookah bars in many young areas, and it's a cool thing to do. It seems cooler than smoking a cigarette."
Data from the University of Michigan's Monitoring the Future survey suggests hookah usage among high school seniors in the past year rose 21 percent.
Eissenberg says this is an issue because many young people do not realize they are inhaling tobacco, charcoal smoke and other carcinogens with each breath.
"The problem is, if you go into a water pipe bar and look at the pipe you are being served, there is nothing on that pipe or on the tobacco or in that charcoal that tells you it's dangerous," Eissenberg says. "I have gotten this outlook from kids: 'It doesn't say it's dangerous, so it must be safe.'"
When smoking a cigarette, the user lights the tobacco with a fire and inhales the smoke. With hookah, the smoke passes from a head containing tobacco and charcoal, through a water bowl and into a hose for inhalation. The tobacco comes in many flavors, ranging from chocolate to fruit to alcoholic varieties.
Hookah smoke is known to contain higher levels of lead, nickel and arsenic, 36 times more tar and 15 times more carbon monoxide than cigarettes, research in the Journal of Cancer Epidemiology, Biomarkers & Prevention shows.
This is because smoking a hookah requires taking harder and longer drags, increasing the levels of inhaled carcinogens and nicotine in the lungs.
"When they take a puff, the smoke is very cool and the draw resistance is very low, so it is easy to inhale and it tastes good," Eissenberg says. "They take dramatically larger puffs, about 500 milliliters per puff. We are talking about an entire cigarette's worth of smoke in a single puff."
The longer the hookah session, the more nicotine and toxins a person takes in.
A 45- to 60-minute hookah session can expose the smoker to about the same amount of nicotine and tar as one pack of cigarettes, Eissenberg says.
"If you aren't a cigarette smoker because you know cigarettes are dangerous and lethal, then there is absolutely no reason to be smoking a water pipe and every reason to avoid it for the same reason," he says. "Water pipe smoking will kill you also."
Dr. Mark Millard, a medical director at Baylor Martha Foster Lung Care Center, has practiced medicine in the Middle East, an area where water pipe smoking has been prevalent for more than 400 years. On one trip, he treated a woman from Saudi Arabia with a hacking cough.
"She was smoking every night for an hour," he says. "That is quite a lot of inhalants. I told her to get rid of her hubbly bubbly (hookah). It's nicotine that is the addictive factor. It makes people want to come back for more. People can get addicted to hookahs, and it does affect your health."
Five years ago, Farhad Ata opened Kush Hookah Lounge.
Ata has smoked hookah his entire life. He says he likes the nicotine buzz and the chill environment. He knows smoking is not healthy, but he has accepted the risks. It's something he says he hopes clients are aware of, too.
"I don't really sit down and talk with them about the health risks," Ata says. "I think some people are already schooled, and they just accept it. Other people don't care. It is still tobacco, no matter what, even if it is flavored. Your lungs are meant for air. Any type of smoke is not good for you, whether it's cigarettes or hookah."
Eissenberg says: Know the risks.
"As a package deal, it's a dangerous thing to do," he says. "Educate yourself. Then make the decision."
Journal information: Pediatrics
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