A hookah, also known as shisha and nargile, is a waterpipe used for smoking flavored tobacco. The tobacco used in hookahs is typically shredded tobacco leaf flavored with molasses, honey or dried fruit. This sweetened tobacco product is generally called shisha in the United States. The popularity of hookah establishments (often referred to as “bars” or “lounges”) has grown in the United States, particularly in cities with large Middle-Eastern communities and in areas with significant young adult populations, such as near college campuses. Hundreds of hookah bars now operate in the United States, with new establishments opening every month.

The health risks associated with hookah smoking are generally thought to be greater than those of cigarette or cigar smoking. Hookah smoke contains significant amounts of nicotine, tar, heavy metals, and carcinogens. Waterpipe smoke may also contain charcoal or wood cinder byproduct carcinogens and carbon monoxide. An unfortunate myth persists that hookah use is less damaging to health than cigarette smoking because the water filtration system and extended hose serve as filters for harmful agents. In fact, the water filtration system only cools the smoke, allowing the user to inhale greater amounts of smoke over a longer period of time. A typical hookah session may last for an hour or more and this period of sustained inhalation increases exposure to carcinogens and is similar, in result, to smoking up to 100 cigarettes.


Legal Issues

A key legal issue relating to hookah smoking is whether such an activity would be covered under a clean indoor air statute or ordinance. For example, Illinois and New Mexico include “hookah” within a definition of the term “smoking” but then exempt those hookah establishments as retail tobacco or specialty stores. Illinois requires that a hookah establishment derive more than 80 percent of its gross revenue from the sale of tobacco products and not sell food or alcoholic beverages. New Mexico exempts hookah lounges under a retail tobacco store exemption, but also requires that alcoholic beverages be prohibited. Maine expressly includes hookahs under the definition of a tobacco specialty store exemption so long as that store was licensed prior to January 1, 2007 and the preparation or consumption of food or drink on the premises is prohibited.

Other statewide smoke-free regulations do not address hookah smoking specifically. Approximately fifteen states, including Puerto Rico and Washington, D.C., contain retail tobacco store exemptions that could possibly cover hookah bars. Whether a hookah establishment might fall under such an exemption depends largely on the language of the exemption and the characteristics of the hookah bar in question. At least seven state smoke-free laws contain “smoking bar,” “tobacco bar” or “cigar bar” exemptions that could also include hookah establishments. This again depends primarily on the language of the exemption. For example, a hookah establishment in Massachusetts might fit under a “smoking bar” exemption so long as certain requirements are met, such as incidental sale of food or alcohol, prohibition on entry of minors during business hours, and valid permit requirements under Massachusetts law.


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