By the time I notice a trend, either it is no longer a trend or it has gained enough traction to dig in for a long stay.
I recently visited Orlando, Florida, with my colleagues as we attended a major estate planning conference. It was on this trip that the prevalence of hookah bars caught my attention. When I asked my colleagues based in Florida and Georgia, they confirmed that I wasn't imagining this; hookah bars are, as they say, "a thing."
Hookahs - water pipes typically filled with fruit-laced tobacco - do not themselves qualify as new in any way. While the origin of water pipes is disputed, this method of smoking has existed for hundreds of years. Shisha, the flavored tobacco available at a modern hookah bar, is relatively newer, but was already popular in private settings in the U.S. as far back as the 1960s and '70s.
The new part is the popularity of establishments devoted to smoking shisha where people, many of them young, gather to spend time together while they partake. That trend, which took off in the mid-2000s, seems to have gained mainstream attention a few years ago. A study published in "Pediatrics" last summer showed that hookah smoking among high school seniors has risen to 21 percent of those surveyed.
The popularity of hookah bars, especially among the 18- to 21-year-old demographic, seems to rest on two major factors. First, the widespread misconception that hookah is less dangerous than smoking cigarettes makes hookah seem misleadingly benign; second, the law of unintended consequences created a vacuum that hookah bars were perfectly situated to fill.
The idea that hookah is less harmful than cigarettes is persistent but incorrect. Dr. Khalid Anis, chairman of the Niche Tobacco Advisory Group for North England, told The Guardian that, "There's a misconception that shisha is not as bad for you as cigarettes, because the tobacco is flavoured and passes through water first." But, he added, "the carcinogens and nicotine are still there," meaning the risks remain. (1) Research by the World Health Organizations suggests hookah may actually increase those risks, since the volume of smoke inhaled over a session may outstrip the amount the amount of smoke cigarettes would produce in a similar period by a wide margin. The American Lung Association notes that, while data on hookah is still relatively limited, "a troubling picture of this trend is emerging" between the study of health effects and the data suggesting use, especially among young people, is on the rise.
But focusing solely on the idea that hookah users may not understand the risks associated with their behavior misses a key facet of the popularity of not just hookah, but hookah bars in particular in the U.S. For older teens and young adults who are under 21, going to a traditional bar is not an option. Hookah bars a venue where young adults can gather and socialize. Hookah users from New Jersey have observed that it is a unique gathering spot for those who can't yet drink; many hookah bars purposely refrain from serving alcohol so they do not have to exclude patrons under the drinking age.
To put it bluntly, by forbidding people who are legally adults but who are under 21 from entering a bar to drink, we have unwittingly encouraged them to go to another sort of bar to smoke. Which is worse?
Even when young people are aware of the risks, they may be willing to run them for the tradeoff of a hookah bar's atmosphere and convenience. Hayleymarie Klatt, a Davie, Florida woman who was 20 when she spoke to the Sun Sentinel about her hookah use, said, "I may be taking some risks to my health. But that's my personal preference, and I'm OK with that." (2)
It might be easy for hookah users to draw a parallel with traditional bars. After all, alcohol is not risk-free. But while alcohol can cause harm, it doesn't always. The same cannot be said for tobacco, however it is consumed.
Yet between the misconception that hookah is not as bad for your brain as alcohol and the fact that a large segment of hookah smokers cannot drink alcohol in public even if they prefer it, hookah bars have arisen as a solution that is arguably worse than the original problem.
Some state legislators have tried to push back against hookah bars. In some places, legislators are working either for stricter smoking bans or to close loopholes in existing laws that allow hookah bars to thrive. A bill under consideration in California would raise the smoking age to 21. While the use of traditional cigarettes is down, especially among young people, hookah and e-cigarettes are bringing renewed public policy focus to tobacco.
Such efforts are well-intentioned and worthwhile, but they don't address the fact that young adults clearly hunger for places to unwind and socialize. The communal, laid-back vibe of hookah clearly has some appeal. But in trying to shield young people from the dangers of alcohol, it seems we have inadvertently steered them toward a more addictive and harmful alternative.