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By Mark Travers

The ban on smoking in restaurants and the workplace hasn’t stopped hookah bars from popping up like weeds. These establishments are located near college campuses and along major streets in Buffalo and Niagara Falls. Hookah bars are places where hookah smoking is done socially in groups, sometimes with the same mouthpiece passed from person to person. The public health community is concerned about the risks and challenges with this latest trend in tobacco use.

Hookahs are water pipes used to smoke a tobacco mixture called shisha that comes in hundreds of flavors, including cherry and chocolate, effectively appealing to kids and young adults. The tobacco, heated with charcoal, produces smoke that travels through water in the pipe and is inhaled through a hose. Users may inhale smoke that is equivalent to 100 cigarettes in one session. Because shisha is unregulated, these products often come with false or misleading labels on nicotine content and other constituents.

Hookah smoking is not safe. When compared to cigarettes, a hookah session delivers twice the nicotine, seven times the carbon monoxide, 30 times the formaldehyde and 80 times the lead. There are many reported cases of emergency room visits for acute carbon monoxide poisoning after use. Secondhand smoke inside a hookah bar can exceed federal air quality standards, as hookahs emit smoke not just from tobacco, but also the charcoal used to heat the tobacco.

So how can hookah bars set up shop when New York State took a strong stand to ban smoking indoors 10 years ago with the Clean Indoor Air Act?

Because retail tobacco shops are exempt under the act, Hookah bars can claim they are a retail tobacco shop if their main business is the sale of tobacco products.

This loophole must be closed so that hookah smoking is prohibited in public places. The World Health Organization recommends that hookah and hookah tobacco be covered by the same regulations as cigarettes and other tobacco products. The National Association of County and City Health Officials supports legislation to reduce and eliminate the harmful public health effects of hookah smoking.

The Clean Indoor Air Act’s definition of smoking should be updated to include new tobacco products such as hookah tobacco and e-cigarettes. Updating this legislation will help individuals and businesses cope with challenges posed by new tobacco establishments. The valuable and popular gains won with the Clean Indoor Air Act legislation must not be clouded with new threats to clean air.

Mark Travers, Ph.D., is a professor of oncology at Roswell Park Cancer Institute with expertise in secondhand smoke and air pollution exposure, tobacco control policies and cancer prevention.