Last month, the CDC issued a public service announcement declaring that “hookah smoking has increased among young people.” This blunt proclamation was motivated by their recent analysis of the 2016 National Youth Tobacco Survey — a nationally representative survey of U.S. students — which found that nearly three in 10 high schoolers who’ve never smoked hookah (6.9 million) reported at least some interest in giving it a shot.
These finding certainly came as a surprise to me, since the government and other anti-tobacco agencies seem to currently be more focused on keeping teenagers away from Juuls, not waterpipes. In fact, one recently published government survey found that a whopping 1.3 million more teens vaped in 2018 than the year prior, prompting Surgeon General Jerome Adams to send out a public advisory against Juuling, “emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks.”
But then again, it makes sense that Juuls — which can be smoked virtually anywhere, including in school bathrooms, behind the basketball courts and even in the occasional classroom — might cause more public panic than the decidedly non-portable hookah, which is more commonly smoked behind thick drapes in dimly-lit clubs.
So is the hookah industry really secretly booming behind everyone’s back? And is the CDC right to be worried that we may soon witness a hookah epidemic among American teens? It’s hard to say for certain, but according to Wilson “Dutch” Voigt, co-founder of DMZtv, a YouTube channel devoted primarily to creating hookah-related content, the hookah industry — which is largely dependent on the existence of lounges where patrons can legally smoke these long-stemmed waterpipes — is currently being hit hard by taxes and regulations.
As an example, Voigt mentions that New York’s hookah scene was recently devastated by new laws requiring hookah-serving establishments to have a permit; to only serve non-tobacco shisha; and to display warning signs about the health risks of smoking their products. Until now, in many states and cities, hookah lounges have been able to circumvent indoor smoking laws due to loopholes allowing for the tobacco-free shisha commonly smoked in hookahs. New York City had such a loophole, but in 2014, the New York University School of Medicine visited eight hookah bars, all of which claimed to use only tobacco-free shisha, found nicotine in the air at every single one. With this in mind, you can see why new laws and regulations have been implemented.
The San Francisco hookah scene has been similarly disrupted, since the city recently implemented a ban on flavored nicotine products intended to keep teenagers away from flavored e-cigarettes. Predictably, the ban also affected hookah lounges, since hookah is currently the most popular flavored tobacco product among our nation’s youth.
While I can’t confirm this, Voigt argues that these government regulations are targeting hookah even more so than other tobacco products. “There’s a whole, long story on that, but I can give you what I suspect,” he explains. “[The government] used to get a lot of money from the cigarette companies, and now they got rid of [many of them] with Campaigns of Truth. There’s no more money coming from the cigarette companies, so now they’re looking to these companies — the hookah industry and the vaping industry — to see if they can tax them, more or less, how they taxed the cigarette companies.”
Despite these new regulations, Voigt says that the worldwide hookah industry is actually keeping its extremely smokey head up. In fact, around the world, waterpipe use among younger people has actually increased over the past 20 years. As weird as it might sound, so-called hookah influencers (and hookah-based events) are especially prevalent in both Germany and Russia, with Voigt explaining that cold weather is one reason for this popularity — people prefer spending their nights inside of a hookah lounge, he says, rather than freezing their asses off while attempting to light up a cigarette outside the local bar.
As for why people choose hookah over other, more accessible methods of smoking, like Juuling, Voigt says it comes down to socializing. “Once you have a hookah, all of a sudden you have friends coming over to smoke,” he explains. “A vape is a more personal thing — y’know, you keep your vape, and you don’t even pass it on to no one. Your vape is your vape, and nobody else is gonna be using it. Hookah is totally different: It’s meant for socializing, which is why you see it in clubs and hookah lounges.”
Keith Minerva, founder of Phoenix Hookah Services, expands on this idea, adding that hookah users are their own unique brand of smoker. “In my experience, hookah smokers don’t generally smoke cigarettes or use other tobacco products regularly,” he explains. “On the other side, cigarette smokers and tobacco users don’t generally smoke hookah if they’ve been smoking cigarettes or using other tobacco products for a long time — that’s because most hookah tobacco has a nicotine level of 0.05 percent and a zero percent tar level, so these heavy cigarettes smokers and tobacco users just can’t get the same buzz from a hookah as they can from a cigarette or a can of dip.”
Now, it’s worth emphasizing that Minerva said “most” hookah tobacco, since the stats he provided are certainly up for debate. In fact, reports I included in a previous article have an entirely different story to tell:
“According to a 2010 study, hookah smokers inhale far more tobacco smoke per session (90,000 milliliters) than cigarette smokers (500 to 600 milliliters). Hookah smoke also contains eight times more carbon monoxide and 36 times more tar than cigarette smoke, which likely puts you at an even higher risk of lung and oral cancers, heart disease and other serious illnesses.”
This confusion about the nicotine levels in hookah is warranted, though, since a 2013 study actually found that the labeling on many brands of waterpipe tobacco are extremely misleading:
“Nicotine labelling on waterpipe tobacco products does not reflect delivery; smoking a brand with a ‘0.05 percent nicotine’ label led to greater plasma nicotine levels than smoking a brand with a ‘0.5 percent nicotine’ label. Waterpipe tobacco products should be labelled in a manner that does not mislead consumers.”
On a final note, Minerva says that some hookah smokers can almost be compared to collectors. “People like myself, who’ve smoked hookah for a long time and enjoy the process of mixing flavors and collecting unique hookahs, will probably never quit to pick up vapes or really any other tobacco product,” he emphasizes.
It seems, then, that the hookah scene is still alive and well. That said, until I see lines of teenagers outside my local hookah lounges, I still have my doubts that it’ll present itself as the next big tobacco-related epidemic.