Katie Lynch sucked in smoke from a long, narrow mouthpiece with pursed lips as if sipping from a straw. Her mother, Kathy Lynch, sat to her right with brow furrowed and arms crossed, watching as Katie cocked her head back, narrowed her eyes and gently puffed a cloud into the air.
Katie, 18, had convinced her mom to come to Jerusalem Café in Westport on a Thursday evening, not to eat Mediterranean food, but to head upstairs to the hookah bar. In the dim red light, people — many of them around Katie’s age — lean back in chairs and booths while they smoke tobacco from hookahs, traditional Middle Eastern water pipes.
Young people in big cities and college towns, including Lawrence and Warrensburg, Mo., are flocking in increasing numbers to hookah bars and lounges. Medical researchers said hookah use in the United States rose dramatically this decade, even as cigarette smoking rates steadily fell, city after city banned indoor smoking, and regulations on the tobacco industry continued to tighten.
Although hookah bar owners said the smoke people inhaled was less dangerous and less addictive than cigarettes, doctors point to research that indicates that may not be the case. One researcher called the spreading hookah use an “epidemic.”
Jerusalem Café added a hookah bar this summer at its 39th Street location. Sinbad’s Café and Hookah Lounge opened recently on Broadway Street near Westport, giving the city its first hookah business not connected to a restaurant. Along with Jerusalem Café on Westport Road, where the hookah bar dates to 2002, and Aladdin Café on 39th Street, Kansas City has at least four hookah businesses.
Hookah bars can operate legally under the smoking ordinance passed last year because of an exception for retail tobacco shops, but they cannot sell food or liquor, and at least 80 percent of their revenue must come from tobacco sales.
Jerusalem Café on Westport Road and Aladdin Café both had to separate their hookah bars from their restaurants to keep them legal. Jerusalem Café’s is upstairs, and Aladdin Café’s is outside.
But the restaurants’ owners said the ordinance had done little to slow their business, especially among college-age people too young to go to bars.
“Between the ages 18 and 21, there’s nothing to do,” said Farid Azzeh, owner of Jerusalem Café. “And this is something.”
A recent import
Hookahs are ubiquitous across the Middle East, where they’re a tradition that dates back centuries, said Mazen Iskandrani, owner of Aladdin Café.
“You can see, between a hookah bar and a hookah bar, another hookah bar,” said Iskandrani, who is from Jordan.
Sami Mac, owner of the new hookah bar Sinbad’s, said he was taking inspiration from cafés where he had played as a musician in Palestine.
Hookahs started spreading across the United States in the late 1990s after Middle Eastern tobacco companies began mass-producing hookah tobacco mixtures with sweet, often fruity flavors, said Kimber Richter, an associate professor of preventive medicine and public health at the University of Kansas.
Visit any of the hookah bars in Kansas City, and you’ll find dozens of flavors, ranging from the familiar and fruity (strawberry or apple) to the more exotic (jasmine or rose).
Mured Alreshiq, who manages Jerusalem Café’s Westport hookah bar, demonstrated how the water pipe works.
The tobacco mixture, usually shipped from Egypt or elsewhere in the Middle East, contains tobacco mixed with flavored molasses. This mixture goes in a metal bowl, wrapped in punctured aluminum foil, at the top of a vase-shaped pipe, about 3 feet tall. On top of the foil go a few small charcoals. Smoke travels down through a tube into a pool of water at the bottom of the pipe. When smokers inhale through a hose, attached just above the water, the water gurgles and the smoke comes out, filtered and cooled by the water.
Each of the Kansas City businesses sells a hookah session for two or three people for $10 to $12, with an additional fee for more smokers. A session can last as long as an hour.
A social activity
It’s no mistake that the hookah bars offer the sessions to groups. Smokers said a hookah was something to enjoy with others, not alone. This is the biggest part of its appeal, they said — that and the fruity flavors.
“You can bring your girlfriend here, but you wouldn’t bring your girlfriend to go smoke a pack of cigarettes,” said 18-year-old Carter Harrington of Platte City, who smoked a hookah with two friends recently at Aladdin Café. Harrington said he had never smoked cigarettes.
Katie Lynch of Lee’s Summit said she didn’t smoke cigarettes, and neither did most of the people she knew who smoked hookah.
“People who wouldn’t touch anything else, who wouldn’t touch a cigarette, come here,” Lynch said.
The water in a hookah pipe cools the smoke and makes it less harsh than cigarette smoke, said Wazim Maziak, an associate professor of epidemiology at the University of Memphis who researches water pipe smoking. This has led to a perception of hookah smoking as safer and more “mellow” than other forms of tobacco smoking, he said.
Alreshiq said about 40 percent of Jerusalem Café’s hookah customers didn’t smoke any other forms of tobacco. He also said most customers were under 25.
Health debate
Ask a hookah bar owner and a doctor about the health risks, and you may wonder if they’re talking about the same thing.
Hookah bar owners said hookahs posed fewer health risks than cigarettes, pointing to numbers on hookah tobacco boxes that said the mixture contains no tar and only 0.05 percent nicotine.
Maziak said research on the health effects of hookah smoking was lacking. But he said evidence abounded that it was far from harmless and could pose many of the same risks as cigarette smoking.
In journal articles, Maziak has called hookah smoking an “epidemic.”
He said studies had suggested that hookah smoke could affect people’s lungs and cardiovascular systems in similar ways to cigarettes and that it could lead to birth problems for pregnant women.
Maziak said he worried that policymakers were treating hookah smoking the same way they treated cigarette smoking 40 or 50 years ago — waiting too long to warn people that it’s probably bad for them.
“We’re waiting for things to become bad,” he said.
Because a hookah produces smoke using charcoal, the smoke contains some carcinogens that come from the charcoal, not the tobacco, he said. The tobacco, in fact, does not actually burn. This could be the reason for studies on the chemistry of hookah smoke that have revealed high levels of tar, even if hookah tobacco contains no tar, as it is advertised.
Hookah smokers Lynch and Harrington both mentioned the “buzz” they felt when they smoked — a lightheaded, relaxed feeling. Maziak said this might actually be the result of carbon monoxide in the smoke.
A research by the Department of Health and the Tobacco Control Collaborating Centre has revealed that smoking a shisha pipe is as injurious to health as smoking tobacco.
Smoking pot can cause as much damage to cells and DNA as tobacco smoke, according to a group of Canadian researchers who are challenging the belief that marijuana is less harmful than cigarettes. Rebecca Maertens, a researcher from Health Canada and co-author of the study, says many Canadians believe marijuana smoke is less toxic, and causes less damage than tobacco because pot is “natural.”
The Department of Health and the Center for Tobacco Control Research has found that both, cigarettes and shisha, harmful.