Says WHO: Don’t get hooked on the hookah.

I don’t know if anyone else caught the Globe’s article on hookah smoking a couple of Sundays ago. The jist of the article was that health officials are becoming alarmed by the rise in hookah smoking among young people who erroneously conclude that it’s a relatively safe alternative to cigarettes. I’m not sure that there’s much of a trend here—or if there is, it’s not really all that new.

Sure, you can order a hookah at Tangierino in Charlestown, but that’s been the case for over a year, at least. A new hookah bar, The Nile Lounge, is set to open in Allston soon, and there are a handful of establishments that offer hookah smoking on their outdoor patios. Mantra built a cool, but pricey hookah den right in the middle of their restaurant about eight years ago, but Boston’s smoking ban killed it shortly thereafter. Do these few instances really amount to a trend? I think a small minority of non-Middle Eastern Americans have been using hookahs for a while, and I’m not sure there numbers are increasing all that much.

On the other hand, Americans of Middle Eastern descent have been using them for decades. My grandfather (OK, he was Greek, but he was also an Ottoman subject) used to smoke one. I smoked one at a Palestinian restaurant in San Francisco about five years ago, but long before that, I noticed a line of ornate hookahs on a shelf at Sevan bakery in Watertown, which is run by an Armenian family from Istanbul. Virtually every Middle Eastern grocer I’ve ever encountered—including the one on Shawmut Ave in the South End—has been selling hookahs and hookah paraphernalia (i.e. tobacco, coals, mouthpieces, etc.) for years.

Whether or not hookahs are truly on the rise in the United States, it is true that they have caught the attention of health officials, who have begun to rail against the dangers of hookah smoking and have raised the regulatory battle cry. This past March, the American Lung Association published a new report entitled An Emerging Deadly Trend—Waterpipe Tobacco Use. They cited a 2005 study by the World Health Organization’s Advisory Note on Waterpipe Tobacco Smoking, which concluded that hookah smoking is 100 times more dangerous than cigarettes. Well, actually, they concluded that smoking the hookah for an hour is more dangerous than smoking a single cigarette. Well, duh. I could have told you that.

Among their findings:

“A waterpipe smoking session may expose the smoker to more smoke over a longer period of time than occurs when smoking a cigarette. Cigarette smokers typically take 8 – 12 40 – 75 ml puffs over about 5 – 7 minutes and inhale 0.5 to 0.6 litres of smoke. In contrast, waterpipe smoking sessions typically last 20 – 80 minutes, during which the smoker may take 50 – 200 puffs which range from about 0.15 to 1 litre each. The waterpipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes…

A typical 1-hour long waterpipe smoking session involves inhaling 100 – 200 times the volume of smoke inhaled with a single cigarette.”

The operative wording here is “a cigarette.” I don’t know that many smokers who smoke a single cigarette. Don’t smokers typically smoke several cigarettes, spread out over their entire day? Moreover, don’t they typically smoke every day? I’m sure there are plenty of “social smokers” who don’t consume nearly as many cigarettes as their chain-smoking counterparts, but I’m sure even this group doesn’t stop at just one. I think it would have been more accurate to compare the effects of hookah smoke vs. cigarette smoke over the course of a month. Even this would be an exaggeration, however, as many hookah smokers, like myself, don’t smoke every month, unlike cigarettes smokers who probably do.

The key, of course, is moderation. I agree that hookah smoking is not risk-free, and that people should be aware of the risks. The WHO study points out that myths about the harmlessness of hookah smoking are as old as the hookah itself (centuries in other words). It’s important to separate myth from reality. For that reason, it doesn’t really make sense to replace the old myths of harmlessness with new myths of deadliness, based on a questionable methodology. My suggestions:

• Limit your hookah smoking to once a month, at the very most.
• Don’t smoke for more than an hour.
• Don’t smoke alone.
• Use natural coals instead of quick-lighting briquettes.
• Always separate the tobacco from the coal with a layer of perforated tin foil.
• Always clean out the hose and the neck after every use.
• Don’t allow smoke to collect above the water in the base. Use the valve (good hookahs have them) to blow out excess smoke.

Of course, the real danger here isn’t so much to one’s health, but to one’s wallet. Most establishments charge $30 a pop for a hookah on the outdoor patio, in which case what you’re really paying for to look oh-so-hip. No thanks. Just go out and buy your own for Chrissake and smoke at home with your friends. You can find a great selection here or here. Click here for natural coals. The hookah’s special mixture of tobacco, dried fruit or flowers, and molasses (called tabamel or shisha) can be purchased here. For some really cool hookah smoking music, click here.

In spite of the fact that the hookah is making inroads into places where it has historically had less of a presence (I saw hookahs in Kiev last year), it is undeniably a Middle Eastern phenomenon in its origins and remains so in the popular imagination. It’s the exotic associations that make it cool to some, but dangerous to others. Let’s face it, the backlash against hookah smoking cannot really be separated from its post-9/11 context in which anything Middle Eastern has become suspect.