Gathered around tables inside a crowded cafe near the University of Arizona, young smokers inhale flavored tobacco from hoses attached to water pipes that are intended for sharing.
Smoke with a sweet smell like vanilla filters through the air as students laugh together, study and drink coffee.
Despite warnings from medical experts that hookah smoking delivers the same nicotine as cigarettes, it’s an increasingly popular activity, particularly with college students, who say it’s relaxing and social.
The marketing of hookah is a deceptive effort by the tobacco industry, critics say. Two campus-area hookah lounge owners, however, say they are meeting demand and that safety is all about moderation.
There are 12 hookah lounges within 3½ miles of the UA, and a 13th, called Royal Hookah, has an “opening soon” sign in its North Fourth Avenue window. By comparison, there are seven Starbuckses within the same radius.
Also within that same 3½ miles are 11 retail stores that sell hookah supplies. Although those stores don’t have lounge areas for smoking, they offer all types of hookah products.
Hookahs are water pipes used to smoke flavored tobacco. The tobacco, also called shisha, is heated by charcoal. Smoke passes through the water and is then drawn through a rubber hose to a mouthpiece. Smoking sessions can last up to an hour. Regulations for hookah smoking exist in only 10 states, including Arizona, where hookah and tobacco are legal only for people over 18.
Health experts, including the U.S. Centers for Disease Control and Prevention, say hookah smokers are at risk for the same kinds of diseases caused by cigarette smoking. These include oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function and decreased fertility. The California Department of Public Health says smoking hookah for 45 minutes to an hour can be the equivalent of smoking 100 cigarettes.
UA students Ian O’Heir and Russel Langstrand estimate they’ve been smoking hookah for at least three years. They are regular customers at Espresso Art on East University Boulevard and have their own hookah pipe at home.
“We usually smoke twice a day, in the afternoon or evening,” O’Heir, 19, said. “It’s a way to relax, and it tastes good.”
“When I have reading to do or boring homework, there’s an aspect of multitasking to smoking hookah,” Langstrand, 20, said. “It’s fun to smoke.”
O’Heir, a business major at the UA’s Eller College of Management, says the positives outweigh the disadvantages.
“We’re not stupid. We know there’s no way it’s good for you,” O’Heir said.
“We’re both active guys, we’re at the gym regularly,” Langstrand said.
Both were varsity athletes in high school and say the hookah has not harmed their health so far.
Hookah is not a safe alternative to cigarettes, a spokesman for a Phoenix-based advocacy arm of the American Cancer Society says.
“Hookah use has several uniquely unhealthy qualities, including the propensity to inhale more smoke due to the length and communal aspect of most hookah sessions,” said Brian Hummell of the American Cancer Society Cancer Action Center.
“Hookah smoke has the same addictive properties, which can lead a hookah user to begin using cigarettes, or becoming a dual user of hookah and cigarettes.”
Part of the reason for its popularity among students under the legal drinking age is that it gives them a group activity and a place to hang out, since bars are not an option. Coffee and hookah is becoming common as well, with more and more students using the lounges as a quiet and relaxing environment to study in.
Hookah lounges bypass the Smoke-Free Arizona Act that bans smoking in most enclosed public places and places of employment. An exemption to the law allows retail tobacco stores to escape the indoor smoking ban if 51 percent of their gross income comes from tobacco products and accessories.
Espresso Art Cafe owner Danny Mannheim says hookah is safe as long as it is in small quantities.
“If you smoke hookah lightly, it’s not more dangerous or damaging than driving in New York City,” Mannheim said. “The same reason people sell salt. It’s about how you abuse it or not.”
The split between people who come to smoke and study and people who come to smoke and socialize is about 50/50, Mannheim said.
People are going to smoke hookah regardless, and the lounges are providing them a place to do it, says Mustafa Adood, manager of Sinbad’s, a restaurant and hookah lounge also on University Boulevard near the UA.
“We provide a service for people who want to come and smoke hookah,” Adood said when asked about the safety issue. “It’s the same service as people who sell cigarettes, except that cigarettes cause cancer.”
But the Mayo Clinic says hookah delivers the same amount of nicotine as cigarettes, that it has higher levels of tar and more carcinogens and an increased level of carbon monoxide due to the charcoal used to heat the tobacco.
Elizabeth Robertson, a recent graduate of the Eller College of Management, wrote her honors thesis for her marketing degree about the deceptive marketing practices of the tobacco industry.
“Many people who smoke hookah would never smoke real cigarettes,” Robertson said. “Because it’s a social thing, the misconception about its safety comes from friends and word of mouth, but a lot of it comes from the tobacco companies themselves.”
For her thesis, Robertson was required to spend a year researching and exploring a concept related to marketing. She found that extensive research has been done on cigarette and tobacco advertising, but the marketing tactics of the hookah tobacco industry are relatively untouched.
At the time, Robertson had friends who regularly went to hookah bars, and her roommates had just purchased their own hookah pipe, which they believed to be safer than cigarettes.
“After spending time at Espresso Art and talking with students there, what stands out the most about the environment is the social aspect of hookah smoking,” said Robertson. “The majority of customers were always consuming hookah in a group setting.”
Some of the students she spoke to were sharing hookahs while studying together, and others were there to just hang out with friends and smoke.
“It was always really common to see students sharing smoking ‘tricks’ with each other,” she said. “Specifically blowing ‘O’ rings with the smoke.”
“The industry promotes the idea that the water of hookah pipes filters out toxins, including tar,” Robertson said. “This doesn’t even make sense when the labeling claims that the tobacco has no tar to begin with.”
Robertson went on to say that no studies to confirm these claims have been done, and online blogs and forums continue to perpetuate the myth that the water filters out toxins.
“Smoking hookah is relaxing,” said UA nursing student Alexandra More, 22, who estimates she smokes at Espresso Art five days a week.
More said she’s been a regular hookah smoker since she started attending UA five years ago.
At 3:30 on a Thursday afternoon, there were at least six tables and a dozen people enjoying a hookah session in the busy café.
“I’ve been here 10 years. The first two years we tried advertising in print media and on the radio,” Mannheim said. “It didn’t work. Because free coffee and other specials are a low-ticket item, it didn’t bring people in from all over town.”
Now, Espresso Art relies on its heavy supply of walk-in traffic from UA students, as well as social media.
The cafe’s Facebook page has 2,700 check-ins and advertises specials, such as happy hour, for their hookah lounge. It also sends out text alerts to promote events and discounts.
More was excited to hear that Espresso Art would soon be joining Foursquare, a popular social media app that allows users to check in at locations and find their friends.
A recent federal study found that college students were the No. 1 users of hookah, and that 17 percent of high school seniors in the U.S. had used hookah in the past year. The same study also found that 22 to 40 percent of college students polled indicated past-year use.
The World Health Organization estimates that hookah sessions actually constitute 200 times more smoke inhaled than a cigarette.
“With the hookah tobacco companies increasing their use of social media and promoting candy-flavored, cocktail-flavored and holiday-themed products, they’re definitely marketing towards a younger crowd,” Robertson said. “Many people in their 40s and even their 30s don’t know much about hookah.”
Although the product is illegal for minors, access to the hookah industry’s websites is not. Some of the sites, including hookahshisha.org, offer smoking tips and flavor combinations as well as all things hookah for sale.
The organization failed to reply to email inquiries and two phone calls.
Another reason for the popularity of hookah lounges is the low cost, Robertson said.
Espresso Art offers 13 flavors of hookah starting at $12.99 for the tobacco and use of the pipe. It also offers refills for as little as half price depending on the flavor.
During a “Breaking Bad” finale party, specially blended theme shisha named for a character from the show was available for $10. If students follow the specials and smoke together, it costs only a few dollars per person.
The yet-to-open Royal Hookah on North Fourth Avenue already has coupons featured in the “Campus Special” coupon book that was distributed six weeks ago at the start of the school year.
Despite the progress that the hookah industry is making, Robertson is optimistic that steps will be taken within the next few years to better regulate and understand hookah.
In 2011, an attempt to change city rules and make it easier for hookah lounges to operate within the city of Glendale failed.
“The FDA (U.S. Food and Drug Administration) is spending so much time on banning flavored cigarettes now,” she said.
“Hopefully next they will focus their efforts on the flavored tobacco involved in hookah.”