Category: Hubble Bubble

Hookah Use Flares Up at Yale

Hookah use flares up at Yale
BY CARI TUNA
Staff Reporter

Hookah at YaleFriends sat together in a small, dimly lit dorm room in Calhoun College last weekend, chatting softly and passing a nargile hose from person to person. Each one took his turn inhaling the flavored smoke from the pipe as the familiar murmur of bubbling water and a subtle, fruity scent filled the air.

Eset Akcilad ’07 leaned back in his chair and released a series of carefully shaped smoke rings from his mouth.

For Akcilad and many other Yalies, the Middle Eastern tradition of smoking the Turkish water pipe (also known as hookah and hubble-bubble) has become a nightly ritual and social outlet. In residential colleges, in frats or at bars, nargiles are more and more frequently drawing friends together for relaxed conversation.

“It’s nice to invite people over and smoke with them,” said Akcilad, who bought his nargile in Turkey, where he lives. “It is a good way to meet people.”

Amanda Elbogen ’07, also a hookah owner, said she enjoys smoking the nargile because of it’s social nature and because it is relaxing and pleasant tasting.

“It’s exotic [and] a really good social activity,” Elbogen said. “It’s often associated with pot … a common misconception. For people who don’t smoke anything else, it’s ideal.”

The average nargile consists of a glass body connected to metal pipe device with a long hose. The top of the pipe has a bowl for holding a special type of frequently-flavored tobacco and a metal tray for catching stray ashes and embers. A liquid, usually water, is placed in the body and a special type of coal is placed over the tobacco.

“When you inhale, it draws air through the water which is connected to the part with the flavor,” said Akcilad. “The coal burns the flavor, and you get the smoke inside.”

The water inside the body cools and filters the smoke. Other liquids such as wine, milk and fruit juice can be used in place of water, each having a different effect on the smoke. The use of milk gives the smoke a smoother, milder taste, while wine has a much stronger affect on the head, Akcilad said.

While generally enjoyed in the privacy of one’s dorm room, hookahs are now seen frequently at fraternities and larger parties.

AEPi member Ian Bishop ’07 said his frat has a specially designated area for hookah smoking.

“Upstairs there’s like a social room … with three or four hookahs … if you want to get away from the hustle and bustle,” Bishop said.

Those students in the market for a nargile often search far and wide for moderately priced, aesthetically pleasing hookahs. Some students obtain their hookahs while living or traveling abroad, while others purchase them, as well as flavored tobacco and hookah accessories, from Web sites such as tulumba.com and onepercent.com. Hookah prices on these sites range from $65-$140.

Elbogen found her hookah, which has a green glass bowl decorated with a colorful floral pattern, during a trip to Jerusalem. She paid 150 shekels for it, which was about $40 at the time — a relative bargain compared to online prices.

“Last year I was in Israel in the back streets of Jerusalem [when] I came across an oasis of hookah vendors,” she said. “You have to find the hookah that fits your personality.”

While Akcilad said he usually purchases his tobacco in Turkey, a small grocery near College Wine sells a variety of flavors. He said his favorite flavor is banana mixed with apricot, while Elbogen said she and her friends prefer double apple.

Nargiles appeal to many non-smokers because most people believe smoking nargile tobacco is less harmful and addictive than smoking cigarettes, Akcilad said.

“I don’t smoke cigarettes, [but] I like the way smoke looks … it’s a really charming thing,” he said. “[A nargile] has more smoke and the same aesthetic value.”

According to Columbia University’s Health Services, few studies have been done on the difference in the health risks associated with cigarettes and nargile because the water pipe is a relatively new trend in the United States.

The flavored tobacco smoked by hookah users is approximately one-third tobacco and two-thirds fruit pulp, molasses, and sometimes honey, although the exact composition varies from brand to brand. The same toxins associated with the tobacco in cigarettes — including tar and carcinogens — are present in nargile tobacco.

According to the Columbia publication, “passing the smoke through water, as is done in a hookah pipe, may remove some compounds, but existing research documents that many toxins remain in water-filtered smoke.”

In addition, the effects of inhaling smoke from the burning fruit and molasses are currently unknown, the Web site said.

Although most recreational nargile users smoke less frequently than cigarette users, the threat of nicotine addiction nevertheless remains. The addictive compound in tobacco smoke is not fully filtered by the water, according to the site.

Despite health risks, Akcilad said he has noticed a significant increase in nargile usage on campus over the past year.

“Last year my room was a place where people would come and chill and smoke,” he said. “Now lots of my friends have bought their own.”

Although hookahs are often used in student rooms, smoking of any kind in Yale dorms is against Undergraduate Regulations.

A student who sets off a fire alarm using a hookah is subject to discipline, Branford Master Steven Smith said.

“The penalty for smoking a hookah is the standard fifty lashes with a wet noodle,” he said. “Setting off a smoke alarm, however, costs a trip to Ex-Comm.”

But dormitory regulations have not put a damper on the on-campus popularity of hookahs, which has coincided with the growing presence of nargile cafes, also known as hookah bars, in many American cities and abroad.

Ted Fertik ’07 said while most hookah bars in New York, especially in Manhattan, are “expensive and crappy,” he has found a smaller, more authentic place in his neighborhood.

Although nargile smoking has been popular in Turkey since the Ottoman Empire, it has made a comeback in Turkey in the past three to four years, especially among members of the younger generation, Akcilad said.

“Lately there has been kind of a self-orienting movement in Turkey [in which] the younger generation has been getting more in contact with traditions,” he said. “[Using nargiles] is one of these cultural waves that comes and goes.”

Is Smoking a Hookah Bad for Your Health?

Below is an interview with Dr. Thomas Eissenberg, associate professor, department of psychology and Institute for Drug and Alcohol Studies at Virginia Commonwealth University:

Q: Is it true that hookah smoke is better than cigarette smoke because it’s filtered through water?

A: Unfortunately, there are no data by which we can compare directly the health effects of smoking tobacco using a waterpipe with those of smoking tobacco cigarettes. The necessary studies have not (yet) been done.

However, we do know that the smoke produced by a waterpipe contains some of the same carcinogens as in cigarette smoke, as well as substantial amounts of carbon monoxide (implicated in cigarette-caused cardiovascular disease.)

The one study that addressed the issue provided no evidence that the water influences the amount of carcinogens, carbon monoxide or heavy metals present in the smoke produced by a waterpipe.

Q: Is there an equal amount of nicotine in hookah and cigarettes? Do you happen to have any of the statistics on how much nicotine and carbon monoxide there is in hookah?

A: Waterpipes are used for periods that can last for 30-45 minutes, while a single cigarette is smoked for about 5 minutes. The average puff on a waterpipe produces about 500 ml of smoke, while the average puff on a cigarette produces about 50 ml of smoke.

A hookah smoker can take about 100 puffs when s/he uses a waterpipe (i.e., in a single 30-45 minute session) while a cigarette smoker takes about 10 puffs.

Waterpipe use episode can involve some 100 puffs of 500 ml of smoke each, or 50,000 ml of smoke (or 50 liters). A cigarette use episode can involve some 10 puffs of 50 ml each, or 500 ml (0.5 liters).

With all this in mind, you wouldn’t be surprised to hear that there is more nicotine in waterpipe smoke, and you are right – one study shows that the smoke form a waterpipe, produced as though a human were smoking it, contains about 2.96 mg nicotine. Similar studies with cigarettes show that cigarette smoke contains about 1.74 mg nicotine.

The difference is not as big as you’d think, given the huge difference in volume of smoke produced, ml for ml, there is less nicotine in waterpipe smoke than in cigarette smoke, though there is MORE nicotine in the smoke produced from a single waterpipe use episode (30-45 minutes) than is produced from a single cigarette (5 minutes).

Of course, the nicotine in tobacco smoke isn’t what causes cancer and cardiovascular disease. For that, you have to look at “tar” (actually, nicotine free, dry particulate matter, or NFDPM) and carbon monoxide (CO.) The same studies show that waterpipe smoke contains 802 mg tar compared to 22.3 mg for cigarettes, and 145 mg CO, compared to 17.3 mg for cigarettes. Thus, a single waterpipe use episode (lasting 30-45 minutes) can yield slightly more nicotine than a single cigarette, and about 36 times the tar and 8 times the CO.

Q: How frequently and how long would each hookah smoking session have to be, before you see dangerous side effects or diseases?

A: Nobody knows the answer to that question. I don’t claim to be a cancer expert, but I have heard some say that the action of carcinogens may be based more on probability than dose. That is, a single molecule of carcinogen has an infinitesimal, but non-zero probability of inducing cancer in the cell(s) that it contacts.

If this statement is true, it would explain the well-known dose-relationship between smoking and cancer, as well as the fact that there are rare cases where people smoke all their lives and do not die of smoking-related disease.

Also, if the statement is true, it suggests that ANY carcinogen intake carries some risk, however small, and that even a single waterpipe use episode or single cigarette could have a non-zero probability of inducing cancer. We would do well to avoid carcinogen inhalation whenever we can.

Q: Is hookah just as addictive as cigarette smoke?

A: I believe that there are two components to tobacco smoking, physical dependence on nicotine and, for lack of a better phrase, a “psychological dependence” on tobacco use (potentially an associative, or learned, phenomenon1,2).

There is enough nicotine in waterpipe smoke and waterpipe users to support physical dependence, and the data suggest that some waterpipe smokers show the hallmarks of dependence (i.e., withdrawal when the stop, behaviors to avoid stopping, failure to quit despite known health risks, etc).

Also, and perhaps more important for the occasional user, there are many of the requirements for a psychological dependence – an elaborate preparation ritual and distinctive cues (smell, taste, environment) that are paired with numerous potent reinforcers that include pharmacologic (nicotine), biologic (rest, relaxation), and social (companionship) stimuli. Given these facts, waterpipe use is likely to be AT LEAST as addictive as cigarette smoking.

Q: If it is just as bad for you as regular cigarettes, why do you think many young people (18 and younger) enjoy smoking hookah?

A: I don’t know if smoking tobacco using a waterpipe is as bad for you as “regular cigarettes”, and I won’t say that it is or that it isn’t. People probably enjoy it for the reinforcers that I just mentioned – the pleasurable stimulant effects of nicotine, the relaxation and resting waterpipe use promotes, and the social facilitation that can accompany it.

Add to that a pleasant aroma, sweet flavor, and room temperature smoke that can easily be inhaled without coughing, as well as a myth that the smoke is not dangerous, and avoiding a waterpipe that is offered by friends becomes quite difficult.

Q: Are there any other proven side effects to long-term hookah smoking, such as infertility?

A: A variety of studies are emerging that link waterpipe use to infectious disease transmission and dental problems. There are heavy metals in waterpipe smoke (perhaps from the charcoal) that may also be associated with some health risks.

I am uncertain of the long-term health effects of inhalation of arsenic, cobalt, chromium and lead3, but I know I would prefer to avoid inhaling those elements.

Q: What unique risks were you referring to when you mentioned the adverse effects of smoking from the heavy-metal pipe?

A: It’s not the pipe that is heavy metal, but the fact that heavy metals have been found in the smoke produced by a waterpipe, in concentrations far above those seen in cigarette smoke.

Q: Is there any additional information you would like to share?

A: The important issue for me is not whether waterpipe smoking should be “banned.” I am on record as opposing bans of psychoactive substances, at least when other approaches are likely to be more effective at reducing addiction, disease and death.

The important issue for me is to know what the risks are, so that folks can make an informed decision about their potentially risky behavior. Being enticed by a sweet flavor, a social atmosphere and a *myth* about water “filtration” does not constitute an informed decision.

The beginning of informed decision-making includes the knowledge that the sweet flavor is accompanied by carcinogens, heavy metals, and lethal carbon monoxide, and that the behavior has been associated with cancer and cardiovascular disease.

What Dr. Herman Kattlove, a medical editor at the American Cancer Society, has to say about hookah smoke and its effect on the human body:

Young people are most sensitive to becoming addicted to nicotine. Nicotine is an addictive substance, so it’s advertised to college students. For this reason, hookah smoke can kick start a smoking habit.

Hookah has been banned for those who are 18 and younger. For most young Americans who smoke hookah, their heart rates will go up and breathing will become labored.

There are very few solid U.S. studies that have been done on the effects of hookah smoke. Most studies are done in Egypt and Middle Eastern countries. Israeli smokers were surveyed and about 90 percent of them said hookah smoke is bad for you.

In the Middle Eastern studies, hookah smoke has the same amount of nicotine and tar particles as cigarette smoke. There are even unique poisons and evidence of lead arsenics that come from smoking out of the hookah’s heavy metal pipe. The amount of carbon monoxide is also very high and related to heart attacks. Secondhand smoke contributes to breast cancer and has been linked to lung cancer.

One session of hookah smoke (approx. 45 min.) is the equivalent of smoking one pack of cigarettes per day. The blood levels and genetic changes of the bronchial tubes and chromosome changes of hookah and cigarette smokers are about the same. There is just as much damage from both.

Hookah is a recent phenomenon, so there is not a lot of evidence to support these findings.

Hookah Lounge Etiquette and Smoking Technique

Hookah Lounge Etiquette and smoking tips

By being aware of this, you may have confidence to travel anywhere in the world and use a hookah.

Be aware that not all the places listed in the directory are hookah lounges exclusively. Some are coffee shops or restaurants with Middle Eastern cuisine and flair, and supply shishas as an aside. They cater to Middle Eastern clientele and are as intimate as a livingroom with a group of regulars, and YOU, as a newcomer, are expected to be on your best behavior. Respect the culture. You know a place is good when you see Middle Eastern people present, don’t drive them away. Many establishments rely on regulars and have close ties with them. (“We used to go there, but it has been overrun by disrespectful kids. They’ve ruined it for the rest of us.”) As a side note, don’t let your thoughts of current world events be translated to other customers. It is best to avoid this topic. We all wish the best for the future.

In general, many hookah lounges are very classy and plush places with unique decor.
Keep with the vibe, dress nicely, be respectful and don’t be a loudmouth.

If you show up in shorts, flip-flops, an ICP shirt and a backwards baseball cap, and you’re a loudmouth, everyone will think you’re an A-H and you’ve ruined the vibe for everyone. You’ll be like a cockroach in the rice bowl. On the other hand, some places cater to you rowdy idiotic slobs and puke-reeking fashion disasters as long as you have money to blow. Do yourself and the industry a favor, keep up the high standards. Since this phenomenon is still rather young, we still have a chance at shaping its destiny. The media is already trying to pigeon-hole the hookah lounge clientele, so let’s perpetuate the favorable reputation and do it RIGHT.

Hookah Lounge owners: I suggest “DRESS CODE ENFORCED” and don’t play Beastie Boys on the stereo.

Some small restaurants may be eventually driven to post “Shisha with meals only.” OBLIGE THEM. The experience will be vastly improved!
Fancy Hookah Bar
It seems that everyone’s missing the point already, thinking that just merely showing up to one of these places makes you cool. Well WAKE UP! Don’t be a kook! Be a pro and dress like one after we help to show you how to ACT like one. Part of what makes shisha smoking so cool is the mastery of the people involved. Don’t dilute the coolness factor.

Hookahs belong on the floor and not on the table, because it is an object of service. Imagine the notion of “putting someone on a pedestal.” This is along the same idea, and the shisha is an item of much lower rank, if you will. Traditional establishments will still adhere to this rule, while some hookah lounges are placing the hookah on the table for everyone to enjoy. Not very authentic, but it does celebrate the hookah. Smaller hookahs on a table are more convenient, as you can imagine, and sometimes this is the only option.

Now some hard rules and tips to stop kooks in their tracks.

Never light your cigarette from the hookah coals, it’s considered VERY bad manners.

Use the hookah hose with your RIGHT hand. The left hand is considered unclean in many countries.

When sharing a hookah and you’re done smoking for the moment, place the hose down on the table for the next person to pick up. Don’t pass it directly. A variant of this is if you must pass, use the RIGHT HAND with the tip facing towards you, not the recipient. Turn the hookah toward the recipient or have the hookah placed in a neutral position to prevent tipping. Sometimes the hose is so long that this isn’t an issue, or a rotating hookah may be used.

Use the tongs to occasionally tap the coals in the tray on the stem to remove ash and keep the coals hot. Replace the coals to a different position on the bowl.

And now for the obvious: On multiple hose hookahs, those not smoking for the moment should plug their mouthpieces with a finger so that the person smoking doesn’t suck air.

Many people suggest using punctured foil on top of your bowl underneath the coals. DID YOU KNOW THAT EXCESSIVE ALUMINUM IN THE BODY CAUSES ALZHEIMER’S? Smoking from household aluminum isn’t good for you anyway, there are also bonding agents that give off fumes. Don’t be afraid with OCCASIONAL smoking, but don’t make it a habit; don’t use household foil on your personal hookah. There is foil available made especially for hookahs, or use a screen meant for hookahs. The latter is recommended, but your bowl will last much longer with foils if the holes are done correctly.

With the tongs, move the coals around the screen occasionally to allow for even burning of the tobacco throughout the session. The center of the bowl should be the ending place the coals should be concentrated, but this doesn’t matter much.

There is no urgency or competitiveness when smoking a shisha unlike sharing smaller pipes. The bowls last a long time, and this is a leisurely activity. Enjoy it. It is recommended that one shisha be shared among no more than three people. Some lounges enforce the two people per shisha rule.

Don’t take too many photos in a hookah lounge, it disturbs the atmosphere. (“Hookah, yaaayy, wooo!!”) In fact, you might get some dirty looks depending on where you are.

Don’t cause or contribute to a commotion. Shisha smoking is a quieter activity but still may be social without being disturbing to others.

Don’t smoke cigarettes unless ashtrays are provided. Take the hint – If there are no ashtrays, then cig smoking is probably not allowed, but ASK FIRST before lighting up. They might have ashtrays behind the counter for you OR they might say no cigarette smoking is allowed in certain areas. Respect people’s wishes and don’t argue. Chances are that in the Middle East, if you don’t see others smoking cigarettes then the activity is frowned upon.

DO NOT use the coal tray for your cigarette ashes. That’s a TOTAL kook move.

With respect comes respect, and this process is initiated with the successful mastery of the shisha and social manners in the presence of other masters. When you have mastered the shisha and know fully and demonstrate the social manners associated with it, you may have confidence in enjoying the shisha anywhere in the world and in teaching others so that the proper etiquette is perpetuated.