This not-so-new cultural activity you might know as hookah smoking is now an American social phenomenon. Hookah bars are popping up all over Colorado and the United States. What is a hookah, you may ask? It's a glass-based water pipe device for smoking that is operated by water filtration and indirect heat. The catch here is that hookahs are most often used to smoke flavored tobacco. It takes about 45 minutes to smoke from the hookah and often longer if more tobacco is added to this community smoking device.

What's in the tobacco? Basically this tobacco is a 1:3 mixture of shredded tobacco leaf mixed in with a sweetener such as honey, molasses or semi-dried fruit. The tobacco mixture is moist and is combined with powdered charcoal that has various chemicals such as potassium nitrate which allows it to be quickly and easily ignited.

The fruit-flavored hookah tobaccos that are popular today got their start in the late 1980s when Egyptian tobacco companies began experimenting with flavored tobacco as a way to sell more of their products to women. Who are these tobacco companies advertising to when they make bubble-gum, banana and watermelon flavored tobacco? Today we might see these fruit flavors as indirect advertisements to young people.

The hookah has a lot of culture wrapped around it through history and in method. Often hookahs are smoked after a family dinner and it is something that becomes traditional. Moreover, hookah-culture is an activity/ritual/custom that occurs in places like "hookah bars," restaurants and family homes. With the adoption of the Colorado Clean Indoor Air Act, hookahs are no longer acceptable in food establishments; however in a tobacco retailer establishment that is exempt from the law, such as a hookah bar, people can smoke for hours on end.

So why should we care or even worry about hookahs and the social norms wrapped around them? Because tobacco is tobacco, whether it is inhaled, chewed or ingested. When I talk to youth in schools one of the most common misunderstandings about hookah smoking is that it only has 30 percent tobacco in each maassel (hookah tobacco). The youth have said to me numerous times, "Isn't smoking from a hookah better for me than smoking cigarettes?" What I always answer is, "Smoking on a hookah for 45 minutes is equivalent to the toxins in a whole pack of cigarettes." This isn't a lie, and there is empirical evidence suggesting this: Consider reading the article entitled, The Latest on Hookahs: What You Don't Know Can Kill You by Kamlesh Asotra (2005). I also like to consider talking about the effects of second hand smoke.

Get this: Hookah smoke produces nearly 100 times more tar than cigarette smoke. It also produces addictive nicotine as well as a number of toxicants from combustion such as tar and other carcinogenic polycyclic aromatic hydrocarbos (PAH); and has significantly higher quantities of toxic heavy metals like arsenic, nickel, cobalt, chromium, lead, and cadmium. In addition, hookah smokers are exposed to three-fold greater amounts of CO than are cigarette smokers. This is because charcoal is added to hookah tobacco to enhance its burning effect.

CO and PAH = Cancer causing toxicants!!! This affects not only the smoker, but also the people in the near distance of a smoker such as a car, hookah bar, home or sidewalk.

Many young people do not realize that hookah smoke is harmful or as harmful as other types of tobacco especially because not all hookah smokers smoke cigarettes and many do not smoke from a hookah every day. Youth and young adults deserve the right to know what they are actually exposing themselves to when they walk through the doors of a hookah bar or friends house that allows (hookah) smoking.

The implications of hookah smoking for social service professionals, teachers, advocates and others including my fellow community members are all wrapped around social norms, health education and public information. There are many myths and common misunderstandings about smoking tobacco from a hookah. If you are working with, have friends/family who or are living with anyone who uses hookahs for recreation, I advise you to engage in educational conversation about the health effects and social concepts around hookah smoking. Until some proactive education exists around hookah tobacco, youth and young adults who are the most common targeted audience from the tobacco industries, will continue to smoke, think it's cool and not know a thing about how it is affecting their health both in the short and long-term. Get the real hype about hookah.

For more information including community presentations or services consider contacting Jefferson County Department of Health and Environment at 303-275-7556.

Pam Hancock is the Jefferson County Department of Health and Environment's Youth Tobacco Cessation/Prevention Specialist.