During my formative years in Lebanon, it wasn’t uncommon for me to witness older men sitting around and smoking “argilah,” which is widely known as hookah in the United States.  

These men would lounge for hours, talking, debating and laughing the day away, well into the evening hours.  Only prayer time and dinner could interrupt their social activity. A few years later I began regularly seeing men and women who congregated in the cafés that lined the streets of downtown Beirut, smoking different flavored tobacco through newer and trendier looking hookahs, manufactured by the growing industry. 

Sam Fawaz.

Fast forward to today, and hookahs are everywhere. College campuses are strategically surrounded by lounges that allow students to kick back and indulge in the practice for hours with their friends.  Suburban communities with large Middle Eastern populations have sprouted more hookah lounges in a short period of time than any other type of business in recent memory, with the exception of sushi restaurants, and homes/garages in our community are inundated with smoke from this activity on a daily basis. 

You now see old and young, including under age teens, lounging side-by-side with their family members and friends, as they take part in a ritual that has never been intended for use so frequently.  

We have many vices as adults, and the temptation to partake in activities that are known to be risky has been with us since the beginning of time. Hookah smoking is not any different.

I’m writing this commentary, not out of my dislike for this trend, or to cast judgment on those who smoke it, but rather to educate those who may have been misled to believe that this practice is less harmful than smoking cigarettes.

Due in part to the attraction of the many flavored tobacco options, studies from the American Lung Association reveal that hookah use is quickly becoming one of the world’s largest tobacco epidemics.  A typical one-hour hookah session is similar to inhaling 100-200 times the volume of smoke that is inhaled from a single cigarette, thus increasing health risks through high levels of carbon monoxide, heavy metals, tar and cancer-causing chemicals.  

Hookah smokers are at risk for the same kinds of diseases that are caused by cigarette smoke, including oral, lung, esophageal and stomach cancer, as well as emphysema, which is a condition that decreases lung function and requires the use of daily inhalers and an oxygen tank. 

In addition, due to the nature of the activity and the customary sharing of the hose and mouthpiece with different smokers, transmissible diseases, such as herpes and tuberculosis can be contracted.   Furthermore, some individuals within and outside our community have begun lacing the tobacco products with illicit substances that could also lead to serious health outcomes.

While I would not want my children to smoke hookah in their lifetime, I am fully aware, as an adult, that we all make our own decisions and are free to go about our lives as we see fit, so long as we know the risks and consequences of our behaviors. 

Until then, I stand firm in my belief that it is our responsibility, as adults and parents, to educate our teens about the hazards of smoking and enforce laws that ban the sale of hookah products, or services to minors.  

— Sam Fawaz, M.D. internal medicine, Beaumont Hospital, Royal Oak is also an Assistant Professor of Medicine at Oakland University’s William Beaumont School of Medicine and the co-founder and organizer of the Hookah Community Coalition.