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Despite the existence of three hookah lounges within walking distance of Thayer Street and health researchers' increasing investigations of hookah usage among college students, many students said Brown does not have a "hookah culture."

"If there is a hookah culture here, I am thoroughly unaware of it," said Dylan Felt '16.

Hookah refers to a mechanism in which smoke is pulled through heated water and inhaled through a long tube. It can be used to smoke any kind of leaf, including marijuana, but is most often used to smoke flavored tobacco, said Kate Carey, professor of behavioral and social sciences.

"Hookah has a long tradition in other parts of the world and is a fairly common, socially-sanctioned way of smoking tobacco in the Middle East," Carey said.

Hookah has spread to the United States, which is now seeing a "recent upsurge in hookah bars near college campuses," Carey added.

Kim Chaika, owner of a hookah supply store on Waterman Street called Hookahs and More, said her business "more than tripled in the past three years."


Smokey socializing

Students smoke hookah for the "communal aspect," said Michael Danziger '13. 

Sujaya Desai '14 said smoking hookah is a "casual" social activity "if you don't feel like going out to a party."

While hookah is definitely a social option at Brown, some international students noted that its prevalence paled in comparison to usage back home. Desai, who hails from Singapore, noted that hookah was more common in her hometown. 

"Hookah is much more common and a lot cheaper back home in Turkey," Natali Senocak '13 said.

But Chaika said Hookahs and More retains a healthy following. 

Hookah's recent popularity "is not just a splash in the pan," she said. "This is part of the culture. It's becoming a social norm. This is your generation."

Chaika estimated that approximately 80 to 85 percent of her customer base is college students. "It's like smoking candy. And your generation is the candy generation," she said.

"It's all about the flavor," Chaika added. She cited California Dream - a mix of pineapple, orange and cherry flavors - as the most popular variety.

"I've back-ordered it," she said. "The kids are driving me nuts."


Poisonous puffing 

While California Dreamin' draws a large fan base, smoking hookah poses health risks that are often underestimated.

"The big problem is that a lot of people think it's not addictive and a lot of people think it's less dangerous than smoking. Both of these assumptions are erroneous," said Belinda Borrelli, professor of psychiatry and human behavior and the director of the program in nicotine and tobacco for the Centers for Behavioral and Preventative Medicine.

"Some estimates indicate that a single water pipe session is the equivalent of 100 cigarettes," Borrelli said. This is because users are puffing longer and inhaling a much greater volume of smoke containing high levels of toxic compounds such as tar, carbon monoxide and carcinogens, she said.

The smoke-filled environment of the hookah lounge means secondhand smoke also affects the user.

Mainstream and side stream smoke creates "a double danger," Borrelli said.

Chaika noted that many users were not inhaling the smoke into their lungs but were keeping the smoke in their mouths and letting it "roll off the back of the palette."

But even this practice does not reduce risk, Borrelli said. "They are still inhaling it. It's going into their mouth and throat. The mouth actually has more sensitive tissue than the lungs," she said.

In addition to smoke danger, Borrelli noted the risk of infectious disease as the pipe is passed from person to person.


Hazy misconception 

Despite these dangers, "just about every study that has looked at hookah perception has identified the sense that college students think it's less harmful and more socially acceptable than cigarette smoking," Carey said.

"Hookah smoking just doesn't carry the same weight," said Melanie Abeygunawardana '16. This perception exists largely because typical hookah smokers on college campuses do not smoke on a daily basis, Carey said.

Smoking hookah tends to be a "once in a while" activity, unlike drinking or smoking cigarettes, which students tend to do on a more consistent basis, said Jessica Liang '16.

Getting together to smoke hookah is a "special event," agreed Lucy Duan '16. But some students are more wary of the health effects.

"Hookah is tobacco, and any tobacco product is not good for you," said Mya Roberson '16. "I choose not to do hookah because I don't want to take in tobacco - I like my teeth," she said.

But Chaika said comparing the health risks of hookah to those of cigarettes is like comparing "apples and oranges."

"Go stand on the corner of Thayer and breathe for an hour. You're gonna get it one way or another," Chaika said.

Hookah research

While hookah has been around for a long time, research in the area has "picked up speed in the last 10 years," said Robyn Fielder MS, a clinical psychology intern at Alpert Medical School who conducts research at the Miriam Hospital's Centers for Behavioral and Preventative Medicine. Fielder and Carey co-authored a study published in the journal Psychology of Addictive Behaviors last May that examined hookah prevalence among college women.

Most current research examines the hookah habits of younger people, Fielder said. Studies have found that about 5 percent of middle school students, 10 percent of high school students and between 25 and 50 percent of college students have tried hookah at least once, Fielder said. 

Fielder's longitudinal study tracked a cohort of 483 female freshmen at Syracuse University. While 29 percent of the participants had tried hookah before coming to campus, 45 percent of the participants had tried it by the end of their first year, Carey said.
"Hookah is marketed as trendy, cool and exotic," Fielder said. 

Research into hookah usage is "a burgeoning field" for public health officials, Fielder said, noting that studies can provide insight into understanding who chooses to smoke hookah, people's reasons for doing so and how prevention and intervention programs can be designed. 


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