Mainstream smoke from hookah contains significant amounts of tar , nicotine , carbon monoxide , heavy metals and particulates .
While many young people may believe that hookah smoking is less harmful than conventional cigarettes , quite the opposite is the case . A typical hour-long hookah smoking session involves inhaling 100-200 times the volume of smoke in a single cigarette . This amount is roughly the equivalent to smoking 100 cigarettes .
Even smoking non-tobacco shisha in a hookah has the significant health risk of inhaling combusted charcoal . When charcoal is burned in the hookah , it releases toxic chemicals in the process including carbon monoxide ( CO ) and polyaromatic hydrocarbons ( PAH ). In indoor settings , even non-users inhale large quantities of these combustion-related toxicants .
Direct comparisons of smoke from hookahs with tobacco and those with tobacco-free shisha have found no less disease risk in the tobacco-free smoke . Both types of hookah smoke contain significantly higher amounts of carbon monoxide , nitric oxide , tar , and carcinogenic polycyclic aromatic hydrocarbons ( PAH ) than those found in a conventional cigarette .
National and local air quality studies in hookah lounges found levels of aerosolized respirable particulate matter ( PM2.5 ) directly comparable to those in establishments that allow cigarette smoking . These levels far exceed the ambient air quality standards established by the Environmental Protection Agency ( EPA ).
According to the CDC National Youth Tobacco Survey , the use of e-cigarettes and hookah among young people has surpassed the use of conventional cigarettes since 2011 . The 2014 CDC survey found current usage rates of electronic cigarettes at 13.4 percent among high school students and 3.9 percent among middle school students . The survey also found current usage rates of hookah at 9.4 percent among high school students and 2.5 percent among middle school students . These compare to usage rates for conventional cigarettes of 9.2 percent among high school students and 2.5 percent among middle school students .
The increasing use of electronic cigarettes and hookah among middle and high school students raises concern that social acceptance of these products could begin to reverse the trend of falling smoking rates and that there may be young people for whom e-cigarettes could be an entry point to use of conventional tobacco products , including cigarettes . Evidence suggests that they may become dual users of e-cigarettes and conventional cigarettes or even triple users of electronic cigarettes , hookah and conventional cigarettes .
Just last month the U . S . Surgeon General published the report E-Cigarette Use Among Youth and Young Adults . In a preface to the report , the Surgeon General , Dr . Vivek H . Murthy , wrote that e-cigarette use among high school students increased “ an astounding 900 percent ” from 2011 to 2015 . In 2015 , nearly 38 percent of high schoolers reported having tried an electronic cigarette at least once .
Last month ’ s Surgeon General ’ s report also raises the concern about the effects of nicotine found in electronic cigarettes on the brains of young people . “ The brain is the last organ to develop fully . Brain development continues to the mid-20s . Nicotine exposure during periods of significant brain development , such as adolescence , can disrupt the growth of brain circuits that control attention , learning and susceptibility to addiction ,” the report states . Among several recommendations , the Surgeon General ’ s report advocates that electronic cigarettes be included in smoke-free laws and policies .
As of October 1 , 2016 , there were 589 local and state laws prohibiting the indoor use of electronic cigarettes in public places , including 13 in Kentucky . In Louisville , many employers , healthcare facilities , educational institutions and tourist venues already prohibit the use of electronic cigarettes and hookah indoors .
The Greater Louisville Medical Society , citing much of the research in this article , has passed a resolution urging Louisville ’ s Metro Council to amend our existing Smoke-Free law to include electronic cigarettes and hookah , prohibiting their use in indoor public places and worksites .
The Louisville Metro Board of Health has also passed a similar resolution . The Kentucky Agency for Substance Abuse Policy , the Kentucky Nurses Association , the Kentucky Chapter of the American Lung Association , the Kentucky Chapter of the American Heart Association , the American Cancer Society Cancer Action Network , the Campaign for Tobacco-Free Kids , and Jefferson County Public Schools have all also publicly supported this position .
It ’ s time for Louisville to become the 590 th place in America and the 14th in Kentucky to include electronic cigarettes and hookah under its Smoke- Free law .
It ’ s time for Louisville to become the 590 th place in America and the 14th in Kentucky to include electronic cigarettes and hookah under its Smoke-Free law . This will protect the public from secondhand exposure to poisons in products that were not yet in widespread use when the original ordinance was enacted in 2008 . It will also be one step to help protect our young people from new health threats . After this has been accomplished , Louisville should also consider raising the minimum age to purchase electronic cigarettes , hookah and conventional cigarettes from 18 to 21 , joining 221 other cities that already have done so . This will further protect our young people and be another indication that Louisville is a city that takes the health of its citizens seriously .
Dr . Moyer is the medical director of the Louisville Metro Department of Public Health . Dr . Skolnick is a retired internal medicine physician .
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