Transcript Confronting the Emerging Threat of Hookah Bars

Confronting the Emerging Threat of
Hookah Bars
Access: Building A Tobacco-Free Future
Seattle, Washington March 26, 2008
Presenter
Michael F. Strande, J.D.
Deputy Director
Legal Resource Center for Tobacco Regulation,
Litigation, & Advocacy
University of Maryland School of Law
500 W. Baltimore St.
Baltimore, Md 21201
[email protected]
410-706-1129 · 410-706-1128 (fax)
What Is Hookah?
• Way to smoke specially made tobacco
• Involves heating the tobacco, usually with
burning embers or charcoal.
• Resulting smoke is filtered through a bowl of
water (sometimes mixed with other liquids
such as wine) and then drawn through a
rubber hose to a mouthpiece.
What Is Hookah?
Waterpipes generally
consist of 4 main parts:
1. Head – where
tobacco heated
2. Bowl – filled with
liquid
3. Pipe – connects the
bowl to the base
4.
Hose / mouthpiece –
through which smoke
is inhaled.
History of Hookah
• Originated in ancient
Persia and India
• Shisha created by mixing
shredded tobacco and
honey, molasses or dried
fruit
– Several U.S. companies
manufacture and sell their
own
• Widely used in Mid East
and imagery in pop culture
Alice’s Adventures in Wonderland (1865)
Health Consequences of Hookah
• General Perception is that Hookah is Safer
• Research limited compared to cigarettes
– Links made to same adverse health effects,
including lung cancer and heart disease
– October 2007 issue of Nicotine and Tobacco
Research indicates that daily usage produces
nicotine absorption levels similar to that
produced by daily cigarette use
Health Consequences of Hookah
The Myth
The Facts
• water acts as a filter
removing impurities
• water cools the smoke
so it feels less harsh
• smell, taste and
smoothness of
sweetened tobacco
provide less-irritation
• smoke for longer
durations and inhale
more deeply
Health Consequences of Hookah
• Hookah sessions often last 40 to 45 minutes, vs. the
5 to 10 minutes it takes to smoke a cigarette.
• Water does absorb some nicotine, BUT studies
suggest MORE smoke is inhaled to satisfy their
nicotine addiction.
– Studies show double the carbon monoxide and triple
the nicotine exposure when comparing one 45 minute
session vs. one cigarette.
• Due to the longer, deeper, more sustained period of
inhalation and exposure, hookah smokers may inhale
as much as 20 cigarettes during a single session.
Health Consequences of Hookah
The Myth
• less tobacco = less
impurities
The Facts
• Still contains tobacco
• commonly used heat
sources (wood cinders
or charcoal), also
release high levels of
potentially dangerous
chemicals, including
carbon monoxide and
metals.
Chemicals found in hookah vs. cigarette smoke
Shahadeh, A. and Saleh, R. (2005). Polycyclic aromatic hydrocarbons,
carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of
the narghile water pipe. Food & Chemical Toxicology, 43:655-661.
Health Consequences of Hookah
• Increases the Risk of
Exposure to
Infectious Diseases
• Shared mouthpieces
and the heated, moist
smoke enhance the
spread of diseases,
such as tuberculosis,
and viruses, such as
hepatitis and herpes
What Is A Hookah Bar?
• The hookah bars market themselves as hip smoking
lounges.
• emphasize the “experience” of smoking a hookah and
equate this with experiencing Middle Eastern culture.
– Arabic décor and music are often present and in
some cases belly dancers present to help create the
“experience.”
• Increasingly marketed to college students.
– intellectually stimulating and relaxing environments
where individuals can play games or socialize.
What Is A Hookah Bar?
• The hookah bars are open late (in Md, usually
until 4 a.m. on the weekends)
• market themselves as the “place to be after
hours.”
• Those that do not serve alcohol are not
regulated by any of the last call rules for
alcohol establishments.
Web Page of
ICE HOOKAH LOUNGE
Towson, Md
Step 1: Choose Your Hookah
Step 2: Choose Your Shisha
Step 3: Choose Your Drink
• Bottled Water
•Soda
•Juice
•Tea
Regulation Via Common Law
• Individual Nuisance suit
– Case by Case Basis
– Smoke drift into home or store
• A private nuisance exists when one person
unreasonably interferes with another's
interest in real property.
• "continuousness or recurrence of the things,
facts, or acts, which constitute the nuisance."
– One act, though causes injury, not enough
Regulation Via Legislation
• Clean Indoor Air Law
– Be aware of Exemptions:
• Retail tobacco shops
– selling primarily tobacco products and tobacco related
accessories; and the sale of other items is incidental
– bright line prohibitions on selling specific items (alcohol)
• Cigar Bar
• Private Club
– Vague definition of smoking
• Smoking defined as the “burning of a lighted cigarette, cigar,
… or any other substance containing tobacco.”
• One hookah bar in Md. attempting to switch to a leaf other
than tobacco.
Regulation Via Legislation
• Local Regulation
– Legislative authority or Local Board of Health
regulations
– based on elimination of Nuisance or control any
“cause of disease”/ spread of contagious disease”
• Business Licensure Requirements
–
–
–
–
–
License to sell tobacco
Limit hours of operation
Limit sale of other items (alcohol; food)
Limit age of patrons
Prohibit live music and dancing (including belly
dancing) unless obtain a permit.
Violation of Current Law?
• Violation of Current Non-Smoking Restrictions
– Absence of non-smoking sections?
• Health Code Violation
– Powers to control spread of infectious disease
– Sanitary Laws
• Mirage Hookah Lounge; Frederick, Md.
• Not cleaning mouth piece; Going from food to
shisha without handwashing
• Sale of Tobacco to Minors
Zoning Regulations
• Power to zone/control land “undoubtedly broad”
– w/in police power to promote public health + safety
– Late night crowds / communicable disease / preserve
character of neighborhood
• Limit #’s / Disperse / Concentrate in certain zone
– In purely commercial / industrial zones
– away from colleges and residential areas
• Variances/Conditional Use Permits (CUP) – in addition, a
city could require hookah bars to obtain use permits. A
planning commission could be specifically directed to
consider proximity to colleges/parks when issuing permits
Zoning Regulations
• Standard of Review determined by nature of right
asserted
• Smoking NOT First Amendment right
– use Rational Basis test
• Rationally related to
a legitimate state interest
• Minimal burden of proof
Recommendations
If possible enact strong
Clean Indoor Air laws
without exemptions
If not possible to
eliminate …
• Regulate through
current health code,
youth access laws
Recommendations
• Through permitting:
– limit the hours of operation
– require employees and customers to be over 18
Preventing hookah bars from being “the place to be
after hours” will reduce customers’ and
employees’ exposure to the dangers of hookah
smoke.
Recommendations
• Curtail the spread of infectious diseases:
– require hookah bars provide individually packaged
disposable mouthpieces.
– While reducing spread of disease, individual
mouthpieces will probably not overcome the problem
entirely because respiratory droplets can still be
deposited within the mouthpiece tubing and diseases
can still be transferred in part due to the moist smoke.
• Mandate warning sign
• Limit Locations
– Zone away from colleges and residential areas
• Seek voluntary advertisement bans
– Have colleges prohibit advertisements in college
papers or on campus
The End
Michael F. Strande, J.D.
Legal Resource Center for Tobacco
Regulation, Litigation & Advocacy
University of Maryland School of Law
500 West Baltimore Street
Baltimore, Md 21201
[email protected]
410-706-1129 • 410-706-1128 (fax)