US Health Policy Related to Hookah Tobacco Smoking

Abstract

Background Although cigarette smoking is decreasing in the U.S., hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposures. The purpose of this study was to assess how a representative sample of U.S. tobacco control policies may apply to HTS. Methods We examined municipal, county, and state legal texts that apply to the largest 100 cities in the U.S. We developed a summary policy variable that distinguishes cities without clean air legislation preventing cigarette or HTS in freestanding bars; with anti-smoking legislation exempting HTS by name; with anti-smoking legislation providing for a different exemption under which HTS may fall; and with anti-smoking legislation and no clear exemption governing HTS. We used multinomial logistic regression to determine associations between community-level socio-demographic variables and our policy outcome variable. Results Although 73 of the 100 largest cities in the U.S. have laws that disallow cigarette smoking in bars, HTS may be allowed due to exemptions in 69 of these 73 cities. While 4 of these cities have passed legislation specifically exempting HTS, 65 may permit HTS via generic tobacco retail establishment exemptions. Compared with cities without clean air legislation, the cities in which HTS may be exempted had denser populations. Conclusions Although three-fourths of the largest cities in the U.S. disallow cigarette smoking in bars, HTS may be permitted in nearly 90% of these cities via exemptions. Closing this gap in clean air regulation may significantly reduce exposure to HTS.

Knowledge, Attitudes, and Normative Beliefs as Predictors of Hookah Smoking Initiation: A Longitudinal Study of University Students

“…While regulation of tobacco products such as cigarettes is relatively comprehensive, the current regulation of HTS in the United States is confusing and inconsistent, possibly leading to the misperception that HTS is less harmful than cigarettes. Although the majority (73%) of the most populous U.S. cities have clean indoor air policies, it is unclear how these policies affect hookah bars and cafes, which are usually present in close proximity to university campuses (Primack, Hopkins, et al, 2012). Furthermore, hookah tobacco does not appear to be under the purview of the Family Smoking Prevention and Tobacco Control Act (U.S. Food and Drug Administration, 2012).…”

The operation, products and promotion of waterpipe businesses in New York City, Abu Dhabi an Dubai

“…For businesses offering food and other sales items, it remains unclear if they will be less resistant to waterpipe regulation. A majority of New York City businesses offered food, and to our knowledge this provides the first direct evidence that many of these businesses may not actually be eligible for exemption from clean air regulations as a tobacco retail establishment as has been previous suggested (11). The average price of a standard waterpipe bowl was not prohibitive of daily use, especially if cost is shared within a group.…”

“…To avoid falling under existing CIAA regulations, US waterpipe business owners classify their business as retail tobacco shops, claiming waterpipe is their primary activity, with the sales of food and alcohol considered incidental. A 2012 study of the 100 largest US cities found 73 banned cigarette use within bars but 63 provided exemptions allowing waterpipe use (11).…”

Review of hookah tobacco smoking among college students: policy implications and research recommendations

“…The ambient air in hookah cafes has higher levels of particulate matter than restaurants that permit cigarette smoking and smoke-free restaurants (31). These risks to health notwithstanding, the vast majority of hookah venues are exempt from compliance with clean air standards (36,37).…”

“…Prior reviews of the hookah smoking literature on college students have focused on epidemiology, specific subpopulations -particularly youths and college students (34), global health impact (35), health risks (8,28), and policy (36,37). This literature review examines hookah tobacco smoking within the context of the current mandate of the U.S. Food and Drug Administration (FDA) to regulate tobacco consumption.…”