Study: Waterpipe Establishments Likely to Set up Shop Near College Campuses

Misconceptions about waterpipe smoke content may lead users to underestimate the health risks, which include all the cardiovascular risks of cigarette smoking, tobacco dependence, and even nicotine withdrawal.

Tobacco restrictions across the country at locations such as restaurants and college campuses have contributed to a significant decline in tobacco usage among adolescents and college-age students. But a new threat is emerging. College students are increasingly taking up waterpipe smoking, and establishments that provide this service are more likely to be located near large colleges and universities, according to a study in the American Journal of Preventive Medicine.

Better known by many as “hookah lounges,” the establishments get around state and local ordinances that prohibit smoking indoors in public establishments via a loophole that allows smoking in establishments that derive a certain percentage of their revenue from tobacco sales. In many places, this provision was added to keep cigar stores from going out of business, and the revenue threshold that must come from sales of tobacco is often high, generally around 75% to 80%. Many waterpipe establishments also serve alcohol and food, but it’s unclear how closely they are regulated to ensure compliance with legal restrictions.

Misconceptions about waterpipe smoke content may lead users to underestimate the health risks, which include all the cardiovascular risks of cigarette smoking, tobacco dependence, and even nicotine withdrawal. Depending on the type of tobacco use and the construction of the pipe and hose through which it is smoked, waterpipe devices can deliver amounts of tobacco and nicotine well in excess of cigarettes, according to a 2010 study in the American Journal of Health Behaviors. This finding was echoed in a more recent 2014 study in Tobacco Control. An article posed to the Mayo Clinic website earlier this year said that accumulated research shows that waterpipe smokers are exposed to more carbon monoxide and smoke than are cigarette smokers.

The AJPM study compiled lists of waterpipe establishments and their addresses from Internet-based directories, then geocoded and overlaid those locations on a US map of accredited colleges and universities. A total of 1,690 waterpipe establishments and 1,454 colleges and universities were included in the study. Overall, 554 colleges or universities (38.1%) were within 3 miles of a waterpipe establishment.

There was a direct correlation between proximity of waterpipe establishments to colleges and universities with higher full-time enrollment levels. Public schools and those with a smoke-free campus policy were at lower odds of having waterpipe establishments within 3 miles of their campuses.

The study authors hope the research spurs a fresh look at the exemptions currently enjoyed by the establishments.