“Whoooo  ARE… YOU….?” asked the truculent caterpillar in the 1865 classic Alice in Wonderland, as he smokes his water pipe. His question is still out to jury, but his pipe has made a comeback straight into young adult culture. The hookah, typically consisting of a bowl (as in “smoke a bowl”) filled with tobacco, affixed to a hollow tube extending down into an enclosed jar partially filled with water, and a hose affixed to the top of the jar from which a user draws the smoke, is becoming increasingly popular among younger and younger adults and adolescents.

There are more than 400 hookah cafes across the country, according to an online database of hookah bars; hookah bars are especially popular among 18- to-24-year-olds, and the growing popularity of hookah bars has led the American Lung Association and the World Health Organization to issue advisories on the dangers of hookah smoking, citing lung and heart disease, cancer, emphysema, and heightened asthma attacks as the associated risks.

Dr. David Burns, professor emeritus of medicine at UC San Diego contends, “You may get [toxic elements] in higher doses than you would from smoking cigarettes because of the very large volume of smoke that you ingest.” Hookah sessions typically last 20 to 80 minutes, and the mildness of the smoke allows for deeper inhalations.

However, while scientists point out the high levels of nicotine, carbon monoxide, and other toxic chemical, they can’t say exactly how unhealthful it is, particularly compared with cigarettes, and hookah smokers contend the wave of relaxation that comes with every puff, along with the fellowship of other smokers, outweigh the risks – often citing the hooka as a safer or more socially accepted alternative to cigarettes.

Have any of your students used a hookah, visited a hookah bar, or been to a party where hookahs are used?

Do you think the hookah is a healthier alternative to other, more serious or impairing activities, such as drinking?

Should youth ministries inform students and families of the trend and associated risks?