Cigarettes are bad for you. We know this. We've all seen the warning labels on advertising and packaging, years of anti-smoking campaigns and medical study after medical study linking first- and second-hand cigarette smoke to cancers, birth defects and other terrible things.

Now, turn your attention to the hookah pipe — some might label this as cigarette's deceptively sexy sister; others claim she's a distant cousin, a thousand times removed, if any relation at all. Ask yourself this: Is hookah smoking hazardous to your health?

The question seems simple enough, but it lies at a crossroads of emerging medical opinion, cultures an ocean away, public health officials with millions of taxpayer dollars backing them and local business owners working to live the American dream. Last year, the Centers for Disease Control and Prevention granted the Southern Nevada Health District $14.6 million to address tobacco and tobacco-related products. Specifically, they mandated part of the money be used to combat hookah smoking, which is increasing in popularity across the country, especially among college-aged individuals. Locally, the practice was introduced to the public more than a decade ago through Mediterranean restaurants but has since expanded. Now, several nightclubs, bars and strip clubs offer hookah, including Blue Martini, Little Darlings and Lavo.

The UNLV branch of the Health District task force conducted a Web survey of more than 4,000 students and found that 15.2 percent have tried a hookah. More alarming, 66 percent of respondents said they believe smoking from it is "somewhat less" or "much less" hazardous than smoking cigarettes.

Not true, according to Malcolm Ahlo. The Health District educator says a one-hour hookah session is the equivalent of 100 cigarettes, a finding pulled from a 2004 report published in the scientific journal Biochemistry, Pharmacology and Behavior. The CDC also claims smoking from a hookah is just as toxic, citing studies by the American Lung Association and American Academy of Pediatrics.

Many rebut such studies, including Jeff Ecker, the corporate general manager of Paymon's, a local Mediterranean restaurant and hookah lounge. In a scathing letter released after the first wave of anti-hookah ads ran in November, Ecker brought up the issue that hookah users do not smoke for an entire hour without breaks. "Partaking in hookahs is a group experience," he wrote. "There has never been in the history of the world a hookah chain-smoker."

Another issue is tar. Anti-hookah materials claim the smoke contains 36 times the amount of tar found in cigarette smoke (a fact pulled from a report published in Food and Chemical Toxicology in 2003). Hookah defenders say tar comes from burning tobacco, which hookahs do not do. They heat it, and most of the tobacco is left in the bowl after use.

Translation: It's safer.

JJ Sayegh agrees. He owns Olive, another Mediterranean restaurant and hookah lounge, and Cuzzins, the valley's only hookah distributor, which packages its product in Jordan. He cites the history of hookah, which dates from the 16th century in the Middle East. "People have been using it for hundreds of years, and they lived longer than we do," he says. "Cigarettes have 100 different chemicals in them. Hookah has four ingredients only (tobacco or green-tea leaves, molasses, glycerin and flavoring). It's natural, and it's not dangerous." Olive sees plenty of former drug users turning to hookah smoking as their new form of recreation, he says. "It keeps people off the streets, gives them a social activity and keeps them relaxed."

In his letter, Ecker takes a dig at the Health District, suggesting that officials weren't content with hurting small businesses with the Nevada Clean Indoor Act in 2006 and decided to "re-create the same havoc on a sector of Las Vegas dominated by immigrants seeking to make a better life for themselves and their families."

Maria Azzarelli, the Health District's tobacco control coordinator, says this kind of outrage is common among hookah shop owners. "We don't get criticisms from those who partake in hookah," she says. "We get it from the owners of the establishments." This is in contrast to anti-cigarette outreach programs, which yield hate mail mostly from smokers.

Azzarelli takes the anger as a good sign. "Perhaps we're being effective in our campaign," she says. "They're getting questioned about the safety of their products."

She and Ahlo stress their hope that the community at large realizes they are not attacking anyone's culture. "We respect people's tradition, but tradition doesn't make it safe," Ahlo says.

Azzarelli adds, "There's this idea that the Health District is trying to eliminate businesses. We're not. We are in the business of public health. We want to inform people that by doing this activity they are not engaging in something safe."

Well-intentioned or not, the bottom line remains the same for local business owners. According to an Olive manager, income has slowed on its dining side in recent years because of the recession while hookah smoking has remained steady. If that drops, the business will suffer. It's difficult not to take it personally, Sayegh says. "We're being grouped in with (cigarettes) and we shouldn't be.

Copyright 2011  Las Vegas Sun