State lawmakers in California, Connecticut and Oregon have introduced legislation to ban or place limits on hookah bars, despite their rising popularity, the New York Times reports.

 
"Teens and young adults are initiating tobacco use through these hookahs with the mistaken perception that the products are somehow safer or less harmful than cigarettes," Paul G. Billings, vice president of the American Lung Association, told the newspaper. "Clearly that’s not the case."
 
Many people falsely believe that hookah smoking is safer than cigarettes, based on the assumption that the water filters out many harmful ingredients, but several recent studies prove otherwise. According to the Centers for Disease Control and Prevention (CDC), "hookah smoking carries many of the same health risks as cigarettes." The CDC says that a typical one-hour hookah session delivers the same amount of smoke as 100 to 200 cigarettes, and the charcoal used to heat the tobacco in most hookahs produces high levels of carbon monoxide, metals and other cancer-causing chemicals, which can affect both smokers and those exposed to secondhand smoke.
 
One student interviewed by the Times admitted that she smoked the hookah for two hours a day during the summer.
 
The CDC also points out that sharing hookah mouthpieces increases the risk of transmitting tuberculosis, herpes, and other illnesses. Smoking in all forms has been linked to lung and oral cancers, as well as heart disease and other illnesses.
 
As a result of these health risks, many state and city legislatures and college administrators are trying to take action against the growing trend. According to the Times, Boston and Maine "have already ended exemptions in their indoor-smoking laws that had allowed hookah bars to thrive," a tactic being considered by other state and local governments. Colleges like Louisiana State University and George Mason University have added hookahs to their anti-smoking policies.
 
A study published April 19 in the journal BMC Public Health called hookah use worldwide an "epidemic," saying the use of water pipes was "alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries." The study's lead author, Elie Akl, associate professor at the University of Buffalo, told the website Futurity that usage in the U.S. was also growing, especially among Arab-American students. "Awareness campaigns need to take into account that waterpipe smoking is increasing, especially among youth, and that it may be a gateway to cigarette use in adulthood," Akl said.