According to a 2013-2014 survey, 79% of youth aged 12-17 who smoked hookah said that they used hookah products because "they come in flavors I like." 11,16.Kid-friendly flavors are available, such as watermelon, tropical fruit, orange cream, caramel, chocolate, tutti frutti, vanilla, and strawberry.These establishments are often exempt from state and local smokefree laws.Hookah bars and cafes despite selling a deadly product market themselves as a social, fun and relaxing environment to young adults, 13,14,15 and can offer musical performances, food, and alcohol, where they are allowed by state or local law.11 Hookah bars and cafes have grown in popularity, particularly in urban areas and around college campuses. According to one study, 79.6% of current hookah users aged 12-17 say that they use hookah because they like socializing while using the product.The Fall 2018 National College Health Assessment found that 14.7% of college students had ever used hookah and 3.1% had used it in the past month.Rates were significantly higher among men than women, and the uninsured than those with private health insurance. In 2017, 2.6 million adults used hookah, water pipes, or pipes.Rates of use are similar among boys and girls, but significantly higher among Hispanic high school students (6.0%) compared to white students (3.3%).Nationwide, an estimated 590,000 high school students, or 4.1%, and 140,000 middle school students, or 1.2% had smoked hookah in the past month.The combustion of charcoal used to heat hookah tobacco may pose additional health risks, since this combustion process produces dangerous substances such as carbon monoxide, metals, and other chemicals.Although the smoke passes through water, this does not eliminate the hazardous, addictive chemicals released from the tobacco.At least 82 toxic chemicals and carcinogens have been identified in hookah smoke.1 They are not a safe alternative to cigarette smoking. Hookah users often perceive it to be less harmful than smoking cigarettes, but studies show that the smoke contains many of the same toxic components found in cigarette smoke, such as nicotine, tar and heavy metals. A user then inhales the smoke through a tube and mouthpiece.
They usually work by passing charcoal-heated air through the tobacco mixture and ultimately through a water-filled chamber. Hookahs are waterpipes that are used to smoke specially made tobacco mixtures that come in a wide variety of flavors.
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