ST. LOUIS (AP) - Since a smoking ban went into effect in St. Louis and St. Louis County at the beginning of this year, numerous hookah lounges and cafes have found various ways to continue lighting up, resulting in a confusing mix of services that some - even hookah lounge owners - say is unfair.
The Middle Eastern restaurant Ranoush, located in the Delmar Loop, spun off into a separate business a few blocks east and into St. Louis, selling only hookah, soft drinks and coffee.
At Al Waha on South Grand, the owner moved hookah smoking to the patio.
Nara Cafe downtown closed its doors to those younger than 21 to allow hookah smoking inside.
Other restaurants limited their hours or food sales so they could sell hookah inside to customers, including those under 21.
"Are you a restaurant? Are you a bar? Or are you a hookah lounge? What are you? That's what's hurting me," said Ranoush owner Aboud Alhamid, who said confusion has resulted in an uneven playing field. He took a strict interpretation of the ban and opened Ranoush Nights three months ago with no food or alcohol service so as not to lose the 18- to 21-year-old hookah smoker and those who want to smoke inside.
Some hookah cafi owners argue for exceptions or even the creation of a special hookah license, saying that hookah smoking is a unique service - a deep-rooted Middle Eastern tradition tied to socializing, relaxing and meditating that dates to the 16th century.
"It's ethnic. It's different," says Riyad Alwadi, owner of Al Waha. "It's not like smoking cigarettes."
Hookah is a water pipe used to hold tobacco soaked in flavorings such as apple, coconut, cherry and mint. Charcoal is used to burn the tobacco, and users inhale the water-cooled smoke through a hose.
According to the U.S. Centers for Disease Control and Prevention, hookah smoke delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Hookah smokers are at risk for the same kinds of diseases caused by cigarette smoking, including cancers and decreased fertility. The charcoal used to heat tobacco produces high levels of carbon monoxide, metals and cancer-causing chemicals.
Hookah smoking is also communal; each person uses his or her own replaceable and disposable hose tip. One hookah session costs about $12 for the group and lasts 45 minutes to an hour.
Arguments over whether hookah lounges (as well as a downtown cigar bar) are considered a restaurant, bar or retail tobacco store have led Pam Walker, the director of the St. Louis Department of Health, to refer the issue to the city's legal counsel for interpretation.
"These hookah bars and cigar bars are a new phenomenon, and there's a question over where they fall," Walker said. "As you can see it's kind of complex, and I need a lawyer to figure it out."
An exemption in the law was meant to be applied narrowly - to bars serving patrons 21 and older with food sales less than 25 percent of total food and alcohol sales. The city also requires that serving areas be less than 2,000 square feet.
"It was meant for these tiny little places with just a microwave in the back ... the corner bar that's been there forever," Walker said. "But people are trying to drive a train through it."
Retail tobacco stores earning more than half their revenue from tobacco and tobacco products are also exempt under the ordinance.
The St. Louis County Department of Health has taken a stance that businesses "where they only hookah" are not regulated in any way as a restaurant or a retail store, said Gerrin Butler, the food and environmental program manager. These businesses do not sell food or alcohol. "The ones that decided just to open up a hookah bar, we don't regulate them," Butler said. "We recognize that that's an establishment that doesn't meet any of those clear definitions."
Because many states and cities have enacted smoking bans, hookah lounges have been growing in popularity in the U.S., especially around college campuses.
Double Apple Cafi and Hookah Lounge opened in February near St. Louis University, and Cafi Nura opened six months ago near Webster University.
The Ninth Street Hookah Lounge opened more than a year ago in the college town of Columbia, Mo., and Jinn Lounge opened about two months ago in Kirksville, Mo., home of Truman State University. Hookah lounges in the Central West End and Delmar Loop are popular spots for Washington University students.
Double Apple co-owner Keren Arismendi said her partner Tareq Khoury used to own a hookah lounge near Lindenwood University in St. Charles. "It was a very busy area, and this area is the same," Arismendi said. "They are all college kids, and they all love hookah."
Arismendi and Khoury got their business permit before the start of the ban. They had planned to open at 11 a.m. with a full menu but learned that would force their hookah services outside. Instead, they limited their menu and don't open until 4 p.m. They also serve alcohol and allow minors, she said.
Health officials fear that ways around smoking bans - as well as outright exemptions for hookah lounges - reinforce the belief that hookah is less harmful than cigarettes. The misconception combined with hookah's increasing popularity represents a growing public health issue, they say.
"The popularity of hookah smoking among young adults is quite alarming given the potential for negative health effects," said Wake Forest University assistant professor Erin Sutfin, the lead researcher on a study published in April about hookah use among college students. "Unfortunately, many young adults are misinformed about the safety of hookah smoking, and some mistakenly believe it is safer than cigarette smoking."
Little research has been done on hookah use by young adults. But Sutfin surveyed nearly 3,800 students from eight North Carolina colleges and universities about their drug habits and knowledge. The research found that 40.3 percent reported having smoked tobacco from a hookah, and 17.3 percent said they actively used hookahs. The hookah smokers were most likely to live within 10 miles of a hookah venue and believe that smoking from a hookah is less harmful than smoking a cigarette.
A 2008 Internet-based survey of nearly 750 college freshmen found that 20 percent had smoked hookah in the past 30 days. Small studies in Florida and California show that significant numbers of high schoolers have smoked hookah. The findings have researchers pointing to the need to address the legality of hookah lounges.
"State smoke-free bans need to include hookahs in their policies," Sutfin said. "Several states with strong smoke-free policies have exemptions for hookahs. Hookah cafis create the perception that this is a safe activity. It is not."
Users interviewed at various hookah lounges, however, say they smoke hookah in moderation and don't feel like it's addictive. "It's not a gateway to anything. I don't want to smoke cigarettes," said Carlos Restrepo, 21, a junior at Webster University. He says he enjoys the relaxed atmosphere and the social aspect of hookah smoking, especially with his younger friends.
Hookah cafi owners said they were unsure how the law was going to be effective when it was being debated, and they continue to struggle to get straight answers on how to be in compliance.
Rimla Javed, owner of the Cafi Nura in Webster Groves, sells a few pastries and sandwiches, but mainly coffee along with her hookah. She said she has been told by health department officials that she has to have a liquor license in order to sell hookah inside "because only bars can be exempt from the smoking ordinance."
But she's willing to do that, "even though she does not want to sell alcohol" and because hookah is her niche, she said. "My biggest competition is Starbucks, and I can't compete with Starbucks."
Unless the law is changed, hookah smoking will disappear from St. Louis in five years.
The city ordinance ends all exemptions in 2016, but the county does not have such a sunset clause.