In cities with indoor smoking bans, hookah bars have been forced to close or switch to tobacco-free mixtures. In many cities though, hookah lounges have been growing in popularity. From the year 2000 to 2004, over 200 new hookah cafés opened for business, most of them targeted at young adults and located near college campuses or cities with large Middle-Eastern communities. This activity continues to gain popularity within the post-secondary student demographic. Hookah use among high school students rose from 4.1% to 9.4% from 2011 to 2014 while cigarette smoking decreased from 15.8% to 9.2% during this same time period, according to the US CDC. According to a 2011 study, 40.3 percent of college and university students surveyed had smoked tobacco from a hookah. As of 8 July 2013, at least 1,178 college or university campuses in the U.S. have adopted 100% smoke free campus policies that attempt to eliminate smoking in indoor and outdoor areas across the entire campus, including residences.
Hookah smokers inhale nicotine, which is an addictive chemical. A typical hookah smoking session delivers 1.7 times the nicotine dose of one cigarette and the nicotine absorption rate in daily waterpipe users is equivalent to smoking 10 cigarettes per day. Many hookah smokers, especially frequent users, have urges to smoke and show other withdrawal symptoms after not smoking for some time, and it can be difficult to quit. These signs and symptoms of addiction and dependence are very similar to the signs of cigarette addiction. People who become addicted to hookah may be more likely to smoke alone. Hookah smokers who are addicted may find it easier to quit if they have help from a quit-smoking counseling program.
In South Africa, hookah, colloquially known as a hubbly bubbly or an okka pipe, is popular among the Cape Malay and Indian populations, wherein it is smoked as a social pastime. However, hookah is seeing increasing popularity with South Africans, especially the youth. Bars that additionally provide hookahs are becoming more prominent, although smoking is normally done at home or in public spaces such as beaches and picnic sites.
- In big cities like Karachi and Lahore, cafes and restaurants offered Hookah and charged per hour.
- The hookah has been a traditional smoking instrument in Bangladesh, particularly among the old Bengali zamindar gentry.
- In the Arab world and the Middle East, people smoke waterpipes as part of their culture and traditions.
- Nargile became part of Turkish culture from the 17th century.
- In South Africa, hookah, colloquially known as a hubbly bubbly or an okka pipe.
In the Arab world and the Middle East, people smoke waterpipes as part of their culture and traditions. Local names of waterpipe in the Middle East are, argila, čelam/čelīm, ḡalyān or ghalyan, ḥoqqa, nafas, nargile, and shisha. Social smoking is done with a single or double hose hookah, and sometimes even triple or quadruple hose hookahs are used at parties or small get-togethers. When the smoker is finished, s/he either places the hose back on the table, signifying that it is available, or hands it from one user to the next, folded back on itself so that the mouthpiece is not pointing at the recipient. Most cafés in the Middle East offer shishas. Cafés are widespread and are among the chief social gathering places in the Arab world (akin to public houses in Britain).