Ann Arbor residents John Deirala, 21, and Laura Peretick, 20, share a hookah at Smoka Hookah Lounge on South University in Ann Arbor.

Angela Cesere | AnnArbor.com

Opposition to hookah — a water pipe that is commonly used to smoke flavored tobacco — is building among national healthy living advocates and some political leaders.

One study showed that an hour-long waterpipe smoking session involves inhaling 100 to 200 times the volume of smoke inhaled with a single cigarette.

Some experts say that the emerging movement against hookah bars could threaten the future of the business, but the last remaining hookah bar in Ann Arbor is doing just fine.

Kyle Saukas, 18, smokes hookah at Smoka Hookah Lounge in downtown Ann Arbor.

Angela Cesere | AnnArbor.com

“We have a ton of business from hookah,” said Ahmad Almusawi, assistant manager of the Smoka Hookah Lounge, located at 1108 South University Avenue. “We’re really busy, especially on the weekends.”

Just a year after Michigan’s statewide indoor smoking ban took effect, multiple hookah bars across the state have closed down due to the stricter requirements placed on hookah businesses, said Regina Calcagno, a representative with the Michigan Department of Community Health.

Smoka Hookah Lounge, which is located on the second floor of the building above Rendezvous Cafe, had to make changes to comply with the smoking ban, too.

Under the law, Rendezvous Cafe was forced to separate its hookah lounge into an entirely new legal entity. To abide by the new state regulations, Rendezvous owner Naizar Alwar last year started the Smoka Hookah Lounge.

“All we did is basically open another business,” Almusawi said. “We had to make two doors instead of one and change the name. We cannot sell food or alcohol, and if you order food from Rendezvous to take upstairs, it has to be to-go.”

For Smoka Hookah, the process was fairly simple. But other bar owners weren’t as fortunate, Almusawi said.

“We were set up for this,” he said. “But a lot of places closed because you can’t really separate a basement from the upstairs without it costing a lot of money.”

Michigan’s Smoke Free Air Law banned smoke in all restaurants, bars and businesses beginning in May 2010. However, the law provided an exemption allowing hookah bars to qualify as a tobacco specialty retail store if the business doesn’t serve food or liquor. The law also prohibits new hookah bars from allowing smoking.

But complicating matters for hookah bar owners is an emerging movement among health activists to raise awareness of the damage hookah smoke can do to your body.

“We’re very concerned about hookah bars because hookah is dangerous, but a lot of people perceive it as being a safe thing to do,” said Shelly Kiser, director of advocacy with the American Lung Association. “Sometimes hookah smoking has more dangers than cigarettes.”

According to a health study conducted by the World Health Organization in 2005, Kiser’s claim has some support.

Among the findings in the study:

--After spending an hour smoking hookah in a bar, users have inhaled about 100 to 200 times as much smoke as they would with a single cigarette.

--Smoke from a waterpipe contains toxins known to cause lung cancer, heart disease and other diseases.

--Hookah smoking sessions often last longer than cigarette smoking, with smokers inhaling 50 to 200 puffs of tobacco.

--Sharing a waterpipe mouthpiece poses a serious risk of transmission of communicable diseases, including tuberculosis and hepatitis.

[Download a PDF of the study here]

Health activists are also concerned that since waterpipe tobacco is flavored, it’s more appealing to young people.

These findings have prompted anti-hookah legislation in other states, according to a recent New York Times report that drew more attention to the issue.

Boston and Maine ended exemptions for hookah bars, while lawmakers in California, Connecticut and Oregon have introduced bills that would ban or limit hookah bars, the Times reported.

Calcagno of the Michigan Department of Community Health said that she is not aware of any pending legislation to ban hookah bars in Michigan, but there are educational efforts to raise awareness about the issue.

“A lot of groups around the state have done a tremendous amount of work to inform their peers that hookah is not as safe as they think it is,” Calcagno said. “It’s not healthy by any stretch of the imagination.”

After passage of the Michigan Smoke Free Air Law and the University of Michigan’s decision to ban smoking on campus starting Friday, Calcagno wonders whether anti-hookah legislation is only a matter of time in Michigan.

“Legislative efforts could definitely come about because this is in the spotlight right now,” she said.

Almusawi said he is not particularly concerned about the prospect of an anti-hookah movement in Michigan. But he argued that hookah smoking should be preserved because of the social and cultural purpose it serves.

“A lot of people are taking these attacks offensively,” Almusawi said. “Hookah smoking is a cultural thing. This is what they do all over the Middle East. Plus, it’s a social activity. People don’t want to sit at home and smoke hookah, they want to get out and see people.”

Almusawi acknowledged that hookah smoking could be addictive, but he argued, “It’s definitely not worse than cigarettes, I’ll tell you that. People don’t come here every day to smoke. It’s just a once-in-a-while kind of thing.”

Lizzy Alfs is a business reporter for AnnArbor.com. Reach her at 734-623-2584 or email her at lizzyalfs@annarbor.com. Follow her on Twitter at http://twitter.com/lizzyalfs.