International flavors abound in this eclectic city. And trends trump trends every week. One that has managed to maintain a regular following longer than most is the hooka, also known as the hubble-bubble, waterpipe and shishah. An estimated 100 million people use this Middle Eastern device each day, says Barry Knishkowy of Israel’s Ministry of Health, and in New York City, it has become a social pastime popular among people of all ages and backgrounds.

The upside to this form of tobacco smoking is that it gives off a sweet smell rather than the harsh fumes of cigarettes or cigars. But, although this means of smoking tobacco filtered through water has widely been thought to be safer and healthier than cigarette smoking, studies show that is hardly the case. In fact, hookah smoking might have more severe health effects. 

According to a study co-authored by Dr. Sana Al-Mutairi of Kuwait University’s Faculty of Medicine and published in this July’s issue of the Asian Pacific Society of Respirology’s publication Respirology, the levels of cotinine and nicotine found in urine samples of hookah smokers are high—not as high as those found in cigarette smokers, but high nonetheless. Rates of chronic bronchitis in hookah smokers, the study states, are greater than those found in cigarette smokers. And, like cigarettes, hookahs have a negative effect on cholesterol levels, correlating with heart attacks, the study notes.

Knishkowy found in another study released last summer that carbon monoxide levels of hookah smokers are up to four times higher than those in cigarette smokers. The good news, though, is that the waterpipes are not addictive—at least not at the same rate as cigarettes. 

But regardless of health effects, the hookah is still popular in major cities across the world—an estimated 100 million people use the waterpipe on any given day, says Knishkowy—and New York City is no different. “The real New York is a mix of cultures,” says Sherif Shabeen, owner of Cozy Café, one of the many popular hookah bars in Manhattan’s East Village. It was New Yorkers’ curiosity about other cultures that became a deciding factor in making hookahs the center of this Egyptian’s new business three years ago. He also included belly dancers and international music as central elements. The popularity of smoking hookahs has become such that questions about it lead Shabeen to ask, somewhat incredulously, “You don’t smoke hookah?”

New Yorkers are even buying hookahs for at-home use, says Steve Zhik, owner of Addiction NYC, a tattoo and piercing parlor at St. Mark’s Place that also sells decorative bongs as well as hookahs. Though, by far, not the most popular item in his store, Zhink says he sells an average of one hookah per day. On Saturday, he had only one five-piped hookah in his store, and the price tag was $250. “People are buying them for personal use, for house parties,” he says.

According to Al-Mutairi’s study, many users of the hookah believe that it’s health affects are less severe or even negligible because of the smoke is filtered through water before it is inhaled. This belief, she states, is false. In a press release from Blackwell Publishing, which publishes Respirology, Al-Mutairi says, “Nicotine kills in all forms.”

But fans of the waterpipe have new alternatives. For the past six months, Shabeen says he has been offering customers a nicotine-free, tar-free, toxic-free alternative for the hookahs. This seemingly healthier alternative is called “Soex Herbal Hukkah,” and, according to Shabeen, it comes from India. So, health-effects aside, the hubble-bubble as a social activity might be here to stay.