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8. The WHO investigatory panel found that the common practice of sweetening and flavoring hookah tobacco, giving it a sweet taste and smell, may account for the increase of its use among young people who otherwise avoid smoking. 9. The smoking of tobacco in a hookah "is frightening because it is a gateway toward a lifetime use of tobacco, including cigarettes," according to Dr. Christopher Loffredo, Ph.D., Director of the Cancer Genetics and Epidemiology program at Georgetown University Medical Center, who has studied hookah smoking since 1997. Dr. Loffredo further reports that: "People think the water absorbs the toxins, and that is true to some extent if the toxins are water soluble, but tar isn't, and tar contains the carcinogens. We believe that, compared to the typical cigarette smoker, waterpipe smokers are exposed to larger total amounts of nicotine, carbon monoxide and certain other toxins. And because the tobacco is burning at a lower temperature, it is more tolerable to inhale deeply, and in fact you need more force to pull air through the high resistance of the water pathway. That means the tobacco smoke can be penetrating deeper in a person's respiratory tract than cigarette smoke does. The damage could be even worse than seen in cigarette smokers, but we haven't done studies long enough to quantify the true cancer risk." 10. According to Dr. Loffredo, another concern is that hookah use may represent a loophole around city and state laws banning smoking in public places. 11. While California Labor Code section 6404.5 generally bans indoor smoking at restaurants and bars, it exempts smoking inside retail or wholesale tobacco shops and private smokers' lounges. It is unclear how substantial the sale of tobacco for offsite consumption must be to qualify for this exemption. While the City is currently studying this issue, the Public Health Institute's Technical Assistance Legal Center, funded by the California Department of Health Services, recommends that this exception should only be available to a business that derives seventy-five percent (75%) or more of gross sales receipts from the sale of tobacco products and tobacco paraphernalia. H. If hookah parlors are permitted in the City and left unregulated, they will pose a serious threat to the public interest, health, safety and welfare for the following reasons: 1. Hookah parlors established in other cities have been associated with increases in noise, loitering, public drinking, possession of illegal weapons, underage drinking, and arson. 75C-5 Ordinance No. NS - XXXX Page 3 of 6