Should a ban on smoking exempt people who do it for 'cultural' reasons? What if the science regarding the detrimental effects of certain types of smoking is inconclusive?

This is an issue lawmakers in the UK will have to struggle with as advocates try to get hookah smoking exempted from England’s smoking ban.

A hookah is a glass waterpipe. It has primarily been used in Arabic communities for smoking herbal fruits after meals, but it has become popular among young people for smoking tobacco, massel (aromatic tobacco), cannabis and the cheaper bango, write Dr Rashid Gatrad and colleagues.

It's difficult to start exempting nationalities and religions from bans designed to protect public health so if the pipes are exempted, look for hookah smoking to spike accordingly.

It is thought that around 100 million people use a hookah daily worldwide but even given those numbers doctors don't have much research data on the effects of hookah smoking.

The ban should apply, the researchers say, because the nicotine content in hookah tobacco is the same as in cigarettes and there is a greater risk of carbon monoxide poisoning, especially if smaller hookah pipes and “quick lighting” commercial charcoal are used. There is also some evidence that hookah smoking causes chromosomal damage.

Compounding the problem, they say, is that family attitudes towards children smoking tobacco in waterpipes are far more permissive than attitudes to cigarette smoking.

Their reports says that rising numbers of children in the UK are being exposed to and experimenting with smoking hookah products. Children as young as 10 years old are known to smoke fruit flavoured aromatic tobacco in areas with large minority ethnic communities such as Leicester and London.

Additional reference: A Short History of the Hooka