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Mohammed Forouzesh, MPH, PHD Professor Emeritus California State University, Long Beach Mohmmed.forouzesh@csulb.edu 949.292.5888 Introduction As a public health professor for over thirty years, I am here to ask for your support for hookah to be included in new laws that bans flavors in tobacco and e-cigarette products.As someone from a Middle Eastern background, I am well aware of the cultural and social practices associated with hookah. According to the World Health Organization (WHO), waterpipe tobacco smoking was usually associated with elderly men in the Middle East. However in the 1990's, it quickly surged to become an epidemic among young people (WHO, 2015). Flavored hookah tobacco products are considered a major factor in the appeal to young people and is becoming a global water pipe epidemic (WHO, 2015). From 2011 to 2015 the prevalence of hookah use among high school and middle school students in the United States dramatically rose by more than 50%. (Singh et al., 2016). Hookah use poses a serious public health concern. In recent days, all Middle Eastern countries have banned the use of hookah in public places because of the direct transmission of infectious diseases such as the Corona Virus through sharing of the mouthpiece. Unlike cigarettes and pipes, hookah users inhale the tobacco fume directly into the lungs for a longer duration to create more smoke. According to a recent University of California Irvine (UCI) study, this method of deep inhalation versus taking individual puffs enables ultrafine particles (with a diameter smaller than 100 nanometers)to enter deep into the lung tissues causing irreversible damage (Nero, 2019). What is Hookah To use hookah, a form of moist tobacco is placed in the head of the water pipe. The tobacco is covered with perforated aluminum foil while the pieces of charcoal placed on top of the foil act as a heat source. Smokers inhale through a mouthpiece, drawing air over the charcoal and through the heated tobacco to produce smoke. One of the problems posed by the use of flavored charcoal, most commonly used by youth, contains many harmful toxins or additives. One of the big myths about hookah usage is that the water in the bowl will filters out the toxic chemicals,providing a shield for the smoker(Nero, 2019). However this is not the case, for the cooling effects of water actually promotes ultrafine particle formation(Nero, 2019). Hookah is often regarded as less harmful and less addictive than cigarettes. However, a typical 1-hour hookah smoking session is equivalent to the inhalation of 100 or more cigarettes (World Health Organization, 2005). According to the University of Pittsburgh Medical Center(UPMC), compared with a single cigarette, one hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine and 10 times the carbon monoxide (Primack, 2016). It was found that 63.8%of high school hookah smokers and 44.3%of middle school hookah smokers chose flavored tobacco (Corey et al., 2014). Although limited in research it has been found that hookah users may have a greater risk