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The WHO Framework Convention on Tobacco Control has stimulated the passage of comprehensive clean indoor air laws throughout the world.1 Although WHO guidelines stress the importance of universal protection from secondhand smoke in such laws,2 many states in the USA exempt certain locations such as tobacco retail establishments and tobacco bars/cigar lounges.3 ,4 Tobacco waterpipe (ie, hookah) establishments are often exempt from these laws, are growing in popularity and may change social norms regarding hookah use.3 ,4 Indeed, hookah use among young people in the USA appears to be increasing,5 as it is elsewhere,6 and the limited research available suggests it may be associated with negative health effects (eg, nicotine dependence, cancer).5 In this letter, we describe the exemptions in Oregon's Indoor Clean Air Act (ICAA), subsequent proliferation of hookah lounges and associated monetary costs, as well as patterns in youth hookah use. To our knowledge, this is the first such published study in the …
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