Hookah use has increased dramatically among American and European youth in recent years because of the social atmosphere it creates, and because many young adults believe hookah is a safer alternative to cigarette smoking; therefore, they do not fully understand the health effects that come along with it. Many municipalities, especially in North America and Europe have enacted smoking bans in public places. Sometimes, however, businesses can obtain special permits allowing smoking within; these permits are typically available only for hookah lounges, cigar bars, tobacconists, and similar establishments where smoking is the focus of activity.