Background:
In Turkey consumption of tobacco products in all indoor places are banned since 2009. Hookah and cigarettes which do not contain tobacco but used in a way to imitate the tobacco products are considered as tobacco products since 2013. The objective of this study was to determine hookah consumption in enclosed spaces of licensed hospitality establishments in Istanbul.

Methods:
This is a cross-sectional study. There are 428 hospitality establishments licensed to offer hookah tobacco products in Istanbul. Seven districts which encompass 51.2% of all the licensed establishments were selected as the study area. Sample size was calculated as 141 establishments assuming a violation rate of 50%, margin of error of 0.05, confidence level of 95% and a 10% non-response. Establishments were selected through simple random sampling. Data were collected through direct observation and presences of hookah use, smoking, signage display were noted. Observations were carried out after 3:00 PM for 10 minutes.

Results:
Of the 141 establishments 128 were accessed (90.8%). The majority were cafes (68.8%) and 3.1% had kids menu. Only 57.0% had existence of open terrace and 68.8% had extensions with removable panels. Of the establishments 15.6% had < 100 meters distance from formal education institutions. Among all 50.7% had no-smoking sign display, and of these only 61.5% were appropriate in terms of size and content. Violation for cigarette smoking and hookah use were 73.4% and 78.1%, respectively. In only four establishments health warnings were present on hookah bowls and two were appropriate in terms of size and content.

Conclusions:
The absence of open terraces, lack of no-smoking signage, health warnings on hookah bowls, proximity to educational institutions and violations indicate problems with licensing and inspection procedures. Hookah premises without open spaces render detection of cigarette smoking impossible. There is a need to revise the methods of enforcement.