Despite the decrease in cigarette use, the popularity of hookah seems to be growing across the nation, especially among teenagers and college students. The hookah, which is also known as the water pipe, allows users to inhale cool, flavored tobacco, and is a trend that seems to be here to stay.

Dr. Wael Al-Delaimy, who was the senior author of a study on the issue based out of San Diego, said the rate at which hookah is gaining popularity “is rather alarming as an emerging public health problem. Our data show that inaccurate perception about hookah harmfulness, its social acceptability, and presence of hookah lounges in residential areas, is driving the higher use among the teens in our study”.

In fact, more than 1/4 of high school students have tried hookah, and 1/3 of them have no intention of quitting the habit. Al-Delaimy claims that studying teen use of hookah is important because a person’s tobacco habits are usually set in place by the time they’re 18 years old.

A study released on Tuesday by the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina that reviewed the use of hookah among college students showed that many young people were misinformed about the dangers of hookah, falsely believing that it’s safer than cigarettes. The facts are though, that hookah tobacco does contain the same harmful ingredients found in cigarettes, including tar, metals, cancer-causing chemicals, and carbon monoxide.