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A new study on hookah usage in high school students revealed that the alternative tobacco product is on the rise, according to Medical News Today.

Hookahs are devices used to smoke flavored tobacco from a water pipe. According to the Centers for Disease Control and Prevention (CDC), many users believe hookahs to be less harmful than conventional cigarettes, but previous research has shown that they are not as safe as commonly thought, as hookahs do expose users to carcinogens.

In a new study published in Pediatrics, researchers sought to measure the popularity of hookah among American teenagers by analyzing data from an ongoing study that looks at the values, behaviors and attitudes of about 15,000 American high school students. Of the 5,540 participants who were questioned about their hookah use between 2010 and 2012, one in five said they had smoked hookah in the past 12 months.

Researchers also found that hookah use was more common among students of higher socioeconomic status.

"Surprisingly, students with more educated parents or higher personal income are at high risk for use," said researcher Joseph Palamar, an assistant professor of population health at New York University Langone Medical Center. "We also found that hookah use is more common in cities, especially big cities. So hookah use is much different from cigarette use, which is more common in non-urban areas."

Additionally, data showed that students who had smoked cigarettes and those who had ever used alcohol, marijuana and other illegal substances, were more likely to use hookahs.

Researchers noted their findings are worrisome, as evidence suggests hookah use is more damaging to health than cigarettes.  Unlike cigarettes, use of hookahs tends to be more “ritualistic,” but researchers are concerned the introduction of hookah pens may “normalize” use to everyday settings, especially among adolescents.

"These nifty little devices are likely to attract curious consumers, possibly even non-cigarette smokers,” Palamar said. "And unlike cigarettes, hookahs come in a variety of flavors and are less likely to leave users smelling like cigarette smoke after use. This may allow some users to better conceal their use from their parents or peers."

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