Almost 1 in 5 senior high school students in the US report using hookahs to smoke tobacco in the past year, according to a new study published in the American Journal of Preventive Medicine.

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Researchers found almost 20% of senior high school students reported hookah use in the past year.

What is more, more than a third of these students say they use hookahs frequently enough to be deemed regular users.

According to study leader Dr. Brian A. Primack, of the Center for Research on Media, Technology and Health at the University of Pittsburgh, PA, and colleagues, their research provides further evidence that hookah use among teenagers is on the rise in the US.

“Hookah smoking does not seem to be just a fad; it seems to be a practice that is increasing steadily over time nationwide,” says Dr. Primack. “And, among hookah smokers, it’s not just something they do once and that’s it. A substantial and increasing proportion of people, particularly adolescents, seems to be smoking hookahs with enough regularity to create a significant public health concern.”

Hookahs, also referred to as water pipes, narghile or shisha, are devices used to smoke flavored tobacco. While popular belief holds that hookah smoking is less harmful than cigarette smoking, research has found it poses similar risks to health, linking it to conditions such as cardiovascular disease and lung and oral cancers.

Hookah smoke contains many of the same toxic chemicals as cigarette smoke – such as tar, nicotine, carbon monoxide and polycyclic aromatic hydrocarbons – and due to the way hookahs are used, smokers may also inhale more of these toxic chemicals than cigarette smokers.

According to the Centers for Disease Control and Prevention (CDC), hookah users inhale around 90,000 milliliters (ml) of smoke per session, while cigarette smokers inhale around 500-600 ml per cigarette.

Last year, a study reported by Medical News Today found hookah use increases uptake of a substance called benzene, which is associated with greater risk of leukemia.

To gain a better understanding of how widespread hookah use is among adolescents in the US, Dr. Primack and colleagues analyzed data from the University of Michigan’s Monitoring the Future study, which includes a nationally representative sample of students from public and private school across 48 US states.

The team identified 8,737 high school seniors who were surveyed about hookah use between 2010 and 2013. They were asked how often they had smoked tobacco using a hookah over the past 12 months and whether they engaged in cigarette smoking.

The researchers found that 19% of the surveyed students reported using a hookah at least once over the past year, with 38% of these reporting using the devices at least six times – a frequency the researchers consider as “sustained use” because the inhalation of tar is the equivalent to smoking a least one pack of cigarettes monthly.

Of the students who reported using a hookah at least once in the past 12 months, 54% said they did not currently use cigarettes. According to the researchers, this suggests adolescents may be turning to alternative ways to smoke tobacco.

Dr. Primack adds:

“If we want to counteract this potentially problematic trend, tobacco prevention and intervention efforts must also address hookah use, and we must continue to collect data specific to hookah use.”

Contrary to the findings of this latest study, MNT reported on a study published in JAMA Pediatrics last year, in which researchers found young hookah users are more likely to engage in cigarette smoking.