While cigarette use is on the decline among US youth, an alarming number of high school students are turning to hookahs, cigars and smokeless tobacco products, researchers warned.
According to a recent report from the Centers for Disease Control and Prevention (CDC), the annual prevalence of hookah use was nearly one in five high school seniors.
"What we find most interesting is that students of higher socio-economic status appear to be more likely to use hookah," said Joseph J. Palamar, an assistant professor of population health at New York University's Langone Medical Center (NYULMC).
Surprisingly, students with more educated parents or higher personal income were at high risk for use.
"We also found that hookah use is more common in cities, especially big cities," added Palamar, who is also affiliated with New York University's Centre for Drug Use and HIV Research (CDUHR).
This study examined data from the 5,540 students who were asked about Hookah use from 2010-2012.
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The study used data from 130 public and private schools throughout 48 states in the US.
Hookah is rapidly gaining popularity among adolescents in the US.
The researchers found those students who smoked cigarettes and those who had ever used alcohol, marijuana or other illicit substances were more likely to use hookah.
"The use of alternative tobacco products such as hookahs has increased an alarming 123 percent in the US," informed study co-author Michael Weitzman, a professor at the NYULMC.
Times are beginning to change.
"Now, something called hookah pens, which are similar to e-cigarettes, are gaining popularity. This new delivery method might normalise hookah use in everyday settings and bring use to a whole new level," Palamar cautioned.
The study appeared in the journal Pediatrics.