A trend beginning centuries ago in Persia and India has college students blowing smoke. It’s called “smoking hookah,” or flavored tobacco, and it’s the new “in” trend for casual smoking.

A hookah is an oriental tobacco pipe with a long, flexible tube that draws the smoke through water contained in a bowl. Recently, hookah cafés have popped up all over the United States. In 2006, there were 300 hookah cafés in operation and that number is growing as hookah use increases in young adults.

So why the increase? For students like Brandon Westergaard, who smokes and owns his own hookah, it’s because it’s entertaining and it tastes good.

“I smoke hookah because it’s relaxing and a good way to socialize. I do it about two to three times a month at most, and usually with a group of four or five people my age (19-20),” said Westergaard, an engineering student at the School of Mines and Technology in Rapid City. “My favorite flavors are pumpkin pie and orange dreamsicle (a combination of orange and vanilla shisha).”

A 2011 study done by the American College Health Association surveying 1,165 SDSU students showed 23.1 percent of male and 14.1 percent of female students have smoked hookah in their lifetime, although not necessarily in the past 30 days of when they were surveyed.

The trend of smoking every once in a while includes more students than Westergaard.

“I do smoke hookah, and I own my own hookah because I got one from a friend. It is cheaper than going to a hookah bar,” said Brody Heid an SDSU freshman from Rapid City. He smokes once every three weeks, on average, with about eight people and prefers the watermelon and double apple flavors.

Even though it might not taste like a cigarette with its orange, watermelon and other fruity flavors, hookah still carries many of the same health risks as other forms of tobacco.

“The tobacco inhalation is quite concerning,” said Brenda Anderson, SDSU Student Health Clinic associate director and nurse practitioner. “Nicotine consumption (while smoking hookah) is more than a cigarette because people usually smoke hookah for about an hour and they [inhale] between 100 and 200 times more nicotine than cigarettes.”

Because students like Heid and Westergaard smoke hookah in groups, several different mouths touch the same hookah, facilitating the spread of germs.

“People are always getting sick, and when you are sharing something the risk of transmitting disease is much higher,” Anderson said.

Risks resulting from smoking hookah are the same as cigars or cigarettes, including oral cancer, lung cancer and stomach cancer, because it carries many of the same cancer-causing chemicals such as tar and heavy metals. It is also dangerous to non-smokers just as cigarette or cigar smoking is.

One student has declined the use of hookah after smoking it regularly resulted in pains in her chest.

“I used to [smoke hookah] more and I also used to own one. Now I just do it with other people usually anywhere from four to 20 people,” said Kaila Vetch, a freshman journalism student from Rapid City, S.D. “I don’t do it as much because it hurts my lungs when I do it a lot.”

According to the Center for Disease Control, the charcoal coals used to heat the shisha to smoke it increases the carbon monoxide intake, which could contribute to reduced fertility among smokers.

“I do not smoke hookah but I guess it’s better than doing illegal drugs,” said Anna Full, a senior biology and pre-med major from Marshall, Minn.

Anderson said she is not a fan of smoking, no matter the form, and wishes students would think about the consequences before joining a hookah circle.

“I hate to see people smoke in general. I encourage people to think about long-term implications and also think of the oral risks and [possible] infections,” said Anderson.