More teens are putting down the cigarettes, but they're picking up another kind of tobacco.
Hookah is a water pipe used to smoke flavored tobacco.
18 percent of high school seniors say they've used a hookah.
Many think hookahs are less dangerous than smoking. But experts say it's not true.
"It is a new niche as cigarette use has decreased," study co-author Dr. Michael Weitzman, a professor of pediatrics and environmental medicine at NYU, told CBS News. While cigarette use among teenagers in the U.S. has decreased by 33 percent in the last decade, hookah use has increased by 123 percent during the same period, he said.
The effects are actually a little more dangerous than cigarettes.
The Columbus Dispatch reports levels of cotinine, a metabolite of nicotine, are 150 to 300 percent higher after a session of smoking from a hookah than smoking a cigarette, according to some studies.
Researchers at New York University found students from higher socioeconomic households are more likely to smoke hookah, as are students who've previously smoked cigarettes or marijuana.
Hookah, also called shisha, is an ancient method of smoking, long popular in the Middle East, in which charcoal-heated tobacco-based or "herbal" non-tobacco-based smoke is passed through water before inhalation. Part of the appeal of hookah lies in the ritualistic way of using it, the researchers said.
The product is often flavored, and it does not tend to leave a tobacco smoke smell, which makes it more appealing to teens. "Young people are certainly attracted to things that have a sweet flavor," Dr. Harold J. Farber, pediatric pulmonologist at Texas Children's Hospital and Baylor College of Medicine, who was not involved in the study, told CBS News.
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