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While the use of cigarette use is declining among youth, evidences suggest American adolescents are turning to other ethnically-linked alternative tobacco products like hookahs and cigars, according to a recent report from Centers for Disease Control and Prevention. 

Now a new study, using data from Monitoring the Future (MTF) has found that the annual prevalence of hookah use was nearly 1 in 5 high school seniors. MTF is a nation-wide ongoing annual study of the behaviors, attitudes and values of American secondary school students. The MTF survey is administered in more than 100 public and private school throughout 48 states in the U.S.. The study considered around 5,500 students with modal age 18. 

"What we find most interesting is that students of higher socioeconomic status appear to be more likely to use hookah," said Joseph J. Palamar, PhD, MPH, a CDUHR affiliated researcher and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC), in the press release. "Surprisingly, students with more educated parents or higher personal income are at high risk for use. 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."

The research further found that those students who smoked cigarettes and those who had ever used alcohol, marijuana or other illicit substances were more likely to use hookah.

"Tobacco use and exposure to secondhand smoke are the leading preventable causes of morbidity and mortality in the US," said a study co-author Michael Weitzman, MD, a professor of Pediatrics and of Environmental Medicine at the NYULMC, in the press release. "Cigarette use has decreased by 33% in the past decade in the US, while the use of alternative tobacco products such as hookahs has increased an alarming 123%. This is especially worrisome given the public misperception that hookahs are a safe alternative to cigarettes whereas evidence suggests that they are even more damaging to health than are cigarettes."

The study has been published in the August 2014 edition of Pediatrics.