Waterpipe, narghile, arghila, qalyān, shisha-- all these refer to Hookah, a single or multi-stemmed instrument for vaporizing and smoking flavored tobacco called shisha. In recent years Hookah smoking has been a popular activity among college students due to its flavor, smell and sweet taste; as well as it has also been used as a tool for socialization. A new study, however, reveals that Hookah smoking may eventually increase the risk of cigarette smoking in adolescents.

In a study conducted by a team of researchers from Dartmouth College and University of Pittsburgh, it was found that teens who had smoked water pipe tobacco but not smoked cigarettes were at increased risk of cigarette smoking after two years.

The study involved 2,541 young adults aged 15 to 23 years old who were followed for a period of two years.

"We found hookah smoking increased the probability of trying cigarette smoking over the next two years by 19 per cent," according to Samir Soneji, PhD, a tobacco regulatory control researcher at Dartmouth and lead author of the study.

Part of the study involved analyzing data on nearly 1,050 non-smokers of the age group 15 to 23. Of those, roughly 7 per cent had used hookahs.

After two years, 39 per cent of those who had smoked hookahs had also started smoking cigarettes, compared with about 20 per cent of those who had not used the device, the study found.

The findings were published in a recent edition of the journal JAMA Pediatrics.

Hookah has been appealing especially to the younger generations because of its seemingly more harmless nature compared to tobacco smoking as well as its overall packaging.

"The wide variety of flavors, low prices, and appealing packaging of these products attract young people, which as this study indicates can lead to cigarette smoking," said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

The researchers suggests the Food and Drug Administration restrict adding flavor to all tobacco products as well as the marketing tactics that are used to make them sound more appealing to adolescents and young adults, which the team could help cut down the rate of cigarette smoking in the country.

Some studies found that one hookah session can be the equivalent of smoking from 10 to 40 cigarettes, and it is much more dangerous that cigarette smoking.

In a report published by the American Lung Association (ALA), Dr. Richard Hurt of the Mayo Clinic attributed such comparison to the long duration of a hookah session.

"When you smoke a cigarette, a person smokes it maybe for just a few minutes and then you're through with it. But hookah sessions are social and people sit there for an hour or so kind of puffing on these things, thinking that the water is filtering out all the bad stuff, when the reality is it does not do that," Hurt said.

ALA also said that a study funded by the National Institutes of Health reported a single hookah session could deliver 1.7 times the nicotine, 6.5 times the carbon monoxide and 46.4 times the tar of a single cigarette.