While cigarette smoking is decreasing in popularity and fewer teens are puffing, hookah smoking is on the rise, according to a report by the Centers for Disease Control and Prevention.

Hookahs, also called water pipes, originated in the Middle East and India centuries ago, but have recently spread west. A hookah consists of a large vase that is filled with water. Charcoal at the top of the pipe heats flavored tobacco that cools as it passes through water. The smoke is inhaled through a long hose.

Many people—especially teenagers and college students—believe the water filters harmful toxins out of the tobacco before it’s inhaled, making it safer than cigarettes. Tobacco used in hookahs comes in flavors like mint, strawberry, cherry, grape and coffee, which can mask the harsh taste of a cigarette and appeal to young people.

But is smoking a hookah actually safe?

"Smoking a hookah is just as risky — if not more — as smoking cigarettes because you’re still inhaling harmful toxins and nicotine," said Chelsea DiDonato Vilello, D.O., a family medicine doctor at Geisinger Mt. Pleasant. "You’re also inhaling more smoke in a hookah session than if you were to smoke one cigarette."

A typical hookah session lasts about an hour, while smoking one cigarette takes just a few minutes. During a hookah session, a person can inhale up to about 200 puffs of smoke, while a cigarette smoker usually takes just 20 puffs.

Typically, one hookah is shared by a small group of people. However, the average smoker may still inhale more smoke than a cigarette.

In addition to being exposed to more smoke, hookah smokers are also inhaling more toxic chemicals. The charcoal that heats the flavored tobacco contains higher levels of dangerous chemicals, metals and carbon monoxide. Some smoke from the charcoal is also inhaled when using a hookah.

Secondhand smoke from hookahs is also unsafe for others, because of smoke from the tobacco and the charcoal.

Smoking a hookah can put you at risk of becoming addicted to nicotine just like cigarettes. It can also put you at risk for the same diseases that cigarettes are known to cause, such as oral cancer, lung cancer, esophageal cancer, stomach cancer and reduced lung functionality.

Additionally, smoking a hookah is associated with periodontal disease, respiratory disease and low birth weight.

"Smoking a hookah might seem like a harmless social activity, but it’s important to understand how bad for people it really is," said Dr. DiDonato Vilello. "People—especially teenagers—should be educated about the risks, just as they are educated about the dangers of smoking cigarettes or using chewing tobacco."