"The biggest surprise was the misconception about the dangers of hookah smoking," said principal investigator for the study Jaime Corvin, assistant professor in the University of South Florida (USF).

"In general, the students we surveyed thought it was safer than cigarette smoking. They did not know the risks," Corvin added.

The researchers interviewed 478 undergraduate and graduate students at USF to evaluate their lifetime and current hookah use.

More than half of the students surveyed (54.4 percent) reported using hookah at some point in their lives.

While more than half of the participants perceived hookah to be a safer alternative than cigarette smoking, 13 percent thought hookah was not harmful at all.

Regardless of their perception of harmfulness, 30 percent of those who never smoked hookah reported they would consider smoking it in the future.

The research suggests that future public health campaigns should address misunderstandings about the risks associated with hookah use as well as the regulation of such alternative nicotine-delivery devices.

Hookah smoking which delivers nicotine and can be just as addictive as cigarettes has been linked to lung, stomach and oral cancers, reduced lung function, decreased fertility and heart disease.

"The World Health Organization (WHO) estimates that one 45-minute session of smoking hookah is equivalent to smoking 100 cigarettes," Corvin said.

The study appeared in the journal Preventing Chronic Disease.

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