According to the University of Michigan's Monitoring the Future survey the number of high school seniors smoking through a hookah has risen more than 20% in the last year.
Hookah smoking dates back hundreds of years, but this ancient Persian tradition has now become popular among young Americans. It's sometimes referred to as a shisha or water pipe and smoked in social settings.
The tobacco on the top is heated by a charcoal. The user then inhales the smoke through its long pipe.
Nayef Alshubaki is the owner of Al Ryan, a Mediterranean restaurant and hookah lounge here in Lynchburg. He says over the years he's noticed an increase in demand for hookah.
"We serve it outside not inside the restaurant. We check their ID's to make sure they are not underage," said Alshubaki.
A national survey just released by Monitoring the Future found 18% of high school students admitted to smoking a hookah in the past year.
For those who believe the practice is a healthier alternative, experts say that is simply not true.
"All the carcinogens and all the disease causing aspects of cigarette smoking is still in the tobacco you use in a hookah pipe," said Lynchburg Pulmonary Physician Dr. Michael Milam.
Dr. Michael Milam also says hookah can be just as addictive as traditional cigarettes. "The younger they start the more likely they are to be addicted and to form life long habits," said Milam.
The study surveyed more than 5,000 high schoolers across the country from 2010-2012. It also found hookah use was most common in teens from a higher socioeconomic status.