There is a recent increase in hookah use (exclusively or in conjunction with cigarettes) among youth/young adults—a “growing threat to public health.” Increased use may be attributable to misperceptions about hookah's deleterious effects, its increasing availability and acceptability, and lack of regulations on hookah-related products and establishments, often located near college campuses. Unlike cigar and other tobacco products, hookah may be a “gateway” to cigarette smoking initiation—thus undoing decades of tobacco prevention and cessation efforts.