Public health agencies across North America largely focus on cigarette smoking when trying to convince people that tobacco is bad for them, but new studies show that hookah smoking plays a larger role in casual smoking habits than you might think.

The studies, which were recently published as part of a dissertation completed at the University of Buffalo, examined hookah smoking habits among New Jersey high school students as well as college students in Western and Central New York.

The high school study found that since 2008, there has been an increase in the number of teens who have used a hookah, who currently use it, and those who smoke it frequently.

Meanwhile, the overall number of people who have used a hookah has increased significantly, from 18 percent in 2008 to 23.6 percent in 2014.

In 2014, the number of people who had smoked a hookah in the last 30 days was actually higher than any other tobacco product, including both cigarettes and e-cigarettes.

When researchers looked into the popularity of hookah smoking among teens, they found a number of possibilities. Hookah tobacco is taxed at a much lower rate. It comes in fun, fruity flavours that aren’t allowed for cigarettes. And there seems to be a perception that it’s healthier than cigarettes and that it doesn’t contain nicotine. But neither of those assumptions are true, according to the CDC.

With regards to college students, the study showed that half of students who don’t smoke cigarettes started using nicotine products with hookah, which shows that there might be an increasing market for non-traditional tobacco products.

Either way, public health officials have their work cut out for them.