Currently, a number of studies identify waterpipe tobacco smoking, most commonly known as hookah, as an emerging trend among college students in the United States. However, the substance abuse field lacks evidence about the factors associated with the spread of waterpipe smoking in this population, such as perception of harm and commercial availability and use. In response to the lack of research, researchers Sutfin, E.L., et al. at Wake Forest Baptist Medical Center conducted one of the first studies investigating the prevalence of waterpipe tobacco smoke use among a large, multi-institution sample of college students. The study found that waterpipe smoking is nearly as popular with college students as cigarettes, particularly at institutions with nearby waterpipe smoking venues and among freshmen.