Contrary to cigarette smoking trends, hookah smoking is on the rise, and is now widely acceptable among various origins and cultures, with estimates ranging around 100 million hookah smokers worldwide, most of them adolescents. However, this phenomenon is not extensively researched, since until recent years it was perceived as marginal. The current study is based on a health-related cross-sectional survey conducted in Israel among young adults aged 21-44. A logistic regression model was used to identify socio-demographic and health-related factors that predicted hookah smoking. The current study included 1,976 interviewees, of which 884 (44.7%) Jews and 1,155 (55.3%) Arabs. The rate of hookah smoking in the sample was 9.5%, 3.5% among Jews and 14.4% among Arabs. The likelihood of being a hookah smoker (95% CI) was higher among Arabs (OR=5.09, p<.001), men (OR=3.46, p<.001), non-religious respondents (OR=1.68, p=.004), respondents with low education level (<12 years) (OR=1.81, p=.003), non-parents (OR=1.92, p<.001), respondents with poor mental health status (OR=1.56, p=.003) and those who did not comply with strict consumption of fruit and vegetables (OR=1.43, p=.012). This study has identi ied the pro ile of the individual with the highest likelihood of being a hookah smoker. These indings, along with the prevalence of hookah smoking among the young adult population in Israel, call for a need to promote a systematic approach. Based on such pro iling it is possible to build designated intervention programs, which will provide health education guidance as well as rehabilitation services. Such programs may contribute to the prevention and reduction of smoking in the young adult population and to improving their health.

Smoking tobacco is the second most common cause of death worldwide and is among the leading serious risk factors for disease. Among the forms of tobacco smoking, the two most common can be specifi ed: cigarette smoking and smoking through a hookah. Cigarette use is related to approximately 450,000 premature death cases in the US each year. Compared to the extensive knowledge regarding the damages caused by smoking cigarettes, scientifi c data on the damages of hookah smoking has accumulated only in recent years. The sources for fi nding articles were "Pubmed" and "Google scholar", using the search terms 'Water pipe tobacco', 'Hookah'and 'Nargileh', including results in English only. Hookah smoking has been linked to various types of cancer, respiratory diseases, coronary heart diseases, lung diseases, infertility problems, dental problems, etc. Nevertheless, Hookah smoking is on the rise, and is now the second most popular form of smoking in the United States. Due to this growing popularity, it seems that the health implications are pushed aside, in light of the following reasons-exposure to fl avored hookah, social nature of hookah smoking, the internet and the mass media, the unharmful perception of smoking hookah. There is an urgent need for developing policies targeted towards hookah smoking on multiple levels, including-raising public awareness through health education guidance and educational programs; legislation regarding public smoking prohibitions, warning labels, taxing regulations and production standards; eff ective and uncompromising enforcement.