New research suggests that people who smoke hookah are at an increased risk of smoking cigarettes two years later.

Researchers from Dartmouth College and the University of Pittsburgh found that smoking water pipe tobacco increased the probability of trying cigarette smoking over the next two years by 19 percent.

For the study, researchers collected data from more than 2,000 individuals between the ages of 15 and 23. They followed these participants for two years, and demonstrated that hookah smoking, which commonly begins as a social custom, and snus use are associated with later cigarette use.

Specifically, hookah smoking and snus use among non-cigarette smoking adolescents and young adults were longitudinally associated with subsequent cigarette smoking including initiation of cigarette smoking, cigarette smoking in the past month, and high-intensity cigarette smoking. Snus is a smokeless tobacco product that originated in Sweden and has become popular among young men living in the rural United States.

Manufacturers of both snus and shisha -- the tobaccos smoked in hookahs -- increase the appeal of their products by adding appetizing flavors and marketing them in social media. Mass media marketing of cigarette products has been banned in the United States since 1971 when the Public Health Smoking Act of 1969 went into effect.

Researchers also found that the volume of carcinogen-containing smoke inhaled by a hookah smoker is 100 times that of a smoker smoking a single cigarette.

Looking forward, Soneji encourages comprehensive Food and Drug Administration regulation of all tobacco products to restrict manufacturers' ability to flavor, package, and market their non-cigarette tobacco products in ways designed specifically to appeal to adolescents and young adults. Doing so may curb the onset of cigarette smoking.

The findings are detailed in the journal JAMA Pediatrics.