Josephine Theodore celebrated her 21st birthday this past Saturday at Tracks Cafe in Brooklyn.

Theodore, a Borough of Manhattan Community college student who styles her hair on the side, invited some of her close friends to the hookah lounge. Music bumping, sipping on a patron margarita, she inhaled the pineapple-flavored fumes through her chest and exhaled through her nose. The scene was captured in a 15-second video she later posted on Instagram.

"When turning up, I love smoking hookah; it enhances my drunkenness and makes me feel lightheaded, spacey even," said Theodore, a regular hookah smoker. "I definitely prefer it over nasty-a** cigarettes."

Theodore is one of many people in their early 20s who smoke hookah, believing it’s a healthy alternative to a cigarette, but recent research shows that it can be just as detrimental to health.

"I smoke hookah about five times a month, when I step out," Theodore said. "Cancer is the furthest thing from my mind when I take a pull of hookah smoke."

The Centers for Disease Control and Prevention (CDC) reported that sheesha, an ingredient used in Hookah contents, produces smoke that can lead to similar respiratory complications and diseases as those caused by cigarette smoking. Hookah smokers inhale more than cigarette smokers, exposing them to more nicotine, the center’s fact sheet for hookah says. The charcoal used to light the hookah also produces high carbon monoxide levels.

"The most common type of cancer that my patients are diagnosed with are lung or throat cancer. This cancer is often caused by smoking cigarettes or hookah," said Razia Jayman, a primary care doctor at Forest Hills Hospital. "It's important that people are more aware of the medical consequences of the things they do."

Originated in the Middle East, hookah is a water pipe where the tobacco contents, called sheesha, are lit by charcoal, filtered through a chamber filled with water, and smoked through a tube and mouthpiece.

Hookah has the same addictive drug, nicotine, as cigarettes contain.

"It is uncommon that we get any clients that depend on hookah," said Tia Marianangeli, director of community relations at Realization Center, who has been there for 15 years now. The center promotes that they are a pioneer in providing the most effective treatment for those affected by addiction. "However, most of the 800-900 clients we have at the two locations deal with addiction to nicotine."

According to a study from a 2012 issue of CDC's Preventing Chronic Disease, hookah smoking has been linked to lung cancer, respiratory illness, low birth weight, and periodontal disease.

"On average, I smoke for about two hours per session," said Yulissa Vargas, another regular hookah user.

A report from the World Health Organization (WHO) stated that a typical one-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette.

The 22-year-old Hunter College student from Corona, Queens, who calls herself a hookah queen, travels to different hookah spots to taste the quality. She wrote in a review after visiting Xhale Hookah Lounge in Forest Hills Queens on Yelp two weeks ago: "5 stars baby! This just became the GO-TO hookah lounge!"

On a double date with her friend,and her boyfriend's cousin, Vargas, her party tried the green lantern and cherry lemonade-flavored hookahs at the lounge.

"We had our hookahs with ice hoses and it was just so smooth and flavorful," she said. "I was extremely happy with both flavors; our hookah burned all night, so it was great."

"Hookah is a fat cigarette in disguise," said Dr. Jayman. "Folks have to be careful."