National data indicate nearly a quarter of college students smoked from a hookah at some point in their lifetime regardless of gender. To address this issue, researchers assessed the perceptions, knowledge, beliefs of hookah users at a large Midwestern University and also determined what other drug related high-risk behaviors were associated with this behavior. An anonymous, online survey was sent to 2,000 randomly selected undergraduate students from a large Midwestern University. Researchers used a cross sectional research design to determine the prevalence and motivating factors associated with hookah use. Respondents included 438 individuals (60% female) with an average age of 23.1 (SD = 12.32), yielding a response rate of 22%. Approximately 15.4% of the sample had previously smoked hookah, while 6% used hookah within the past 30 days. Common motivating factors associated with smoking hookah included socializing/partying (29%), peer influence (27%), and for relaxation (25%). Correlations were calculated comparing hookah use to other high risk behaviors with the two highest correlations consisted of 30-day tobacco use (r = 0.67) and marijuana (r = 0.39). The results from this study suggest hookah use is limited to a small percentage of students. Students appear to smoke hookah for social reasons and underestimate the addictive properties associated with the product. Researchers and practitioners need to develop and evaluate specific interventions to educate college students about the health hazards associated with hookah use.