Hookahs have been around for centuries, but they've never been more popular than now in KELOLAND. Rapid City has two lounges that allow customers to use the water pipes for smoking tobacco.
But what exactly is a hookah, and how do the health risks compare to cigarettes and cigars?
It's not something many people associate with South Dakota, but hookahs have become a common item in Rapid City.
"I'd go to different house parties, for example, and see hookahs more and more. So it's just becoming more appealing," Sahara Nights co-owner Spencer Seljeskog said.
That's why the 21-year-old college student decided to open up Sahara Nights in Rapid City.
"It's more of a lounge. We're all couches so it's just very relaxing, very inviting. People can come and congregate for an hour, two hours comfortably," Seljeskog said.
"It's a nice place to hang out, hang with friends, and of course, smoke some hookah. I think that's the best part," 18-year-old hookah smoker Kalei Lyons said.
Hookahs are used to smoke a mixture of tobacco and flavored molasses called shisha. The bowl containing the shisha is wrapped in perforated tin foil before red-hot coals are placed on top.
The coals heat the tobacco mixture, allowing the smoker to draw big puffs from the hose.
"You do get a buzz off it, but it's not harsh like cigarettes. It's almost a social event for me," 20-year-old hookah smoker Tyler Vogel said.
"It makes me feel relaxed. I would just sit back and relax with my friends, listen to music," Lyons said.
Lyons says she doesn't smoke cigarettes because of the health hazards. But that's not a concern she has about smoking hookah.
"They're safe, I guess, you could say. Really can't kill yourself from it," Lyons said.
But according to the World Health Organization, smoking hookah may actually be more hazardous to your health than cigarettes.
"The people that use a hookah or water pipe are inhaling the smoke of the fuel, which is often charcoal. So they're getting both the toxins from the tobacco smoke and also the toxins from the fuel," family physician Dr. Allen Nord said.
It's a dangerous combination that many hookah smokers don't consider. And that's not the only aspect of these pipes that concern health officials.
"They inhale usually a very large amount of nicotine that's associated with this. Sometimes a session of smoking hookah can last for an hour, and that's like smoking an entire pack of cigarettes," Nord said.
"Is hookah good? No. But is it bad? I personally don't think it's nearly as bad as they convey it as," Seljeskog said.
Seljeskog says different testing techniques have yielded a wide array of results as to the harmfulness of smoking hookah. Even the World Health Organization acknowledges that more research on the health consequences is needed.
Regardless, Nord says enough is known about the hazards of smoking hookah that it's clearly not a good idea.
"I think it's just terribly important to understand that this is not a safe alternative to cigarettes or smoking a cigar. It's probably more dangerous," Nord said.
Like all other tobacco products, people as young as 18 can smoke in a hookah lounge, something that may be setting up many young smokers for long-term health problems.