As many as 10 million people will die annually by the year 2030 due to tobacco-related causes. While much research has focused on cigarettes, the increasing popularity of smoking hookah (water pipe) has received much less attention. Epidemiological studies have been carried out in India, Pakistan, Syria, Kuwait, and Lebanon, but there are few in the United States. Hookah smoking is typically a social activity and there are many myths and rumors about the relative safety of smoking hookah compared to cigarettes. The aim of this study was to identify the knowledge, attitudes, and practices of hookah smokers in the San Francisco Bay Area. We sampled 50 participants (25 male and 25 female) who were mostly college students at the University of California, Berkeley. Hookah smoking was occasional among those sampled, with only six participants (12%) reporting weekly hookah smoking. The majority of respondents considered hookah smoking to be harmful to their health (88%), yet 52% had no intention of quitting. More definitive studies conveying the possible harm of hookah smoking are necessary to serve as a basis for health education programs and policy changes towards this potentially harmful activity.