Hookah smoking is growing in popularity among college-age students in the United States. Community-based, semistructured, in-depth interviews were conducted with 20 college-age individuals who had used a hookah to smoke tobacco. A structured analysis of responses was conducted and framed in terms of the health belief model's four main constructs. Although hookah smokers were aware of the potential severity of tobacco-related illnesses, they did not express a perceived susceptibility to those illnesses. To the extent that cues to action exist with respect to hookah smoking, they generally serve to promote a risky behavior that is perceived to be largely social in nature. Copyright © Taylor & Francis Group, LLC.