In one county in northeastern Ohio, high school students are smoking tobacco products at the same rate as adults, Science Daily reports. In 2013, more than 22%, or one in five high school students in Cuyahoga County, reported use of any tobacco product in the past 30 days, according to data from Case Western Reserve University. What's also surprising is the type of tobacco high school students there are using; cigars and hookahs, or water pipes, are more popular than cigarettes, matching a national trend. More students report cigar use at 15.1% than any other tobacco product. The second most common choice is hookah at 10.6%, which exceeds 10.4% for cigarettes - a first since the researchers began surveying county youth more than 10 years ago. And, more often than not, kids are using multiple tobacco products, smoking both cigarettes and cigars. "When we think about smoking, we mostly think about cigarettes because that is what most adults use," said Erika Trapl, PhD, associate director of the Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University. "But our data show that it's other tobacco products, like flavored little cigars, that are luring kids into a potential lifetime of tobacco addiction. The rates are high across the county and it is a serious concern." The survey data show cigars aren't an urban problem. Across the county, use is higher in eastern suburbs at 22% and 17% in western suburbs - significantly more than cigarette and hookah use. The inner ring suburbs on the east side of the county showed higher cigar use and the inner ring suburbs on the west side were the opposite, with higher cigarette and hookah use. In addition to increased cigar use, the data show the emergence of hookah use, a water pipe, often smoked with flavored tobacco. Of the tobacco products surveyed, it saw the largest increase in usage from 2011 to 2013. "A possible contributing factor to the rise in non-cigarette smoking may be the exclusion of cigar and hookah products from the Food & Drug Administration's Center for Tobacco Products," said Trapl. "Unlike cigarettes, the products don't require ingredient reporting; the nicotine levels, carcinogens and chemical additive levels are unknown." The FDA recently proposed a new rule to extend their regulatory authority to cover alternative tobacco products, including e-cigarettes, cigars, pipe tobacco, and hookah tobacco.