Objectives: To assess hookah use among youth for prevalence, associations, and changes over time. Methods: Data from the 2008 and 2010 New Jersey Youth Tobacco Survey were analyzed to examine hookah smoking by gender, race/ethnicity, and grade level. Results: Prevalence of hookah use increased significantly among black and Hispanic students. Frequency of use was generally occasional. In multivariate models, Asian race; Hispanic ethnicity; and concurrent use of cigarettes, cigars, and bidis predicted current hookah smoking. Conclusions: Prevalence of hookah use is rising among New Jersey's youth, particularly among minority populations, representing a growing public health concern.