Purpose: The purpose of this cross-sectional study was to examine waterpipe smoking and beliefs about waterpipe smoking in a sample of college students from a public university in Virginia. Data sources: A web-based survey was sent to 1000 undergraduate students recruiting them to participate in the study. Measures from the investigator-developed Theory of Reasoned Action (TRA) Waterpipe Questionnaire were used to capture belief-based components of the TRA related to waterpipe use. Descriptive statistics were used to examine the prevalence of waterpipe smoking and beliefs associated with waterpipe smoking. Conclusions: Of the sample (n = 223), 71% of males and 52% of females reporting ever smoking tobacco using a waterpipe and 22% of males and 5% of females reporting current waterpipe smoking. Of the sample, 28% of males and 10% of females were current cigarette smokers and 25% of males and 10% of females were current marijuana users. Common beliefs associated with waterpipe smoking are also presented. Implications for practice: Nurse practitioners working with college students need to be aware of the multiple forms of tobacco that students may engage in. They also should be aware of the common beliefs about waterpipe smoking. This information is useful when targeting and counseling patients about alternative tobacco products like waterpipe smoking. © 2012 The Author(s) Journal compilation © 2012 American Association of Nurse Practitioners.