Background: Water pipe tobacco smoking has similar health risks as other forms of tobacco use, such as increased risk of cardiovascular disease and lung cancer, decreased pulmonary function, as well as various other oral diseases. Because there are perceptions among young people that its health effects are less harmful, its use in this group is reportedly high, though its prevalence is not known. This study purposed to determine the prevalence and perceptions of water pipe smoking amongst Technical and Vocational Education and Training (TVET) college students in Johannesburg, South Africa.Methods: A cross-sectional quantitative survey was conducted among the students. Using the STATA statistical software, bivariate analysis was used to calculate the prevalence of water pipe smoking, and the chi square test was used to explore associations between socio-demographic variables and water pipe smoking. The quantitative questions on perceptions were analysed using summary statistics.Results: A total of 479 TVET students, 57.8% females and 42.2% males, with a mean age of 22 participated in the study. The prevalence of water pipe smoking was 61.6%, with more males compared to female students (70.8% vs 54.9%) using the pipe. More than half (62.2%) have a false perception regarding the health risks of water pipe smoking.Conclusion: There is a high prevalence of water pipe smoking and false perceptions about the health risks of water pipe smoking amongst TVET college students. Thus, the current Tobacco policy should be amended to include the regulation of water pipe smoking as well as increased health education about the dangers of smoking water pipe.