When Srijana Bajracharya, professor of health promotion and physical education, was a child in Nepal, she saw her uncle light up his hookah every day after work. When he died at age 49 from lung cancer, he had never touched a cigarette.

“People are pretty conscious not to start [smoking cigarettes],” she said. “If they knew that hookah has the same effect then probably they would be more cautious,” she said.

While the amount of cigarette smokers in America has decreased by nearly half in the past three decades, according to the World Health Organization, hookah is a trend that has become popular with young adults.

Hookah bars offering flavored tobacco have been popping up in college towns — like Rochester-based Look-Ah-Hookah, which opened a location in Ithaca in June.

Despite its pleasant taste and relaxing nature, hookah holds more dangers than students are aware of.

The health risks of smoking hookah lie in the method of how people use it as a social activity. There is a greater opportunity for chemical intake, because cigarette smokers do not continuously smoke tobacco in the same way as hookah smokers.

According to a December 2009 article published in the Journal of Preventative Medicine, a typical session of smoking hookah, in relation to smoking one cigarette, delivers greater carbon monoxide levels, similar nicotine amounts and “dramatically more smoke exposure.” Participants in the study smoked hookah for a maximum of 45 minutes, the normal session length, or a single cigarette. After each session, toxin levels in each person were measured.

Water pipes, or hookahs, are devices that have been used for centuries in Eastern Mediterranean areas to smoke tobacco. Smokers place a paste-like mixture called shisha of 30 percent tobacco and 70 percent honey, molasses or fruit pulp into a bowl that  is then heated by charcoal and cooled by passing through a water chamber.

Because the cooling process makes the smoke thicker and smoother, hookah smoke produces roughly 100 times more tar than cigarettes for each gram of tobacco, according to an article published in the March 2008 issue of the Harvard Mental Health Letter. In the study, researchers used a smoking machine that simulated smoking hookah and measured chemical levels in the smoke.

Junior Julianna Durr, who smokes cigarettes, has been smoking hookah about once a week for two years. She said she likes hookah for its social aspect, as it provides a calm atmosphere that both brings people together.

“I met a lot of my good friends through hookah outside the dorms my freshman year,” she said. “These are people who I would have usually walked by in passing without saying two words to them. [Hookah] was definitely how I bonded with them.”

Matthew Taylor, assistant manager of Look-ah-Hookah, said the company chose Ithaca for a new location because there are so many students.

“There already seems to be kind of a hookah culture developed here, and we want to take that out of houses and bring that more into a bar environment,” he said.

Bajracharya said the mystical, foreign idea of hookah is a business tactic hookah bar owners use to downplay the truth that it is still tobacco.

“It is a new way to entice people,” she said. “They’re telling people, ‘It’s not cigarettes. It’s something else,’ so they can easily draw people’s attention because it’s different.”

Zachary Anderson ’08, a frequent hookah smoker and former manager of Look-ah-hookah, said it’s understandable that people think such businesses entice young people into smoking, because many shisha flavors, such as Code 69, which is meant to taste like sangria, or mojito, appeal to younger tastes. Despite the flavors, he said students shouldn’t be surprised to hear hookah carries serious health risks.

“It’s an addictive substance … they should know it’s still tobacco,” he said.

A study from the journal Tobacco Induced Diseases, published in December 2009, surveyed 235 hookah users in San Diego, Calif., hookah bars and found 58 percent of people believed hookah was less harmful than cigarettes, versus 31 percent who believed it was more harmful and 11 percent who thought it carried the same risk.

For Bajracharya, cigarette and hookah use are synonymous, because people in Nepal smoke hookah in the same, addictive way Americans smoke cigarettes. She said she was confused to see students in America, a society that is educated on the risks of tobacco, using hookah as a social activity.

“On one hand, tobacco use is [perceived] as crazy, yet hookah is getting out there,” she said.

Sophomore Elijah Kagan said his generation has been bombarded by anti-cigarette ad campaigns, yet the hazards of hookah are not often mentioned.

“You’re not going through health class being taught the dangers of smoking hookah — it’s the dangers of smoking cigarettes,” he said. “When you get to college and you see people smoking hookah, it’s a social thing. You’re having a good time. You don’t really have a care in the world, and you’re like, ‘Oh, this isn’t a cigarette, therefore it’s not as dangerous for me.’”

Erica Weiss, who has been a nurse at the Hammond Health Center for nine years, said the center offers pamphlets on the risks of hookah. Weiss said the fact that the pamphlets disappear so quickly suggests there is a misconception among students that hookah is less harmful than cigarettes.

“The fallacy is in the water,” she said. “People think it’s a filter, but it’s not really filtering, so people are smoking for 45 minutes, taking turns, and they’re inhaling deeper, so the amount they’re getting is more than with cigarette use. That in itself amplifies the amount that you’re getting.”

Sophomore Andrew Fischer said while statistics prove hookah is more harmful than cigarettes, he believes most people don’t become dependent on hookah because they don’t smoke it the same as cigarettes.

“You don’t seem to see people that are addicted to hookah,” he said. “I view it more as like people that smoke the occasional cigar. It’s as bad as chowing down on Mickey D’s once in a while. Yeah, it’s still not good for you, but if it’s once in a while, the long-term effects probably wont be there.”

Maura Flanagan ’10, the manager of Exscape, a head shop on The Commons, said while the health statistics are alarming, occasional hookah use should be viewed in the same light as any social activity.

“Obviously, there’s a level of the hookah bars’ responsibility because they’re delivering a drug,” she said. “But at the same time, there’s no one at a bar door saying to you, ‘Alcohol is bad for you,’ and no one’s up in arms about that.”