Health risks of alternatives to unhealthy habits may be just as dangerous.

The anti-tobacco campaign has been widely regarded as successful by many. The number of cigarette smokers is down and tobacco sales have decreased nation-wide according to the Center for Disease Control, and more public places are prohibiting smoking due to second hand smoke.

As a result, new forms of smoking have been introduced, such as hookah, steam stones and hookah pens. But the health risks of alternatives may be just as dangerous as cigarettes.

“Compared to the urine samples collected after a week of not smoking, the urine sample collected after the evening of hookah smoking had ... two times higher levels of NNAL, a breakdown product of a tobacco-specific chemical called NNK, which can cause lung and pancreatic cancers; and 14 percent to 91 percent higher levels of breakdown products of volatile organic compounds such as benzene and acrolein, which are known to cause cancer, heart and lung diseases,” Healthday News reported.

Because of the way a hookah is used, smokers may absorb more of the toxic substances, also found in cigarettes, more than cigarette smokers. So while Americans are making an honest effort to be health conscious, they seem to be replacing it with an equally abusive substance.

A typical hour-long smoking session involves 200 puffs, while smoking a cigarette involves about 20. The CDC found that the amount of smoke inhaled during a typical hookah session is about 90,000 milliliters, compared to the 500 to 600 milliliters inhaled when smoking a cigarette.

The smoother smoke, pleasant aroma and taste likely cause users to inhale more deeply over a longer period. This results in inhaling a larger volume of tobacco smoke than cigarette smokers do.

Ellen Wells, a Purdue assistant professor of occupational health sciences, said one of the top 10 public achievements of the past century is the recognition of smoking hazards and reduction of smoking rates; hookah could be undoing the progress made.

“The limited research we have to date indicates that hookah use is as harmful, if not more harmful, than smoking cigarettes,” Wells said. “The increased use of hookah threatens to chip away at these significant and hard-won public health gains (such as) reductions in lung cancer, respiratory and low birth weight among newborns.”

The Center for Disease Control reports the charcoal used to heat the tobacco produces high levels of carbon monoxide, metals and carcinogens. Even after it has passed through water, the smoke from hookah still has high levels of the toxic agents.

Frank Rosenthal, a professor of occupational and environmental health sciences, recognizes many students falsely assume the smoke is safer after it passes through water. He said people are very conscious of the health effects of tobacco, but still want to smoke, so hookah appears to be an easy solution.

“The smoke that people breathe from a hookah pipe still contains a lot of nicotine and carcinogens,” said Rosenthal. “The hookah does not do a good job of removing these substances.”

Like cigarettes, the smoke from hookah can cause oral cancer, lung cancer, stomach cancer and esophageal cancer. In addition to these diseases, a recent study reported by Healthday News found a link between hookah and pancreatic cancer.

Hookah retailers also offer some sweetened and flavored non-tobacco products. However, the CDC found the studies of tobacco-based shisha and “herbal” shisha show smoke from both contain carbon monoxide and other toxic agents known to increase risks for smoking-related cancers and diseases.

“There’s a tendency for individuals to think that if a product is available in the marketplace, it must be safe; but this is not necessarily the case,” said Wells. “It could just be that the public health science/regulations have not yet caught up to the newest innovations.”