Smoking a hookah can be more harmful than cigarettes and can cause diseases like cancers much more easily, doctors say.According to Centres for Disease Control and Prevention (CDC), an hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs. 
In fact second-hand smoke from hookahs can also be a health risk for non-smokers. It contains smoke from the tobacco as well as smoke from the heat source used in the hookah," said Amar Singhal, Cardiologist at the Sri Balaji Action Medical Institute, New Delhi.
Since hookah involves inhaling a large amount of smoke in a short span of time, the damage done to the lungs is high and can cause wheezing, meningitis and acute bronchitis," Singhal said. Over a period of time, it can develop into cardiovascular and respiratory illnesses, lead to low birth weight, lung, esophageal and pancreatic cancer. Sadly, not many hookah smokers understand the implications as many think hookah is not as harmful as cigarette," Singhal added.
The World Health Organisation (WHO) says tobacco causes over five million deaths world wide which is likely to increase to 8.4 million if the situation is not brought under control.
Doctors said that hookah smokers may be at risk for some of the same diseases as cigarette smokers. These include oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function and decreased fertility.
Among the initial symptoms that can cause drastic health problems due to smoking of hookah and water pipes includes pain in chest while breathing and changing colour of sputum.
Sudhir Khandelwal, Head of the Psychiatric Department at AIIMS, said every form of tobacco consumption such as hookah, inhaling and chewing of betel leaves causes similar damage that chewing of tobacco does.
Though a person starts with hukkah occasionally, but with time they become addicted to it," Khandelwal told IANS, adding that youth consuming tobacco in any form were more likely to get into active cigarette smoking.In all, 50 per cent of the cancers in India are directly or indirectly related to tobacco consumption," he said.
Hookahs are water pipes used to smoke specially made tobacco that comes in different flavours, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. Although many believe it is less harmful, hookah smoking has several of the same health risks as cigarette smoking.
The scary part about hookah smoking is its effects on pregnant women, who may not be aware that they are inhaling tobacco. This puts the baby in danger and the child may be born prematurely, underweight, or have breathing trouble," he added.
Compared to a single cigarette, hookah smoke contains higher levels of arsenic, lead, and nickel. It produces 36 times more tar and 15 times more carbon monoxide than cigarettes, as smoking a hookah requires longer and harder drags, he noted.

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