Smoking a hookah can be more harmful than cigarettes and can cause diseases like cancers much more easily doctors say. Read: Hookah delivers 2.5 times more tar to your lungs than cigarettes. 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