It can be, largely because with a hookah you carry on inhaling for much longer than you would with cigarettes. People tend to sit together and spend a lot of time smoking their hookah and chatting, and the amount of tobacco taken in is much greater than they realise. We will probably have more exact figures on the effects of this in a few years, because hookah use is quite a growing trend in western countries. People like it because the tobacco is flavoured, it is a way to socialise and you don't get - or think you don't get - the effects of dry smoke. But smoke inhaled through a water pipe is just as harmful, even though you don't get the smell or the second-hand smoke that you do with cigarettes. Also, hookahs are just as addictive as cigarettes - the nicotine works in the same way - so it's not just a social activity.

You can learn more about the harmful effects of hookah use here.