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This then leads to decreased apoptosis (i.e.programmed cell death), increased transformation and increased growth of small blood vessels

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Maher Karam-Hage, a tobacco treatment expert and addiction specialist at the University of Texas MD Anderson Center, explained in a center article

Archived from the original on 15 November 2009

Moreover, advertising and promotion of smoking accessories, such as cigarette papers, filters, equipment for rolling cigarettes and imitations of tobacco products, among others, may also promote the consumption of these products 9

Your calculation about 400 puffs in shisha may not be the most accurate way to measure this I think it is not the number of puffs but the much larger volume of smoke that is at issue