Cross-sectional study identifying forms of tobacco used by Shisha smokers in Pakistan.

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker\u27s tobacco, chewable tobacco and snuff tobacco among shisha smoker\u27s and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan. Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18. Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65(16%) chewed tobacco and 33 (8%) snuffed it.The median age at initiation of Shisha smoking was 20 years. 280 (69%) considered Shisha smoking to be less deleterious to health than cigarettes. Respiratory disease was the most commonly cited health effect reported. Most 248 (61%) of the participants were infrequent shisha smokers. Conclusion: There is high frequency of tobacco usage in the form of cigarettes, chewable tobacco and snuff tobacco among shisha smokers of Pakistan. The highest frequency is for cigarette smoking. The rise in Shisha smoking as a trendy social habit appears to be occurring despite emerging scientific evidence of its potential health risks