Pattern of Shisha and Cigarette Smoking in the General Population in Malaysia

  • Al-Naggar, Redhwan A. (Population Health and Preventive Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM)) ;
  • Bobryshev, Yuri V. (Faculty of Medicine, School of Medical Sciences, University of New South Wales) ;
  • Anil, Shirin (College of Medicine, King Saud University)
  • Published : 2015.01.22


Background: Smoking is a primary risk factor for cancer development. While most research has focused on smoking cigarettes, the increasing popularity of shisha or water pipe smoking has received less attention. This study measured the prevalence and risk factors for shisha and cigarette smoking and related knowledge. Materials and Methods: This cross-sectional analytical study was conducted in Shah Alam, Malaysia. Participants aged ${\geq}18years$ were selected from restaurants. Data regarding demographic variables, smoking patterns, and knowledge about shisha smoking were collected in local languages. Logistic regression was performed to assess risk factors. Results: Of 239 participants, 61.9 % were male and 99.2% revealed their smoking status. Some 57.4% were smokers: 50.7% only cigarettes, 5.9% only shisha and 42% both. Mean age of starting cigarette smoking was $17.5{\pm}2.4years$ and for shisha smoking $18.7{\pm}2.0years$. In a univariate model, male gender, age 33-52 years and monthly income > MYR 4,000 increased the risk and unemployment and being a student decreased the risk. In a multivariate model, male gender increased the risk of smoking, while being a student decreased the risk, adjusting for age and income. The perception of shisha being less harmful than cigarettes was present in 14.6% and 7.5% had the opinion that shisha is not harmful at all, while 21.7% said that it is less addictive than cigarettes, 39.7% said that shisha did not contain tar and nicotine, 34.3% said that it did not contain carbon monoxide and 24.3% thought that shisha did not cause health problems. Conclusions: Prevalence of shisha and cigarette smoking is high in the general population in Malaysia and knowledge about shisha smoking is relatively low. The findings of our study might have implications for understanding similarities and differences in incidence of shisha and cigarette smoking in other cultural/geographic regions.


  1. Akl EA, Gaddam S, Gunukula SK, et al (2010). The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol, 39, 834-57.
  2. Al-Naggar RA, Al-Dubai SAR, Hamoud T, Al-Naggar RC, Al-Jashamy K (2011). Prevalence and associated factors of smoking among Malaysian university students. Asian Pac J Cancer Prev, 12, 619-24.
  3. Al-Naggar RA, Bobryshev YV (2012). Shisha smoking and associated factors among medical students in Malaysia. Asian Pac J Cancer Prev, 13, 5627-32.
  4. Al-Naggar RA, Saghir FSA (2011). Water pipe (shisha) smoking and associated factors among Malaysian university students. Asian Pac J Cancer Prev, 12, 3041-7.
  5. Aydin A, Kiter G, Durak H, Ucan ES, Kaya GC, Ceylan E (2004). Water-pipe smoking effects on pulmonary permeability using technetium-99m DTPA inhalation scintigraphy. Ann Nucl Med, 18, 285-9.
  6. Centers for Disease Control and Prevention. How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease (2010): A report of the surgeon general. Atlanta (GA): Centers for Disease Control and Prevention (US).
  7. Chaouachi K (2006). A critique of the WHO TobReg's “Advisory Note” report entitled: “Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators”. J Negative Results Biomedicine, 5, 17.
  8. Cheah YKA, Naidu BM (2012). Exploring factors influencing smoking behaviour in Malaysia. Asia Pac J Cancer Prev, 13, 1125-30.
  9. Do YK, Finkelstein EA (2012). Youth employment, income, and smoking initiation: results from Korean panel data. J Adolesc Health, 51, 226-32.
  10. Eissenberg T, Shihadeh A (2009). Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med, 37, 518-23.
  11. Habil H (2000). Tobacco smoking in Malaysia. Tobacco: The Growing Epidemic: Springer, 2000, 39-40.
  12. Hu X, Primack BA, Barnett TE, Cook RL (2009). College students and use of K2: an emerging Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tob Induc Dis, 5, 16.
  13. Jabbour S, El-Roueiheb Z, Sibai AM (2003). Narghile (water-pipe) smoking and incident coronary heart disease: a case-control study. Ann Epidemiol, 13, 570.
  14. Jacot SI, Cornuz J (2009). New modes of tobacco and nicotine use. Rev Med Suisse, 5, 1457-61.
  15. Jamil H, Janisse J, Elsouhag D, et al (2011). Do household smoking behaviors constitute a risk factor for hookah use? Nicotine Tob Res, 13, 384-8.
  16. Kiter G, Ucan ES, Ceylan E, Kilinc O (2000). Water-pipe smoking and pulmonary functions. Respiratory Medicine, 94, 891-4.
  17. Knishkowy B, Amitai Y (2005). Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116, 113-9.
  18. Manaf RA, Shamsuddin K (2008). Smoking among young urban Malaysian women and its risk factors. Asia Pac J Public Health, 20, 204-13.
  19. Maziak W, Eissenberg T, Rastam S (2004). Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria. Ann Epidemiol, 14, 646-54.
  20. Morrow M, Barraclough S (2003). Tobacco control and gender in Southeast Asia. Part I: Malaysia and the Philippines. Health Promot Int, 18, 255-64.
  21. National Cancer Institute (2014). Accessed October 5, 2014.
  22. Public health officials warn about the unrecognized health hazards of smoking from a hookah. Harvard Mental Health Letter. Accessed August 5, 2014.
  23. Shihadeh A (2003). Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol, 41, 143-52.
  24. Shihadeh A, Saleh R (2005). Polycyclic aromatic hydrocarbons, carbon monoxide,”tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol, 43, 655-61.
  25. Smith JR, Novotny TE, Edland SD, Hofstetter CR, Lindsay SP, Al-Delaimy WK (2011). Determinants of hookah use among high school students. Nicotine Tob Res, 13, 565-72.
  26. Smith-Simone S, Maziak W, Ward KD, Eissenberg T (2008). Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two US samples. Nicotine Tob Res, 10, 393-8.
  27. Varsano S, Ganz I, Eldor N, Garenkin M (2003). Water-pipe tobacco smoking among school children in Israel: frequencies, habits, and attitudes. Harefuah, 142, 736-41.
  28. World Health Organization (2011). WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco: executive summary. Geneva 2011.
  29. World Health Organization (2014). Noncommunicable diseases country profiles 2014: Malaysia. Geneva 2014.

Cited by

  1. Systematic Review on International Practices in Controlling Waterpipe Tobacco Smoking vol.16, pp.9, 2015,
  2. Assessment of the Extended Theory of Planned Behavior for Nicotine Dependence Prediction: An Application of Path Analysis vol.In Press, pp.In Press, 2017,