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

Background: Smoking is a primary risk factor for cancer development. While most research has focused onsmoking cigarettes, the increasing popularity of shisha or water pipe smoking has received less attention. Thisstudy measured the prevalence and risk factors for shisha and cigarette smoking and related knowledge. Materialsand
Methods: This cross-sectional analytical study was conducted in Shah Alam, Malaysia. Participants aged ≥ 18years were selected from restaurants. Data regarding demographic variables, smoking patterns, and knowledgeabout 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% weresmokers: 50.7% only cigarettes, 5.9% only shisha and 42% both. Mean age of starting cigarette smoking was17.5 ± 2.4 years and for shisha smoking 18.7 ± 2.0 years. In a univariate model, male gender, age 33-52 yearsand monthly income > MYR 4,000 increased the risk and unemployment and being a student decreased therisk. In a multivariate model, male gender increased the risk of smoking, while being a student decreased therisk, adjusting for age and income. The perception of shisha being less harmful than cigarettes was present in14.6% and 7.5% had the opinion that shisha is not harmful at all, while 21.7% said that it is less addictive thancigarettes, 39.7% said that shisha did not contain tar and nicotine, 34.3% said that it did not contain carbonmonoxide and 24.3% thought that shisha did not cause health problems.
Conclusions: Prevalence of shishaand cigarette smoking is high in the general population in Malaysia and knowledge about shisha smoking isrelatively low. The findings of our study might have implications for understanding similarities and differencesin incidence of shisha and cigarette smoking in other cultural/geographic regions.