Knowledge, attitudes and practice of university students regarding waterpipe smoking in Pakistan

Document Type



Pulmonary and Critical Care



To study the awareness, perceptions and practice of university students in Karachi, Pakistan, with regard to shisha (waterpipe) smoking. Design: Cross-sectional survey conducted among students at four different universities of Karachi, selected through random cluster sampling.


A total of 450 participants, 59.6% males (n = 268) and 40.4% females (n = 182), were included in the study. About half of the participants reported having ever smoked shisha (n = 241, 53.6%). On examining factors associated with starting shisha smoking, curiosity was found to be the most common reason (n = 1,48, 61.4%), followed by pleasure-seeking (n = 113, 46.9%), peer pressure (n = 55, 22.8%), boredom (n = 43, 17.8%) and stress (n = 26, 10.8%). Of 241 participants who had ever smoked waterpipes, the majority (n = 149, 61.8%) were current smokers. A vast majority of participants (n = 269, 60%) considered waterpipe smoking to be less unhealthy than cigarette smoking. Boredom in youth, use of waterpipe In leisure activities and peer pressure were identified as the most common reasons for the escalating popularity of waterpipe smoking in Pakistan. Conclusions: Waterpipe smoking is very popular among Pakistani university students, and knowledge among university students about the dangers of waterpipe smoking is alarmingly low.


International Journal of Tuberculosis and Lung Disease