Background: In Malaysia, although the number of Shisha smokers has not exceeded the regular cigarette users, waterpipe smoking (Shisha) has been appeared as a new form of tobacco use, especially among the new generation. This study aims to describe the comparative characteristics, familiarities, and motives for Shisha use in some states of Malaysia. Methods: A cross-sectional survey using a new validated self-administered, bilingual questionnaire was conducted among Shisha smokers in Pulau Penang and Kuantan Malaysian cities. Five hundred questionnaires were distributed evenly and randomly in Shisha lounges around the mentioned two cities. Results: A total of 297 people (55.8%) agreed to participate in the study. The majority of the study participants were male (82.1%), Malay (82.8 %), and currently studying or graduated from university or college (67.5 %). Almost half (49.3%) of the study participants were Shisha users. The majority (80.3%) of respondents had smoked Shisha at least once in the last six months More than half of the respondents (58%) were influenced by comrades in the first trial of Shisha smoking. The catchy smell, the flavor, and taste of Shisha, and curiosity were the main attractive factors for smoking Shisha among study participants (30%, 29%, & 12%, respectively). However, the major contributory factors to continue smoking Shisha were pleasure and happiness, relief from tension, stress, and boredom, and passing of time (61.3%, 56.6%, & 47.4%, respectively). Study results showed that respondents' residency was a differential significant factor in attitudes, perceptions, and motivation toward experimentation and continuation of Shisha smoking. The vast majority of Penangites perceived that Shisha was purified from harmful substances, Shisha smoking did not irritate the bronchi, and there was no association between Shisha smoking and lung cancer (82.5%, 64.6%, & 62.1%, respectively). About half of the respondents believed that Shisha was less harmful, less addictive, and contained less nicotine than a cigarette (44.1%, 68.9%, & 67.5, respectively). There is a strong belief among the study population (67.5%) that the popularity of Shisha will increase over the next half-decade. Conclusion: High prevalence of Shisha smoking associated with the considerable poor level of knowledge about Shisha use has been noticed among the study population. The results indicated the role played by peers in instigating the testing or using shisha. Study findings affirm the necessity for further research into contributory factors influencing Shisha use.
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