Cancer and cardiovascular disease are smoking related diseases, which causes premature death globally (Beaglehole, et.al. 2011). The current global estimate of 1.3 billion smokers is expected to increase to 1.6 billion by 2025, and the number of deaths due to smoking-related diseases is expected to reach 8.3 million by 2030, up from 4.8 million in 2006 (Mathers, et.al. 2006). As developing countries comprise 73% of the world’s smoker population, these countries will be more adversely affected by the health, economic and social impacts of smoking-related diseases (Peto, et.al. 1992 & 1994) . Smoking related diseases have been the primary cause of mortality for the past three decades in Malaysia (MOH, 2003). By year 2020, Malaysia seeks to cut the current smoking prevalence into half because the country has spent as much as 2.92 billion Malaysian ringgit treating chronic obstructive pulmonary disease, ischemic heart disease and lung cancer (Norsiah, 1990 & MOH, 2003). A representative sample of the Malaysian population was surveyed in the second National Health and Morbidity Survey (NHMS II) in 1996 and of the 32,991 participants 24.8% reported being active smokers. Almost half were current smokers (49.2%), among males aged 18 years and older. Prevalence of smoking was lower among high-income earners and professionals in the service or production sectors. However, smoking was more common among respondents with low socioeconomic status and among those with primary school education (MOH, 1997). In Malaysia, shisha or hookah water pipe smoking is an upcoming trend which is picking up quite fast and also may be the next major risk factor for respiratory disorder. Many people are not aware that shisha smoking is much more dangerous compared to cigarette smoking and little research has been done on shisha or hookah smoking as the priority was more on cigarette smoking.Shisha pipes have been in use for about 400 years, originating in India and Asia (CDC, 2011). In…

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