Background Information:

Hookah use or Shisha has a long history, originating in ancient Persia and India and later spread throughout the Middle East, Northern Africa, and Asia during the 15th century(1, 2). Hookahs and hookah cafes/ bars have followed Middle Eastern immigrants to other regions of the world, including an increased popularity in the United States. Now, in addition to their prevalence in Middle-Eastern communities, hookah bars have become popular among youth and college students in urban areas(2, 3). The trend is further demonstrated by a Monitoring the Future survey, for instance in United states of America hookah user in the past year had increased from 17 percent in 2010 to 23 percent in 2014(4).

Shisha is the word name originating from Egypt (Sheesha) meaning water pipe connected to the container or hookah and it is flavored tobacco made up of shredded tobacco leaf combined with molasses, honey, or dried fruit. A hookah is a type of water pipe often used to smoke flavored tobacco. Alternative names for it include: hubble-bubble or goza(5, 6). The contents of shisha include tobacco powder (nicotine) mixed with fruit flavor, which is normally filled in a container whereby fire source is in between and another portion is filled with water. Sometime Shisha is heated indirectly with burning embers or heated charcoal. The smoke then travels through a water-filled basin before being drawn out through a rubber hose and mouthpiece. Smoking shisha is often a social activity, with several people sharing a hookah for an extended period of time. Then a flavored smoke passes through a water pipe (plastic tube) which is being smoked as cigarette. Other water pipes can be disposed after use. The people who smoke shisha tend to enjoy by blowing out in air and inhale part of smoke(6). The main group of people using shisha include the youths from 15 to 40 years old who tend to smoke shisha weekly during weekend as part of refreshment(7, 8). The main suppliers of shisha are from both individual business people and also from certain hotels, restaurants and beach premises. Therefore, shisha is often sold at recreation centres by individual people as income generating business. Such places include big hotels, restaurants, bar, at beach areas, Casino and night club premises (5, 9, 10).

It has been observed that people involved in this business tend to blend it with drugs and other intoxicants such as heroin

and marijuana for intention of attracting more customers in need. Recently it has been observed that some businessmen do mix with drugs such as pethidine which is a strong analgesia in a group of drugs called opioids.

The shisha business in Tanzania was initially experienced in big cities such as Dar salaam, Arusha and thereafter Mwanza, Mbeya and now it has spread almost throughout all regions(1). Among the groups mostly interested in shisha involve secondary and university students who are the main customers of shisha especially when visiting casinos, night clubs and beach premises during weekends(1, 11). According to the report from one of the persons who deals with Shisha business, he reported that shisha is one of the fast-growing businesses with increasing number of customers in every day. The perception of the government on shisha is that, it is one of the most dangerous behavior that can affect human health even more than cigarette smoking and alcohol intake(12). Due to effects of nicotine, tar, heavy metals and carcinogens (cancer-causing chemicals), Shisha smoking can cause Lung or esophageal cancer that may ultimately lead to stroke

Other health effects of shisha smoking include: organ dysfunction due to toxic effect of carbon monoxide, Addiction and dependence, Communicable diseases such as TB, HIV, Herpes and Hepatitis and also hypertensive heart diseases(5).