Conducted by researchers in the Aga Khan University Hospital's department of pulmonary and critical care medicine and their colleagues from the Dow University of Health Sciences (DUHS), the study suggests that more and more youngsters are getting hooked to such hookahs with parental approval.
As many as 450 students-268 male and 182 female-took part in the study, published in The International Journal of Tuberculosis and Lung Disease.
While water-pipe smoking was restricted only to rural areas for decades, the researchers say a number of shisha smoking venues have emerged in major cities of Pakistan in the last few years, and that they are increasingly attracting the youth.
In their study report, they also write that the country is witnessing a surge in water-pipe smoking in both urban young men and women with greater parental approval for the addiction, compared with cigarette smoking.
According to them, 64.2 per cent of the male and 37.9 per cent of the female participants in the study had smoked shisha at least once in their lifetime, with 77.3 per cent of the males who had smoked shisha continuing with the habit.
The same was the case with 33.3 per cent of the women participants, they added.
The study also revealed that 56.4 per cent of the participants smoked shisha less than once per month, 30.2 per cent did so at least once a month, 10 per cent at least once per week, and only 3.4 per cent were found to be regular smokers of shisha.
The majority smoked for more than 30 minutes at each sitting, and also shared their water-pipes with others.
The researchers say that the flavor is the most likeable attribute of water-pipes.
While about a third of the current water-pipe smokers consider themselves addicted to shisha, only about a fifth are willing to quit it.
As regards parental attitudes towards shisha smoking, 78.5 per cent of the participants claimed that their parents had no problem with this practice, while only 21.1 per cent of the parents approved of cigarette smoking.
So far as the youth's knowledge about the health hazards posed by smoking are concerned, it was found that around 17.6 per cent of the participants were unable to identify even a single harmful effect of water-pipe smoking.
The study also revealed that most of the participants considered cigarette smoking more hazardous than shisha smoking.
Curiosity, pleasure-seeking, peer pressure, boredom and stress and a lack of entertainment were found to be the key factors behind the initiation of water-pipe smoking.
A widespread myth about water-pipe smoking, the study points out, was that the passage of smoke through the steaming water in water-pipes "purifies" the smoke of all harmful elements.
However, it had been established that exposure to carbon monoxide and nicotine after water-pipe smoking was at almost the same levels as those associated with cigarette smoking, said the research paper.
"It has also been proven that long-term habitual use of water-pipes, as with regular cigarette smoking, is associated with lung, gastrointestinal and bladder problems as well as pulmonary, cardiovascular and haematological disease. Other dangers include infections such as tuberculosis, hepatitis C, pulmonary aspergillosis and Helicobacter pylori infection, which have been assumed to spread from pipe sharing," the Dawn quoted the study as saying.
The researchers suggested that water-pipe tobacco be subjected to the same regulations as cigarette and other tobacco products, and that awareness about the health hazards of pipe smoking be created.