Background:
Globally tobacco use kills nearly 6 million people annually; a figure expected to increase to 8 million deaths every year by 2030. Though perceived to be safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking. Yet, this practice has gained popularity especially among youths in Kampala. The extent to which this form of tobacco consumption is practiced by the youths, their attitudes and knowledge regarding the health risks in Uganda is unknown. This study therefore aimed to establish knowledge, attitudes, practices and factors associated with shisha smoking among youths.

Methods:
A cross-sectional study was conducted among 530 systematically selected youths aged between 18-30 years found in bars in the two divisions of Kampala between April and May 2014. Youths who are incapacitated were excluded. Three outcome variables; knowledge, attitudes and practice were assessed. Data was collected using a semi structured interviewer administered questionnaire. Descriptive statistics of key variables were generated at univariate analysis. Multivariable logistic regression analysis with Odds Ratios and corresponding 95% Confidence Intervals were used to measure associations. STATA version 12.0 was used for analysis.

Results:
Of 530 participants, 86.4% had low knowledge, 69.2% had negative attitudes and 36.4% smoked Shisha. 75.7% smoked flavored and sweetened tobacco, 37.6% smoked on weekly basis, 92.8% smoked in the company of friends, 91.2% shared shisha pipes and 93.8% smoked in bars. A further 62.7% smoked shisha with cigarettes. Factors associated with shisha smoking included; smoking cigarettes (Adjusted Odds Ratio (AOR): 6.33, 95% CI: 4.13-9.58); positive attitude (AOR: 4.13, 95% CI: 2.65-6.44); Age (25-30 years) (AOR: 1.72, 95% CI: 1.13-2.62) and no knowledge (AOR: 0.50, 95% CI: 0.29-0.88).

Conclusions:
Shisha smoking among youths attending bars is high with three in every ten youths smoking shisha. Targeted social mobilization would increase awareness regarding adverse health effects of shisha smoking.