Background: Smoking is a significant menace to the public’s health because it directly causes more than seven million deaths worldwide each year. Smoking shisha is a type of tobacco consumption in which smoke is filtered by way of water before being inhaled. It's a common misconception that shisha smoking is healthier than cigarettes because it contains fruits flavour, but this is false belief. Objective: To determine the prevalence of shisha smoking and associated factors to initiate shisha smoking among students of University of the Punjab. Methods: This cross sectional study included 435 university students aged 20-40 years from New Campus, university of the Punjab Lahore. A structured questionnaire was used to collect data from students. The data was analyzed through Statistical Package for Social Sciences (SPSS) version 17.0. The frequency distribution and mean± standard deviation were calculated for categorical variables, and continuous variables, respectively. The comparison of categorical variables across groups was done by Chi-square test or Fisher’s exact test. The p-value ≤ 0.05 was considered significant. Results: In this sampled population, majority of the students (92%) had heard about shisha smoking and the overall prevalence of shisha smoking was (23.9%).Statistically significant difference was observed between shisha smoker and non-shisha smoker regarding factors starting shisha smoking including; family member uses shisha, pleasures seeking and boredom (p- value < 0.05). Whereas no statistical significant difference was found between shisha smoker and non-shisha smoker regarding; factors starting shisha smoking; curiosity, fashion, status symbol, stress, and peer pressure (p- value >0.05). Conclusion: This study concluded that the prevalence of shisha smoking was higher in male than female students. Most of the study participants had ever heard about shisha smoking and a significant number of participants ever smoked shisha in their life. The present study results revealed that having a shisha smoker family member , pleasure seeking and reducing boredom had a significant impact on initiation of shisha smoking among students of University of the Punjab. Society has to make efforts to reduce shisha smoking. Keyword: Shisha smoking, Prevalence, University Students