Academic journal article Iranian Journal of Public Health

Factors That Contribute in the First Hookah Smoking Trial by Women: A Qualitative Study from Iran

Academic journal article Iranian Journal of Public Health

Factors That Contribute in the First Hookah Smoking Trial by Women: A Qualitative Study from Iran

Article excerpt


Hookah is a traditional method of smoking tobacco, especially in the Eastern Mediterranean Region (EMR) and the Middle and Far East (1). However, in the past 2 decades it has increased in popularity in other parts of the world (2).

Although many more men use tobacco than women and women make up only about 20% of the world's one billion smokers, there is evidence that the epidemic of tobacco use among girls is increasing in some countries and women are a major target for the tobacco industry in its effort to recruit new users to replace those who will quit or die prematurely from tobacco-related diseases (3). The advent of a flavored tobacco, called maassel, along with its mystic appeal, novelty, affordability, and the social atmosphere in which smoking often occurs, has made hookah smoking attractive to women as well as men (2).

According to a systematic review about the side effects of hookah smoking, hookah smoking is significantly associated with a number of deleterious health outcomes such as lung cancer, oesophageal cancers, cardiovascular disease and adverse pregnancy outcomes such as low birth weight(4). In spite of these deleterious health effects, hookah smoking is widely believed to be a less harmful form of tobacco smoking (5) and a safer alternative to cigarette smoking (6).

The results of a national survey in Iran in 2007 showed that more than half of tobacco smoking women (e.g., 1.9% of overall 3.2%) smoke tobacco employing hookah, and in Iranian women hookah smoking has become the most common method of tobacco smoking (7).

Because of rapid increases in hookah use in Iranian women and the harmful effects of smoking on women's health including their reproductive health, more data are needed regarding the factors that influence hookah smoking initiation among women. This study is qualitative phase of a sequential exploratory mixed methods study which aims to explore the influence of different factors on the initiation of hookah smoking in women and then develop the "Hookah Smoking Initiation for Women Questionnaire (HIWQ)"; and, determine the psychometric properties of the HIWQ. Most Iranian studies associated with smoking are carried out quantitatively. They have focused on cigarette smoking (8,9) and some scholars in recent years (10,11) have examined the causes of hookah smoking in both men and women. But they used the same questions, gathered from literature review, for measurement hookah smoking causes in both genders, despite the fact that risk factors for smoking may vary by gender (12) and also the factors related to smoking initiation or maintenance may be different in women from men (10) and the culture of Iranian women is different from women in other countries. Thus there is an urgent need to develop a questionnaire to measure the onset reasons of hookah use for Iranian women. The information of such questionnaire would help develop health promotion initiatives and interventions that specifically address women. Such understanding is also useful for development of smoking cessation strategies that are appropriate for women.

In this article the role of psychosocial needs and gaps, as a risk factor associated with the initiation of hookah smoking among women, is discussed.


In this research, a qualitative approach was adopted using in-depth interviews in Tehran in 2012.The inclusion criteria were: being a woman, being a resident of Tehran, and having a history of hookah smoking even as much as one or two puffs. Interviewees were carried out by an investigator who was familiar with the principles of qualitative approach and she had practical experience in qualitative research. Participants were recruited from different characteristics, in terms of age, education, marital status, occupation, geographic region and the age at onset of hookah smoking, to ensure that women from diverse demographic backgrounds are present in the interviews. These women had different patterns of hookah smoking and we classified them as current and former user of hookah. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.