International Journal of Behavioral Medicine

, Volume 23, Issue 6, pp 686–696 | Cite as

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

  • Reza Ziaei
  • Reza Mohammadi
  • Saeed Dastgiri
  • Eija Viitasara
  • Vahab Asl Rahimi
  • Abolfazl Jeddi
  • Joaquim Soares



The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15–17-year-old high school students in Iran.


Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15–17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking).


Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking.


Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students’ and their parents’ awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents’ access to WPs and tobacco in society.


Global Youth Tobacco Survey High school students Iran Prevalence of waterpipe/hookah smoking Student health Waterpipe/hookah smoking 


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Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  1. 1.Department of Health Sciences, Unit for Public Health ScienceMid Sweden UniversitySundsvallSweden
  2. 2.Department of Neurobiology, Care Sciences and Society, Unit for Family MedicineKarolinska InstituteStockholmSweden
  3. 3.Department of Community MedicineTabriz University of Medical SciencesTabrizIran
  4. 4.Unit for Adolescence HealthProvince Health CenterTabrizIran

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