Factors Affecting Hookah Smoking Trend in the Society: A Review Article

Victoria Momenabadi, Mohammad Hossein Kaveh, Seyed Yaser Hashemi, Vahid Reza Borhaninejad


Background: An increase in hookah smoking is considered to be a serious health problem in societies with different cigarette smoking patterns. Thus, determinants of increase in this behavior are needed to be identified. This study aimed to review the articles related to the causes of hookah smoking in the society.

Methods: This study reviewed the scientific references of authentic databases and journals, including Web of Science, PubMed, Iranian Databases, Elsevier, Embase, Scopus, MEDLINE, CINAHL, CDC, and World Health Organization (WHO). Overall, 84 scientific studies conducted during 1990-2015 were collected.

Results: Several studies on the prevalence of smoking hookah and its associated factors in the society suggested that numerous factors played a role in interest in smoking hookah. The most common reasons for individuals’ inclination to smoke hookah were positive viewpoints toward smoking hookah, wrong beliefs about its low risks, presumed lack of addiction, social acceptance, ease of access, wrong cultural habits, and regulative weakness.

Conclusion: Evidence indicated that a large spectrum of individual and social factors was effective in various levels of hookah consumption. Besides, it seems that single-component interventions and those solely based on individual factors could not result in effective prevention. On the other hand, interventions based on ecological approaches are suggested in this regard. Overall, it is essential to focus on the exclusion of positive viewpoints toward hookah, develop the ability to say “no,” relaxation, and resistance against temptations to smoke hookah, culturalization, and regulation of strong laws.


Hookah; Consumption of tobacco products; Risk factors

Full Text:



Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349(9064): 1498-504.

Differences in worldwide tobacco use by gender: findings from the Global Youth Tobacco Survey. J Sch Health 2003; 73(6): 207-15.

Zareipour M, Sadeghi R, Sadeghi Tabatabaei S, Seyedi S. Effective factors on smoking based on basnef model in male students in tehran medical sciences university in 2009. J Urmia Nurs Midwifery Fac 2011; 9(1): 23-9. [In Persian].

Kiter G, Ucan ES, Ceylan E, Kilinc O. Water-pipe smoking and pulmonary functions. Respir Med 2000; 94(9): 891-4.

Roskin J, Aveyard P. Canadian and English students' beliefs about waterpipe smoking: a qualitative study. BMC Public Health 2009; 9: 10.

Kuper H, Adami HO, Boffetta P. Tobacco use, cancer causation and public health impact. J Intern Med 2002; 251(6): 455-66.

Sepetdjian E, Shihadeh A, Saliba NA. Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke. Food Chem Toxicol 2008; 46(5): 1582-90.

Primack BA, Walsh M, Bryce C, Eissenberg T. Water-pipe tobacco smoking among middle and high school students in Arizona. Pediatrics 2009; 123(2): e282-e288.

Maziak W, Eissenberg T, Rastam S, Hammal F, Asfar T, Bachir ME, et al. Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria. Ann Epidemiol 2004; 14(9): 646-54.

Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re- emerging strain in a global epidemic. Tob Control 2004; 13(4): 327-33.

Rastam S, Ward KD, Eissenberg T, Maziak W. Estimating the beginning of the waterpipe epidemic in Syria. BMC Public Health 2004; 4: 32.

Teraghghijah R, Hamdeyeh M, Yaghoobi N. Predicting factors of waterpipe and smoking in Public universities students. J Res Med Sci 2011; 34(4): 249-56. [In Persian].

Moumennasab M, Najafi SS, Kaveh MH, Ahmadpour F. Prevalence of risky health behaviors among the students of Khorramabad Universities. Yafteh 2006; 8(2): 23-9. [In Persian].

Almerie MQ, Matar HE, Salam M, Morad A, Abdulaal M, Koudsi A, et al. Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study. Int J Tuberc Lung Dis 2008; 12(9): 1085-91.

Fielder RL, Carey KB, Carey MP. Prevalence, frequency, and initiation of hookah tobacco smoking among first-year female college students: a one-year longitudinal study. Addict Behav 2012; 37(2): 221-4.

Poyrazoglu S, Sarli S, Gencer Z, Gunay O. Waterpipe (narghile) smoking among medical and non-medical university students in Turkey. Ups J Med Sci 2010; 115(3): 210-6.

Anjum Q, Ahmed F, Ashfaq T. Knowledge, attitude and perception of water pipe smoking (Shisha) among adolescents aged 14-19 years. J Pak Med Assoc 2008; 58(6): 312-7.

Joveyni H, Dehdari T, Gohari MR, Gharibnavaz H. The survey of attitudes, subjective norms and perceived behavioral control of college students about hookah smoking cessation. J Health Syst Res 2012; 8(7): 1311-21. [In Persian].

Jamil H, Geeso SG, Arnetz BB, Arnetz JE. Risk factors for hookah smoking among arabs and chaldeans. J Immigr Minor Health 2014; 16(3): 501-7.

Erbaydar NP, Bilir N, Yildiz AN. Knowledge, behaviors and health hazard perception among Turkish narghile (waterpipe)-smokers related to narghile smoking. Pak J Med Sci 2010; 26(1): 195-200.

Lipkus IM, Eissenberg T, Schwartz-Bloom RD, Prokhorov AV, Levy J. Affecting perceptions of harm and addiction among college waterpipe tobacco smokers. Nicotine Tob Res 2011; 13(7): 599-610.

Sabahy AR, Divsalar K, Bahreinifar S, Marzban M, Nakhaee N. Waterpipe tobacco use among Iranian university students: correlates and perceived reasons for use. Int J Tuberc Lung Dis 2011; 15(6): 844-7.

Griffiths MA, Harmon TR, Gilly MC. Hubble bubble trouble: The need for education about and regulation of hookah smoking. J Public Policy Mark 2011; 30(1): 119-32.

Martinasek MP, McDermott RJ, Martini L. Waterpipe (hookah) tobacco smoking among youth. Curr Probl Pediatr Adolesc Health Care 2011; 41(2): 34-57.

Afifi R, Khalil J, Fouad F, Hammal F, Jarallah Y, Abu FH, et al. Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region. Soc Sci Med 2013; 98: 125-34.

Combrink A, Irwin N, Laudin G, Naidoo K, Plagerson S, Mathee A. High prevalence of hookah smoking among secondary school students in a disadvantaged community in Johannesburg. S Afr Med J 2010; 100(5): 297-9.

Barnett TE, Curbow BA, Weitz JR, Johnson TM, Smith-Simone SY. Water pipe tobacco smoking among middle and high school students. Am J Public Health 2009; 99(11): 2014-9.

Barnett TE, Shensa A, Kim KH, Cook RL, Nuzzo E, Primack BA. The predictive utility of attitudes toward hookah tobacco smoking. Am J Health Behav 2013; 37(4): 433-9.

Braun RE, Glassman T, Wohlwend J, Whewell A, Reindl DM. Hookah use among college students from a Midwest University. J Community Health 2012; 37(2): 294-8.

Hammal F, Mock J, Ward KD, Eissenberg T, Maziak W. A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control 2008; 17(2): e3.

Giuliani KK, Mire OA, Jama S, Dubois DK, Pryce D, Fahia S, et al. Tobacco use and cessation among Somalis in Minnesota. Am J Prev Med 2008; 35(6 Suppl): S457-S462.

Ahmed B, Jacob P 3rd, Allen F, Benowitz N. Attitudes and practices of hookah smokers in the San Francisco Bay Area. J Psychoactive Drugs 2011; 43(2): 146-52.

Daniels KE, Roman NV. A descriptive study of the perceptions and behaviors of waterpipe use by university students in the Western Cape, South Africa. Tob Induc Dis 2013; 11(1): 4.

Makhoul J, Nakkash R. Understanding youth: using qualitative methods to verify quantitative community indicators. Health Promot Pract 2009; 10(1): 128-35.

Khalil J, Afifi R, Fouad FM, Hammal F, Jarallah Y, Mohamed M, et al. Women and waterpipe tobacco smoking in the eastern Mediterranean region: allure or offensiveness. Women Health 2013; 53(1): 100-16.

Griffiths MA, Ford EW. Hookah smoking: behaviors and beliefs among young consumers in the United States. Soc Work Public Health 2014; 29(1): 17-26.

Afifi RA, Yeretzian JS, Rouhana A, Nehlawi MT, Mack A. Neighbourhood influences on narghile smoking among youth in Beirut. Eur J Public Health 2010; 20(4): 456-62.

Baghianimoghadam MH, Rahaee Z, Morowatisharifabad MA, Sharifirad G, Andishmand A, Azadbakht L. Effects of education on self- monitoring of blood pressure based on BASNEF model in hypertensive patients. J Res Med Sci 2010; 15(2): 70-7.

Botvin GJ, Baker E, Dusenbury L, Tortu S, Botvin EM. Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study. J Consult Clin Psychol 1990; 58(4): 437-46.

Carroll KM, Budney AJ, National Institute on Drug Abuse, Higgins ST. Therapy manuals for drug addiction. Washington, DC: U.S. Dept. of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse; 1998.

Smith-Simone S, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples. Nicotine Tob Res 2008; 10(2): 393-8.

Abughosh S, Wu IH, Peters RJ, Essien EJ, Crutchley R. Predictors of Persistent Waterpipe Smoking Among University Students in The United States. Epidemiol 2011; 1: 102.

Ward KD, Eissenberg T, Gray JN, Srinivas V, Wilson N, Maziak W. Characteristics of U.S. waterpipe users: a preliminary report. Nicotine Tob Res 2007; 9(12): 1339-46.

Khalil J, Heath RL, Nakkash RT, Afifi RA. The tobacco health nexus? Health messages in Narghile advertisements. Tob Control 2009; 18(5): 420-1.

Ghafouri N, Hirsch JD, Heydari G, Morello CM, Kuo GM, Singh RF. Waterpipe smoking among health sciences university students in Iran: perceptions, practices and patterns of use. BMC Res Notes 2011; 4: 496.

Giuliani KK, Mire O, Ehrlich LC, Stigler MH, Dubois DK. Characteristics and prevalence of tobacco use among Somali youth in Minnesota. Am J Prev Med 2010; 39(6 Suppl 1): S48-S55.

Noonan D. A descriptive study of waterpipe smoking among college students. J Am Assoc Nurse Pract 2013; 25(1): 11-5.

Dar-Odeh NS, Bakri FG, Al-Omiri MK, Al-Mashni HM, Eimar HA, Khraisat AS, et al. Narghile (water pipe) smoking among university students in Jordan: prevalence, pattern and beliefs. Harm Reduct J 2010; 7: 10.

Smith JR, Novotny TE, Edland SD, Hofstetter CR, Lindsay SP, Al-Delaimy WK. Determinants of hookah use among high school students. Nicotine Tob Res 2011; 13(7): 565-72.

Sutfin EL, McCoy TP, Reboussin BA, Wagoner KG, Spangler J, Wolfson M. Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina. Drug Alcohol Depend 2011; 115(1- 2): 131-6.

Noonan D, Patrick ME. Factors associated with perceptions of hookah addictiveness and harmfulness among young adults. Subst Abus 2013; 34(1): 83-5.

Jamil H, Janisse J, Elsouhag D, Fakhouri M, Arnetz JE, Arnetz BB. Do household smoking behaviors constitute a risk factor for hookah use? Nicotine Tob Res 2011; 13(5): 384-8.

Heinz AJ, Giedgowd GE, Crane NA, Veilleux JC, Conrad M, Braun AR, et al. A comprehensive examination of hookah smoking in college students: use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use. Addict Behav 2013; 38(11): 2751-60.

Eissenberg T, Ward KD, Smith-Simone S, Maziak W. Waterpipe tobacco smoking on a U.S. College campus: prevalence and correlates. J Adolesc Health 2008; 42(5): 526-9.

Primack BA, Sidani J, Agarwal AA, Shadel WG, Donny EC, Eissenberg TE. Prevalence of and associations with waterpipe tobacco smoking among U.S. university students. Ann Behav Med 2008; 36(1): 81-6.

Smith SY, Curbow B, Stillman FA. Harm perception of nicotine products in college freshmen. Nicotine Tob Res 2007; 9(9): 977-82.

Jahanpour F, Vahedparast H, Ravanipour M, Azodi P. The trend of hookah use among adolescents and youth: A qualitative study. J Qual Res Health Sci 2015; 3(4): 340-8.

Jamil H, Templin T, Fakhouri M, Rice VH, Khouri R, Fakhouri H. Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults. J Immigr Minor Health 2009; 11(4): 310-7.

Madjzadeh Sr, Zamani G, Mousavi Kazemi SH. Qualitative survey on the factors affecting tendency to hookah in hormozgan provenice and appropriate campaign methods against it. Hakim Res J 2002; 5(3): 183-7.

Kelishadi R, Mokhtari MR, Tavasoli AA, Khosravi A, Ahangar-Nazari I, Sabet B, et al. Determinants of tobacco use among youths in Isfahan, Iran. Int J Public Health 2007; 52(3): 173-9.

Al Nohair SF. Prevalence of smoking and its related behaviors and beliefs among secondary school students in Riyadh, Saudi Arabia. Int J Health Sci (Qassim) 2011; 5(1): 51-7.

Karimy M, Niknami S, Heidarnia AR, Hajizadeh E, Shamsi M. Refusal self-efficacy, self esteem, smoking refusal skills and water pipe (Hookah) smoking among Iranian male adolescents. Asian Pac J Cancer Prev 2013; 14(12): 7283-8.

Bejjani N, El Bcheraoui C, Adib SM. The social context of tobacco products use among adolescents in Lebanon (MedSPAD-Lebanon). J Epidemiol Glob Health 2012; 2(1): 15-22.

Mzayek F, Khader Y, Eissenberg T, Ward KD, Maziak W. Design, baseline results of Irbid longitudinal, school-based smoking study. Am J Health Behav 2011; 35(6): 746-55.

Tamim H, Al-Sahab B, Akkary G, Ghanem M, Tamim N, El Roueiheb Z, et al. Cigarette and nargileh smoking practices among school students in Beirut, Lebanon. Am J Health Behav 2007; 31(1): 56-63.

Veilleux JC, Kassel JD, Heinz AJ, Braun A, Wardle MC, Greenstein J, et al. Predictors and sequelae of smoking topography over the course of a single cigarette in adolescent light smokers. J Adolesc Health 2011; 48(2): 176-81.

Dehdari T, Jafari A, Joveyni H. Students' perspectives in Tehran University of Medical Sciences about factors affecting smoking hookah. Razi j Med Sci 2012; 19(95): 17-24. [In Persian].

Al-Dabbagh S, Al-Sinjari KM. Knowledge, attitude and believes of Nargila (hubble-bubble) smoking in Iraq. J Bahrain Med Soc 2005; 17(2): 128-34.

Israel E, El-Setouhy M, Gadalla S, Aoun el SA, Mikhail N, Mohamed MK. Water pipe (Sisha) smoking in cafes in Egypt. J Egypt Soc Parasitol 2003; 33(3 Suppl): 1073-85.

Chaaya M, El-Roueiheb Z, Chemaitelly H, Azar G, Nasr J, Al-Sahab B. Argileh smoking among university students: a new tobacco epidemic. Nicotine Tob Res 2004; 6(3): 457-63.

Khani Mogaddam R, Shojaezadah D, Sadeghi R, Pahlevanzadah B, Shakouri moghaddam R. Survey of prevalence and causes of the trend of hookah smoking in Tehran University Students of Medical Sciences 2010-2011. Tolooe Behdasht 2012; 11(4): 103-13. [In Persian].

Khader YS, Alsadi AA. Smoking habits among university students in Jordan: prevalence and associated factors. East Mediterr Health J 2008; 14(4): 897-904.

Morris DS, Fiala SC, Pawlak R. Opportunities for policy interventions to reduce youth hookah smoking in the United States. Prev Chronic Dis 2012; 9: 120082.

Dehdari T, Zarghi A, Ramazankhany A. Principles of health promotion. Tehran, Iran: Nazari publication; 2010. p. 23-6. [In Persian].

Gorji A, Mohammadi T, Hosseini L. Cigarette price and smoking rate in 1983-2005 period in Iran. J Health Adm 2010; 12(38): 31-6. [In Persian].

Highet G, Ritchie D, Platt S, Amos A, Hargreaves K, Martin C, et al. The re-shaping of the life-world: male British Bangladeshi smokers and the English smoke-free legislation. Ethn Health 2011; 16(6): 519-33.

Momenabadi V, Iranpour A, Khanjani N, Mohseni

M. Effect of educational intervention on water pipe behaviour of students in dormitories of Kerman medical university: BASNEF model. J Health Promot Manag 2015; 4(3): 12-22. [In Persian].

Joveyni H, Dehdari T, Gohari M. Waterpipe smoking in the male college students: an education intervention using theory of planned behavior. Journal of Research and Health 2013; 3(4): 497-503. [In Persian].

Dobbins M, DeCorby K, Manske S, Goldblatt E. Effective practices for school-based tobacco use prevention. Prev Med 2008; 46(4): 289-97.

Didarlou AR, Shojaeezadeh D, Mohammadian H. Planning health promotion Tehran-Iran. Tehran, Iran: Sobhan Publications; 2009.

Sohrabi F, Hadian M, Daemi H, Asgharnezhad Farid A. The effectiveness of healthy behavior training program in changing attitude of students towards substance abuse. J Behav Sci 2008; 2(3): 209-20.

Norman E, Turner S. Adolescent substance abuse prevention programs: Theories, models, and research in the encouraging 80's. J Prim Prev 1993; 14(1): 3-20.

Park E. School-based smoking prevention programs for adolescents in South Korea: a systematic review. Health Educ Res 2006; 21(3): 407-15.

Covell K. Adolescents and drug use in cape Breton: a focus on risk factors and prevention [Report]. Sydney, NS: Cape Breton Victoria Regional School Board; 2004.

Valente TW, Unger JB, Ritt-Olson A, Cen SY, Anderson Johnson C. The interaction of curriculum type and implementation method on 1-year smoking outcomes in a school-based prevention program. Health Educ Res 2006; 21(3): 315-24.

Majdzade SR, Zamani GH, Kazemi SH. Survey of tendency of Hormozgan people to using of hubble- bubble smoking and appropriate ways to combat it. Hakim Res J 2002; 5(3): 183-7. [In Persian].

Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire. Br J Addict 1991; 86(9): 1119-27.

Takano Y, Sogon S. Are Japanese more collectivistic than Americans? J Cross Cult Psychol 2008; 39(3): 237-50.

Kuper A, Kuper J. The social science encyclopedia. Milton, Abingdon: Taylor & Francis; 1996.

Dawson M, Chatman EA. Reference group theory with implications for information studies: a theoretical essay. Info Res, 2001; 6(3).

Violet D, Garland TN, Pendleton BF. High school students' marital lifestyle preferences: a test of reference group theory. Hum Relat 1986; 39(11): 1056-66.

Urberg KA, Luo Q, Pilgrim C, Degirmencioglu SM. A two-stage model of peer influence in adolescent substance use: individual and relationship-specific differences in susceptibility to influence. Addict Behav 2003; 28(7): 1243-56.

Habibi M, Besharat M A, Bahrami-Ehsan H, Rostami R, Ferrer-Wreder L. Predicting Substance use in adolescents based on risk indices and individual protective preventing, family, peers and location. Journal of Clinical Psychology 2012; 4(1): 43-53. [In Persian].

Sale E, Sambrano S, Springer JF, Turner CW. Risk, protection, and substance use in adolescents: a multi-site model. J Drug Educ 2003; 33(1): 91-105.

Mayberry ML, Espelage DL, Koenig B. Multilevel modeling of direct effects and interactions of peers, parents, school, and community influences on adolescent substance use. J Youth Adolesc 2009; 38(8): 1038-49.

Repetti RL, Taylor SE, Seeman TE. Risky families: family social environments and the mental and physical health of offspring. Psychol Bull 2002; 128(2): 330-66.

Beaglehole R, Bonita R. Global public health: A scorecard. Lancet 2008; 372(9654): 1988-96.

Momenan AA, Sarbandi Zaboli F, Etemadi A, Azizi F. Pattern of waterpipe (Ghalyan) use among intermediate and high school students: a cross-sectional study in Tehran, Iran. Payesh Health Monit 2007; 6(2): 135-44. [In Persian].

Taremian F, Bolhari J, Pairavi H, Ghazi Tabatabaeii M. The prevalence of drug abuse among university students in Tehran. Iran J Psychiatry Clin Psychol 2008; 13(4): 335-42. [In Persian].

Gillum RF. Frequency of attendance at religious services and cigarette smoking in American women and men: the Third National Health and Nutrition Examination Survey. Prev Med 2005; 41(2): 607-13.

Ahmadi K. Relationship between religious beliefs and cultural vulnerability in the family. J Behev Sci 2007; 1(1): 7-16. [In Persian].

Sapp SG, Harrod WJ. Social acceptability and intentions to eat beef: an expansion of the fishbein-ajzen model using reference group theory. Rural Sociology 1989; 54(3): 420-38.

Maziak W, Eissenberg T, Ward KD. Patterns of waterpipe use and dependence: implications for intervention development. Pharmacol Biochem Behav 2005; 80(1): 173-9.

DOI: http://dx.doi.org/10.22122/ahj.v8i2.387


  • There are currently no refbacks.