Open Access Open Badges Research article

Waterpipe smoking among health sciences university students in Iran: perceptions, practices and patterns of use

Nasim Ghafouri1, Jan D Hirsch12, Gholamreza Heydari34, Candis M Morello12, Grace M Kuo15 and Renu F Singh1*

Author Affiliations

1 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA, USA

2 Veterans Affairs San Diego Healthcare System, San Diego, CA, USA

3 Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis & Lung Disease, Tehran, Iran

5 School of Medicine Department of Family and Preventive Medicine, University of California, San Diego, CA, USA

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BMC Research Notes 2011, 4:496  doi:10.1186/1756-0500-4-496

Published: 16 November 2011



In recent years waterpipe smoking has become a popular practice amongst young adults in eastern Mediterranean countries, including Iran. The aim of this study was to assess waterpipe smoking perceptions and practices among first-year health sciences university students in Iran and to identify factors associated with the initiation and maintenance of waterpipe use in this population.


Out of 371 first-year health sciences students surveyed, 358 eight students completed a self-administered questionnaire in the classrooms describing their use and perceptions towards waterpipe smoking. Two hundred and ninety six responders met study inclusion criteria. Waterpipe smoking was common among first-year health sciences university students, with 51% of students indicating they were current waterpipe smokers. Women were smoking waterpipes almost as frequently as men (48% versus 52%, respectively). The majority of waterpipe smokers (75.5%) indicated that the fun and social aspect of waterpipe use was the main motivating factor for them to continue smoking. Of waterpipe smokers, 55.3% were occasional smokers, using waterpipes once a month or less, while 44.7% were frequent smokers, using waterpipes more than once a month. A large number of frequent waterpipe smokers perceived that waterpipe smoking was a healthier way to use tobacco (40.6%) while only 20.6% thought it was addictive. Compared to occasional smokers, significantly more frequent smokers reported waterpipe smoking was relaxing (62.5% vs. 26.2%, p = 0.002), energizing (48.5% vs. 11.4%, p = 0.001), a part of their culture (58.8% vs. 34.1%, p = 0.04), and the healthiest way to use tobacco (40.6% vs. 11.1%, p = 0.005).


Social and recreational use of waterpipes is widespread among first-year health sciences university students in Iran. Women and men were almost equally likely to be current waterpipe users. Public health initiatives to combat the increasing use of waterpipes among university students in Iran must consider the equal gender distribution and its perception by many waterpipe smokers as being a healthier and non-addictive way to use tobacco.