Cigarette and Water-Pipe Use in Iran: Geographical Distribution and Time Trends among the Adult Population; A Pooled Analysis of National STEPS Surveys, 2006- 2009

To assess the geographical distribution and time trends of manufactured cigarette and water-pipe use among Iranian adult population.
Pooled data from four consecutive nationally and provincially representative STEPS surveys, 2006-2009, were analyzed. Prevalence of current daily manufactured cigarette smokers, current daily water-pipe and current daily dual users and associated 95%CIs were estimated using complex sample analysis techniques.
Overall, the prevalence of current daily tobacco use, including cigarette and water-pipe, was estimated 23.7% for men and 3.0% for women, in which 20.2% of men and 0.8% of women were exclusively cigarette smokers, 2.7% and 2.2% were exclusively water-pipe users, and 0.6% and 0.01% smoked both cigarettes and water-pipes. The prevalence of cigarette smoking ranged from 12.3% to 27.7% in men and 0.1% to 1.8% in women, and was generally highest in the northwest of the country. Conversely, the prevalence of water-pipe smoking ranged from 1.7% to 10.9% in men and 0% to 16.8% in women, and was highest in the south and southeast. No secular trends were observed for daily cigarette smoking in either men (P = 0.637) or women (P = 0.308) from 2006 to 2009. However, the prevalence of water-pipe decreased slightly in women (P = 0.012) and men (P = 0.055), though the later was not statistically significant.
In Iran, widespread geographical variation in the use of different types of tobacco products should be taken into account when planning for tobacco prevention policies and programs. Iran may serve as an important setting for etiological studies to examine the effects of long-term water pipe use on diseases.