Factors Related to Hookah Smoking Among the Iranian Population: A Systematic Review

Hookah smoking has become prevalent, especially among the Iranian population. Knowing the associated factors is essential in designing preventive interventions. This systematic review was conducted to consolidate the factors linked to hookah smoking in the Iranian people.

This study searched 3 Iranian databases—Magiran, SID, and IranMedex—for articles in Persian and 4 international databases—Scopus, PubMed, Web of Science, and Google Scholar, for articles in English. The search spanned from April 23, 2023, using the keywords “waterpipe,” “hookah,” “goza,” “shisha,” “hubble bubble,” “narghile or smoking,” and “predictive factors or predictors.” This review followed the PRISMA (the preferred reporting items for systematic reviews and meta-analyses) framework.

The review included 16 studies (7 English papers and 8 Persian articles). Based on these studies, positive attitudes towards hookah smoking, subjective norms, self-efficacy, perceived threat, socializing with friends, passing leisure time, entertainment, unemployment, pleasant feeling, reducing anxiety and fatigue, and easy access to hookah were related to hookah smoking.

The synthesized evidence from this systematic review highlights the influence of social, cultural, and contextual factors, such as unemployment, anxiety, fatigue, and easy access, on hookah smoking in Iran. Incorporating the above factors in designing and implementing public health interventions might effectively deter hookah use among Iranians.