title: Waterpipe smoking among health sciences university students in Iran: perceptions, practices and patterns of use.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA, USA. rfsingh@ucsd.edu.
authors.forename: Nasim
authors.initials: N
authors.lastname: Ghafouri
authors.forename: Jan D
authors.initials: JD
authors.lastname: Hirsch
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Heydari
authors.forename: Candis M
authors.initials: CM
authors.lastname: Morello
authors.forename: Grace M
authors.initials: GM
authors.lastname: Kuo
authors.forename: Renu F
authors.initials: RF
authors.lastname: Singh
references.citation: Subst Use Misuse. 2010 Jun;45(7-8):1245-61
references.pmid: 20441461
references.citation: Prev Med. 2006 Jun;42(6):423-6
references.pmid: 16624397
references.citation: Atmos Environ (1994). 2010 Jan 1;44(1):8-14
references.pmid: 20161525
references.citation: J Infect Public Health. 2010 Dec;3(4):179-87
references.pmid: 21126722
references.citation: Harm Reduct J. 2010 May 24;7:10
references.pmid: 20497563
references.citation: Int J Public Health. 2011 Apr;56(2):175-80
references.pmid: 20020176
references.citation: Med Princ Pract. 2010;19(5):390-4
references.pmid: 20639664
references.citation: BMC Public Health. 2005 Feb 25;5:19
references.pmid: 15733316
references.citation: Nicotine Tob Res. 2009 Jul;11(7):806-11
references.pmid: 19420278
references.citation: Am J Prev Med. 2009 Dec;37(6):518-23
references.pmid: 19944918
references.citation: Public Health. 2005 May;119(5):400-4
references.pmid: 15780328
references.citation: Int J Public Health. 2007;52(3):173-9
references.pmid: 17958284
references.citation: Nicotine Tob Res. 2007 Oct;9(10):987-94
references.pmid: 17943617
references.citation: Int J Tuberc Lung Dis. 2003 Sep;7(9):860-5
references.pmid: 12971670
references.citation: Med Princ Pract. 2008;17(6):435-9
references.pmid: 18836270
references.citation: Pharmacol Biochem Behav. 2005 Jan;80(1):173-9
references.pmid: 15652393
references.citation: J Community Health. 2010 Feb;35(1):36-42
references.pmid: 19866347
references.citation: BMC Public Health. 2011 Apr 19;11:244
references.pmid: 21504559
references.citation: Prev Med. 2004 Apr;38(4):479-84
references.pmid: 15020182
references.citation: Ann Epidemiol. 2004 Oct;14(9):646-54
references.pmid: 15380795
references.citation: Int J Epidemiol. 2010 Jun;39(3):834-57
references.pmid: 20207606
references.citation: Int J Tuberc Lung Dis. 2011 Jun;15(6):844-7
references.pmid: 21575309
references.citation: Arch Iran Med. 2009 May;12(3):232-7
references.pmid: 19400599
references.citation: Eur J Public Health. 2004 Mar;14(1):76-8
references.pmid: 15080396
references.citation: BMC Public Health. 2004 Aug 04;4:32
references.pmid: 15294023