Journal of Community Health

, Volume 35, Issue 1, pp 36–42 | Cite as

Lifestyle-Related Determinants of Hookah and Cigarette Smoking in Iranian Adults

  • Nizal Sarrafzadegan
  • Nafiseh Toghianifar
  • Hamidreza Roohafza
  • Zahradana Siadat
  • Noushin Mohammadifard
  • Jennifer O’Loughlin
Original Paper


To identify lifestyle-related determinants of hookah and cigarette smoking in Iranian adults, a total of 12,514 men and women aged ≥19 years in three counties in central Iran (Isfahan, Najafabad, Arak) were selected in multistage random sampling. Data on socio-demographic characteristics and lifestyle were collected in interviewer-administered questionnaires, as part of the baseline survey of the Isfahan Healthy Heart Program. Unhealthy lifestyle-related factors independently associated with cigarette and hookah smoking, were identified in sex-specific multivariate logistic regression analyses. High stress levels (OR: 1.55; 95% CI: 1.35–1.78 for men; OR: 1.63; 95% CI: 1.17–2.27 for women), family member smoking (OR: 1.61; 95% CI: 1.27–4.92 for men; OR: 2.49; 95% CI: 2.20–2.95 for women), and short/long sleep duration (OR: 1.18; 95% CI: 1.01–1.39 for men; OR: 1.52; 95% CI: 1.10–2.35 for women) were associated with cigarette smoking in both men and women. Poor diet was also related to cigarette smoking in men (OR: 1.55; 95% CI: 1.62–1.89). Family member smoking was associated with hookah smoking in both men (OR: 1.16; 95% CI: 1.05–3.12) and women (OR: 1.56; 95% CI: 1.02–4.92), and in addition high stress levels (OR: 2.87; 95% CI: 1.14–5.83) and short/long sleep duration (OR: 1.07; 95% CI: 1.02–2.41) were associated with hookah smoking in women. Unhealthy lifestyle-related factors co-occur with cigarette and hookah smoking in Iranian adults, likely increasing the risk for chronic health problems. Sex differences in the determinants of hookah and cigarette smoking may need to be taken into account in planning tobacco control strategies.


Tobacco use Hookah Life style Iran 



The authors thank the scientific and executive collaborators of the IHHP, and in particular Dr. Ahmad Bahonar for his technical support. The authors also thank Miss Hengameh Noori for her help with data management. Jennifer O’Loughlin holds a Canada Research Chair in the Early Determinants of Adult Chronic Disease.


  1. 1.
    WHO study Group on Tobacco Product Regulation (TobReg). (2005). Waterpipe, tobacco smoking: Health effects, research needs and recommended actions by regulators. World Health Organization. Tobacco Free Initiation.Google Scholar
  2. 2.
    Global Youth Tobacco Survey Collaborative. (2002). Tobacco use among youth: A cross-country comparison. Tobacco Control, 11, 252–270.CrossRefGoogle Scholar
  3. 3.
    Maziak, W., Ward, K. D., Afifi Soweid, R. A., & Eissenberg, T. (2004). Tobacco smoking using a waterpipe: A re-emerging strain in a global epidemic. Tobacco Control, 13, 327–333.CrossRefPubMedGoogle Scholar
  4. 4.
    Shihadeh, A. (2003). Investigation of mainstream smoke aerosol of the argileh water pipe. Food and Chemical Toxicology, 41, 143–152.CrossRefPubMedGoogle Scholar
  5. 5.
    Bedwani, R., el-Khwsky, F., Renganathan, E., Braga, C., Abu Seif, H. H., Abul Azm, T., et al. (1997). Epidemiology of bladder cancer in Alexandria, Egypt: Tobacco smoking. International Journal of Cancer, 73(1), 64–67.CrossRefGoogle Scholar
  6. 6.
    El-Hakim, I. E., & Uthman, M. A. (1999). Squamous cell carcinoma and keratoacanthoma of the lower lip associated with “Goza” and “Shisha” smoking. International Journal of Dermatology, 38, 108–110.CrossRefPubMedGoogle Scholar
  7. 7.
    Ashmawi, M. (1993). Some predictive markers of artherosclerosis among smokers. Ain Shams Medical Journal, 44, 633–639.Google Scholar
  8. 8.
    Jabbour, S., El-Roueiheb, Z., & Sibai, A. M. (2003). Narghile (water-pipe) smoking and incident coronary heart disease: A case–control study. Annals of Epidemiology, 13, 570.CrossRefGoogle Scholar
  9. 9.
    Knishkowy, B., & Amitai, Y. (2005). Waterpipe (narghile) smoking: An emerging health risk behavior. Pediatrics, 116(1), e113–e119.CrossRefPubMedGoogle Scholar
  10. 10.
    Maziak, W., Eissenberg, T. E., & Ward, K. D. (2004). F actors related to level of narghile use: The first insights on tobacco dependence in narghile users. Drug and Alcohol Dependence, 76, 101–106.CrossRefPubMedGoogle Scholar
  11. 11.
    Kulwicki, A., & Rice, V. H. (2008). Arab American adolescent perceptions and experiences with smoking. Public Health Nursing, 20(3), 177–183.CrossRefGoogle Scholar
  12. 12.
    Maziak, W., Eissenberg, T., Rastam, S., Hammal, F., Asfar, T., Bachir, M. E., et al. (2004). Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria. Annals of Epidemiology, 14, 646–654.CrossRefPubMedGoogle Scholar
  13. 13.
    WHO Report on the Global Tobacco Epidemic: The MPOWER package. (2008). Geneva: WHO, pp. 14–21.Google Scholar
  14. 14.
    Mohammad, K., Noorbala, A. A., Majdzadeh, S. R., & Karimloo, M. (2000). Trend of tobacco smoking in Iran 1991–2000. Hakim Research Journal, 3(4), 290–297.Google Scholar
  15. 15.
    Sarraf-Zadegan, N., Boshtam, M., Shahrokhi, S., Naderi, G. A., Asgary, S., Shahparian, M., et al. (2004). Tobacco use among Iranian men, women and adolescents. European Journal of Public Health, 14, 76–78.CrossRefPubMedGoogle Scholar
  16. 16.
    Sarrafzadegan, N., Baghaei, A., Sadri, Gh., Kelishadi, R., Malekafzali, H., Boshtam, M., et al. (2006). Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevention and Control, 2, 73–84.CrossRefGoogle Scholar
  17. 17.
    Sarraf-Zadegan, N., Sadri, G., Malek Afzali, H., Baghaei, M., Mohammadi Fard, N., Shahrokhi, S., et al. (2003). Isfahan Healthy Heart Programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Acta Cardiologica, 58(4), 309–320.CrossRefPubMedGoogle Scholar
  18. 18.
    World Health Organization. (1998). Guidelines for controlling and monitoring the tobacco epidemic. Geneva: WHO.Google Scholar
  19. 19.
    Maziak, W., Eissenberg, T. E., & Ward, K. D. (2004). Factors related to level of narghile use: The first insights on tobacco dependence in narghile users. Drug and Alcohol Dependence, 76(1), 101–106.CrossRefPubMedGoogle Scholar
  20. 20.
    Leparki, E., & Nussel, E. (1987). CINDI: Contrywide integrated non-communicable diseases interventional programme: Protocol and guidelines for monitoring and evaluation procedures (pp. 73–82). Berlin: Springer.Google Scholar
  21. 21.
    Centers for Disease Control and Prevention. Sleep and sleep disorders. [].
  22. 22.
    Physical Activity and Health. A Report of the Surgeon General Executive Summary. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. [].
  23. 23.
    Goldberg, D. (1992). General Health Questionnaire (GHQ-12). UK: NFER-Nelson Windsor.Google Scholar
  24. 24.
    French, S. A., Hennrikus, D. J., & Jeffery, R. W. (1996). Smoking status, dietary intake, and physical activity in a sample of working adults. Health Psychology, 15, 448–454.CrossRefPubMedGoogle Scholar
  25. 25.
    Larson, N. I., Story, M., Perry, C. L., Neumark-Sztainer, D., Hannan, P. J., & Stat, M. (2007). Are diet and physical activity patterns related to cigarette smoking in adolescents? Findings from project EAT. Preventing Chronic Disease, 4(3), A51.PubMedGoogle Scholar
  26. 26.
    Tamim, H., Terro, A., Kassem, H., Ghazi, A., Khamis, T. A., Abdul Hay, M. M., et al. (2003). Tobacco use by university students, Lebanon, 2001. Addiction, 98, 933–939.CrossRefPubMedGoogle Scholar
  27. 27.
    WHO Regional Office for the Eastern Mediterranean. (2006). Tobacco use in shisha: Studies on waterpipe smoking in Egypt. World Health Organization: Egyptian Smoking Prevention Research Institute.Google Scholar
  28. 28.
    Greenlund, K. J., Liu, K., Knox, S., McCreath, H., Dyer, A. R., & Gardin, J. (1995). Psychosocial work characteristics and cardiovascular disease risk factors in young adults: The CARDIA study. Coronary artery risk disease in young adults. Social Science and Medicine, 41, 717–723.CrossRefPubMedGoogle Scholar
  29. 29.
    Van Loon, A. J. M., Tijhuis, M., SuTtees, P. G., & Ormel, J. (2005). Determinants of smoking status: Cross-sectional data on smoking initiation and cessation. European Journal of Public Health, 15, 256–261.CrossRefPubMedGoogle Scholar
  30. 30.
    McCaffery, J. M., Papandonatos, G. D., Lyons, M. J., Koenen, K. C., Tsuang, M. T., & Niaura, R. (2007). Educational attainment, smoking initiation and lifetime nicotine dependence among male Vietnam-era twins. Psychological Medicine, 22, 1–11.Google Scholar
  31. 31.
    Sidney, S., Sternfeld, B., Haskell, W. L., Jacobs, D. R., Jr., Chesney, M. A., & Hulley, S. B. (1996). Television viewing and cardiovascular risk factors in young adults: The CARDIA study. Annals of Epidemiology, 6(2), 154–159.CrossRefPubMedGoogle Scholar
  32. 32.
    Phillips, B. A., & Danner, F. J. (1995). Cigarette smoking and sleep disturbance. Archives of Internal Medicine, 155(7), 734–737.CrossRefPubMedGoogle Scholar
  33. 33.
    Rapp, K., Buechele, G., & Weiland, S. K. (2007). Sleep duration and smoking cessation in student nurses. Addictive Behaviours, 32(7), 1505–1510.CrossRefGoogle Scholar
  34. 34.
    Riedel, B. W., Durrence, H. H., Lichstein, K. L., Taylor, D. J., & Bush, A. J. (2004). The relation between smoking and sleep: The influence of smoking level, health, and psychological variables. Behavioral Sleep Medicine, 2(1), 63–78.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Nizal Sarrafzadegan
    • 1
  • Nafiseh Toghianifar
    • 2
  • Hamidreza Roohafza
    • 2
  • Zahradana Siadat
    • 3
  • Noushin Mohammadifard
    • 4
  • Jennifer O’Loughlin
    • 5
  1. 1.Isfahan Cardiovascular Research Center, Isfahan University of Medical SciencesIsfahanIran
  2. 2.Tobacco Control UnitIsfahan Cardiovascular Research Center, Isfahan University of Medical SciencesIsfahanIran
  3. 3.Epidemiology DepartmentIsfahan Cardiovascular Research Cente, Isfahan University of Medical SciencesrIsfahanIran
  4. 4.Nutrition DepartmentIsfahan Cardiovascular Research Center, Isfahan University of Medical SciencesIsfahanIran
  5. 5.Department of Community HealthMontreal General HospitalMontrealCanada

Personalised recommendations