Regular Hookah smoking and associated factors among Hookah smokers in Northwest Iran

Hookah smoking has gained global popularity, particularly in the Eastern Mediterranean region and Iran, raising public health concerns. This study aimed to quantify the prevalence of regular hookah smoking among users and to identify demographic and behavioral factors associated with habitual use in Ardabil city, northwest Iran. A cross-sectional study was conducted in 2023 involving 450 hookah smokers selected through multistage sampling in Ardabil. Participants completed standardized questionnaires capturing demographic data, smoking behaviors, and related risk factors. Statistical analyses included chi-square tests, independent t-tests, and logistic regression, with significance set at p < 0.05. Regular hookah smoking prevalence was 43.4%. After adjustment, male sex (OR = 3.12, 95% CI: 1.45–6.72), single marital status (OR = 0.49, 95% CI: 0.27–0.91), history of self-injury (OR = 3.16, 95% CI: 1.73–5.77), alcohol consumption (OR = 2.78, 95% CI: 1.62–4.78), and a high tendency toward hookah use (OR = 5.68, 95% CI: 1.43–22.51) were significantly associated with regular use. Our findings reveal a substantial rate of regular hookah smoking in this population, underscoring the need for targeted interventions. Modifying social attitudes and behaviors toward hookah use may support effective prevention strategies to reduce habitual smoking rates.