Sociocultural factors contributing to hookah tobacco smoking amongadolescents and young adult women

Background: Tobacco smoking is a major health challenge accounting for more than sevenmillion deaths throughout the world. Hookah tobacco smoking (HTS) is currently a serious andgrowing public health threat in the world, especially in adolescents and young women. The aim ofthe study was to explore sociocultural factors contributing to HTS among adolescents and youngadult women in Iran.Methods: This qualitative study was conducted from August ۲۰۱۷ to January ۲۰۱۹ in Isfahan andHamadan cities, Iran; it included ۱۳–۳۰-year-old females with experience of HTS. For datacollection, in-depth semi-structured personal interviews were conducted at participants’ preferredtime and place. Concurrent with data collection, data were analyzed through conventional contentanalysis.Results: Overall, ۴۲ persons participated in this study. Thirty- four participants were adolescentand young adult women with HTS experience and with mean (SD) age of ۲۲.۹۷ (۴.۸۹) years, onaverage. Twenty-nine of these women (۸۵%) still smoked waterpipe tobacco at the time of thestudy, while five of them had ceased HTS. The remaining eight participants were two mothers, onegirlfriend, and one boyfriend, two male hookah tobacco smokers who worked in hookah bars, onefemale teacher, and a male smoking control staff. The study participants described the varioussociocultural factors contributing to HTS. These factors were categorized into four following maincategories: hookah glamorization by its producers and sellers, media advertisement or silence,common sociocultural traditions, and governmental policies and regulations.Conclusion: A wide range of sociocultural factors affects HTS among Iranian adolescents andyoung adult women. Therefore, interdisciplinary multidimensional strategies are needed for HTSmanagement and prevention among these at-risk groups. Public education, strict supervision oftobacco import, export, and selling, ample employment opportunities for young people andeffective leisure time management are essential to reduce HTS