Determinants of Waterpipe Smoking Among Women: A Systematic Review

Saeed Bashirian, Majid Barati, Manoochehr Karami, Behrooz Hamzeh, Maryam Afshari, Elahe Ezati


Background: The present study aimed to assess the determinants of waterpipe smoking among women based on a systematic review regarding the increasing prevalence of waterpipe smoking in women and the tendency of them to this type of tobacco.

Methods: The present study was a systematic review. The search strategies were based on using a combination of MeSH and free‑text terms. Searches were performed in Iranian databases and PubMed, ScienceDirect, Web of Science, EMBASE, Scopus and Medline. Databases inclusion criteria included articles and gray literature in English or Persian, published between January 2000 and December 2018. The keywords were related to women and waterpipe and related terms. The quality of the articles was assessed using the EPHPP tool.

Results: In the initial search, out of 1027 articles, 15 articles were studied. Inclusion criteria in this study were the target population of women and girl and descriptive and qualitative studies on waterpipe use among women. The mean prevalence of waterpipe smoking in quantitative studies was 13.980/0. Studies have shown that waterpipe smoking in women is influenced by several individual (awareness, favorable attitudes, and positive prototype), interpersonal (role of family and friends), and socio‑political factors.

Conclusions: Due to the influence of various determinants on women’s inclination to waterpipe smoking, there is a necessity to act and impose interventions such as lessening women’s favorable attitude toward waterpipe, increasing women’s awareness, encouraging negative prototype about waterpipe smoking, and restricting access to tobacco products that can be useful. Interpersonal factors such as the role of family and friends are one of the major determinants in waterpipe smoking. It seems that developing the skill of saying “no” to the pressure of friends can help prevent waterpipe use. Furthermore, educating the family about the risks of waterpipe use is an effective strategy in this respect.


Determinants; waterpipe smoking; women

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