The present research, as compared to the related literature, shows a worrying rate of HS among women. It seems that HS is commonplace among women as women have a more positive attitude toward HS than men. Also, as mentioned in a work of research, tobacco flavors attract women in particular (31). These can explain why quitting HS is hard for women. In their research, Danaei et al. (32) found that the majority of men intended to quit HS while the majority of women intended to continue. Considering the adverse effects of HS on women, it requires immediate measures by policy makers and local health authorities.
This study aimed to determine the behavioral and socio-demographic predictors of HS frequency among women in southern Iran. The present findings showed that almost 69% of women SHs more than twice a day. Contrary to this finding, another study found a smoking rate of 74.1% among women who SHs once a month . Compared to the related literature, the rate of SHs was higher among women in the present research [5, 33]. These divergences can be due to the differing cultural backgrounds and geographies. It appears that HS in Bandar Abbas has cultural roots and has turned into a value among local residents. In a review study, cultural issues were referred to as the main motivator of HS among women . As the researcher believes, women in Bandar Abbas perceive HS as positive and this attitude has affected their higher rate of smoking. Thus, society should take initiatives to turn the positive view of hookahs into a negative socially unacceptable behavior such as smoking cigarettes. Otherwise, when women hookah smokers perceive this behavior more acceptable than smoking cigarettes, they prefer to SHs more often.
The present research revealed that a longer duration of SHs was accompanied by a stronger tendency to SHs in women. This would point to the physical or psychological dependence on hookahs through time. In the previous body of research, physical and psychological dependence on hookah was mentioned as an underlying reason for HS [10, 35].
The present findings showed that more than half of the had a smoker family member. Moreover, women with a smoker family member tended to SHs 2.37 times as much as other women. It seems that the presence of a smoker in the family directed people more to SHs. In their research, Jamil et al.  included 245 white American adults who had at least one tobacco smoker in the family, which shows that this factor was a primary predictor of HS. Some other research indicated that HS among other family members was strongly correlated with HS by adolescents . A body of research pointed out the effect of hookah smoker family members as a reason to begin to SHs by women [38, 39]. Thus, in developing interventions to reduce the rate of HS, besides focusing on women smokers, their families should be addressed too.
The present findings revealed that about half of women HSs experienced SHs for the first time with friends. Individual who experienced HS for the first time with friends tended to SHs twice as much as others. Concerning this, a body of research explored the effect of friends/peers on HS [40, 41]. Several studies reported drug abuse among peers as a key predictor of drug abuse among adolescents especially girls [42-44]. A study among female university students found peer pressure as the strongest predictor of tobacco consumption . Some other research brought several reasons for continuing to smoke including inability to refuse friends’ suggestion to smoke and inability to help smoking in recreational places or among friends . Thus, emphasis on avoiding smoker friends and empowering people to resist the suggestions of smoker friends can tremendously reduce the rate of HS.
According to the present findings, A single-parent women or women raised by someone other than their parents tended more to SHs. Zhang et al. , maintained that smoking rules at home differ between single-parent and two-parent families. In 1995-96, there was a rate of 46% of smoke-free homes for single-parent families and 63% for two-parent families. In 2006-7, these rates were respectively 75% and 8%.This finding can be explained as those who have lost a parent for some reason have been deprived of father’s or mother’s expression of emotions. Thus, they tend to find a way to compensate for that, for instance through smoking hookahs, Also, this finding is consistent with another study .
The present research revealed that intention was a predictor of HS among women. This finding has been consistent with another study that showed that HS is primarily motivated by prior intention . The correlation between intention and behavior and more generally the effect of behavioral intention on the occurrence of high-risk behaviors has been proven in another study . Similarly, another study found that women intending to SHs commenced HS seven times as frequently as others (women without any prior) . The strong correlation between intention to SHs and the actual behavior indicates that preventive measures at this stage can lower the chance of beginning to SHs.
The present findings revealed that An increase in age is accompanied by a higher frequency of SHs among women above 30 years of age . There are several other studies with similar findings [52, 53]. Guliani et al.  reported that the older age groups showed a higher tendency to SHs and quitting tobacco was hard for them. Contrary to the present study, some other research found that an increase in age was followed by a less tendency to HS among women . These differences can be partly due to different cultural and geographical conditions. As an instance, more persistence of older people in SH can be explained by such factors as aimlessness, lower work load and duties, loneliness, more free time, positive attitude to HS and recurrent consumption over years.
The present results revealed that HS among the ever-married group was many times as frequent as the never-married. With this respect, some research found a higher rate of HS among widows and divorcees than the single individuals . Some other research, however, reported that perceived family norms of the married people can influence their intention to ease smoking . Besides, married women are more encouraged to stop smoking than the never married . Such different findings can be explained by the target geography and dominant culture as well as the type of tobacco product consumed (cigarette/hookah), because the ever married (the divorcees and widows) might be more emotionally depleted due to the loss of their spouse; similarly, the married people confront more problems than single individuals. Thus, they might show more tendency to SHs in order to regain peace of mind. A review study showed that social and psychological gaps and the need for peace are among the key determiners of HS among women .
In light of the present findings, women with a lower SES, SHs more frequently than those of higher SES. With this concern, a study revealed that the rate of tobacco smoking in low- or middle-income countries is higher than higher-income countries . Contrary to the present finding, another study found that a high SES did not led to a higher rate of SHs among women . This difference can be partly explained by different target geographies involved, and as in the context of the present research tobacco was grown for years and made available to every household at a low price. Furthermore, people with financial problems might be unable to enjoy normal recreations, which are often more expensive, making them opt for cheaper recreations. A body of research also pinpointed the affordability of hookahs as a reason why it was prevalently used [59, 60].
As the present results revealed, women with a lower schooling level have more tendency to SHs, With this respect, a related study maintained that lacking knowledge about the adverse effects of HS was a reason for SHs . Majdzadeh et al.  showed that the increasing rate of HS was due to the lower awareness of its adverse effects. Contrary to the present findings, another study observed that education did not have any protective effect on the rate of HS . This difference can be partly explained by the underlying features of the target group such as education and type of culture dominating the population.
The present research revealed that working women had a lower tendency to smoke than those not working outside home. It seems that the former had less spare time to spend on SHs. A review study also pointed out HS as a spare time activity .
As the results showed, about more than half women smokers had their first experience of HS inside the family and with relatives . With this respect, some research revealed that young Iranian women SHs without any fear of the reaction of those around them in family gatherings . Their family members were likely to have hookahs at home to use in the gatherings .
The present findings showed majority of women consumed local tobacco, but the type of tobacco did not predict the frequency of SHs. Similar to the present findings, other studies found no significant correlation between tobacco type (local/fruity) and the rate of dependence on nicotine [26, 64] . However, the findings by Griffiths et al.  on American adolescents showed that consuming fruit-flavored tobacco was due to its pleasant smell, lower perceived risk than conventional tobacco and lower perceived dependence. This divergence can be attributed to the traditional/conventional pattern of HS behavior, and as in the present research context, locally-produced tobacco is prevalently used as it is commonly cultivated in the area for years.
Strengths and limitations
The data were collected as self-rating information. There was a possibility of halo effect . Yet, the researcher attempted to reduce this effect by ensuring respondents of the confidentiality of the information they produced. Moreover, this research was conducted on women in Bandar Abbas which can limit the generalizability of findings to other geographies and target populations. To increase generalizability, attempts were made to collect the required data from different groups of women selected from different parts of the city, with different demographic features.
Another limitation of the present research is not using the nicotine dependence scale. Yet, it was attempted to include women who regularly SHs on a daily basis. It is suggested that further research employ this instrument which enjoys a higher precision to measure dependence on nicotine.
The absence of a similar study with the same purpose and research population to compare the results can be mentioned as another limitation of the present research. Yet, it was attempted to include studies that explored the same tobacco type, women population, similar behavioral variables and demographic features.
Despite that, a strength of the present research was the inclusion of old hands in HS, which can provide a more realistic picture of the actual behavior. Moreover, the present research can provide useful information for health authorities to develop effective interventions in future.