The KCS data helped to conclude that HS was the most prevalent tobacco type (17.6%) compared to cigarettes (9%). Age, gender, education, alcohol consumption and ETS showed to be the main predictors of hookah and cigarette smoking. Marital status, place of residence and psychiatric disorders were predictors of HS only and BMI and drug abuse showed to be predictors of cigarette smoking only.
In the present research, the prevalence of cigarette smoking was .30% and 20.80%, respectively, among women and men. The overall prevalence was 9%. In their research, Abdollahpour et al. reported the rate of cigarette smoking to be 41.07% and 32.68% among women and men, respectively . This reported rate was higher than the present findings. Drope et al. found that 14.2% of men and .4% of women were cigarette smokers. This rate among men showed to be lower than the present research, but about women it was consistent with the present findings . The prevalence of HS in the present research showed to be 13.70% and 23% among women and men, respectively. The overall rate of HS was found to be 17%. It seems that in the south of Iran, HS is more prevalent than cigarettes, which is consistent with their local culture. Thus, hookah showed to be the commonest tobacco type consumed in this region. It is socially accepted especially among women . In a cross-sectional study in Tehran, the prevalence of HS showed to be 17.6% among 1,830 participants, which is consistent with the present findings . This is a higher rate than that of adults in the U.S. (.6%) . and lower than a similar research in Kuwait which reported the prevalence of HS 79.9% and 21.1% among women and men, respectively . Different geographical contexts and demographic information makes the comparison of information difficult. Yet, the prevalence of hookah and cigarette smoking in the present research was higher than the Iranian national report by Nemati et al. (5.6% vs. .3%). The prevalence of exposure to ETS in the present research was found to be 15.1% and 19.8% among women and men, respectively. This rate is lower than the works of research by Abdollahpour et al. (4) and Zeng et al. These divergences can be explained partly by the different national rules and regulations in different countries and demographic features.
The logistic regression analysis in the present research showed that masculinity increased the risk of HS for about 1.83 times as high. These findings are similar to the results of other studies in Iran and foreign countries [25–27]. Contrary to the present findings, a body of research showed that the prevalence of HS among women was higher than men [28, 29]. Another study showed to gender-based difference in the prevalence of HS . These divergent findings can be partly attributed to the idiosyncratic cultural, geographical differences, gender distribution, features of the target population and sample size. It is noteworthy that though in the present research the prevalence of HS is higher among men than women, among women, HS is significantly more prevalent than consuming cigarettes, alcohol or drugs. The difference showed to be statistically significant. This would point to the fact that HS is more socially acceptable in Bandar-e-Kong population. The results of an extensive survey in 2007 in Iran showed that from among tobacco types (hookah, pipe and cigarette), more than half of women (1.9% out of 3.2%) consumed hookahs among all tobacco types. It seems that HS is rooted in public culture for long in the south of Iran especially in Hormozgan, and has turned into a local cultural value. It is a socially accepted behavior . Thus, public awareness-raising through mass media and enculturation of the adverse effects of HS seems to be essential. HS needs to be considered as a detrimental social behavior as cigarettes and other addictive drugs are.
The present findings showed that tobacco consumption, alcohol consumption and drug abuse are more prevalent among men than women and this divergence showed to be statistically significant. A body of research also reported the higher prevalence among men [4, 32–34]. Internalization of gender roles in participants and sociocultural acceptance of cigarettes and drugs among men can be part of the reason for the higher prevalence of smoking by male population . Contrary to the present findings, another study no difference was found across genders in terms of alcohol consumption and drug abuse. This difference can be partly due to the age range and other idiosyncrasies of the target population and cultural and ethnic differences even within the country. It is further noteworthy that overall at the global scale, men are more prone to detrimental habits than women. The former tend to underestimate the detriments of drug abuse more than the latter . Particularly in more conservative communities, where women are more controlled than men, access to cigarettes, alcohol and drugs is harder for women, and consuming such stuff is deemed culturally unacceptable for women in Islamic countries .
The present research showed that women are more exposed to ETS at home, than men. In some other research, Al-Zabadi et al. in Palestine observed that more than half of the participants admitted that a family member or a spouse also consumed tobacco and they, thus, were exposed to ETS . Contrary to the present findings, Skorge et al., Alamgir Kabir et al. showed that men are more exposed to ETS than women. This divergence can be explained by the fact that Skorge et al. and Alamgir Kabir explored ETS at work and public places. Women are mostly housewives and are, thus, less exposed to ETS. Besides, different social and cultural features of different countries can account for such divergences. These findings can be explained by the fact that the sociocultural idiosyncrasies of Iran has led to the higher prevalence of cigarette smoking in men than women. Consequently, those in the vicinity of smokers, primarily women and children, are more exposed to ETS. Raising smokers’ and non-smokers’ awareness of the adverse effects of ETS at home can be an effective strategy with this concern.
In the present research, men are significantly more exposed to ETS at work than women. This finding is consistent with a body of research by Skorge et al., Alamgir Kabir et al. and Akansha Singh. This would point to the gender-related differences in occupation. Probably a higher percentage of men are employed than women. Thus, it is not far from expectation that men are more exposed to ETS at work. It seems that there is a strong need for smoke-free rules and regulations at work, as it is essential to optimally take care of smokers and non-smokers by providing a smoke-free environment .
The present research revealed that the beginning age of smoking cigarettes was lower among men than women. A body of research also reported the same finding[4, 43]. This finding can be explained by men’s more freedom of action in family and society and their more active social role. During adolescence and adulthood, the male enjoy more social presence under less supervision. However, the female are more controlled in family, which can be part of the reason for this gender-based difference. A relevant study showed that stricter family control over men is less effective than on women in ceasing alcohol or tobacco consumption and other illicit drugs .
Furthermore, the present findings revealed that an increase in age is followed by a decrease in tendency to smoke cigarettes and hookahs. In other words, the young showed a stronger tendency to smoke [25, 45, 46]. Contrary to the present research, another study reported a higher rate of TU at a higher age [4, 47, 48]. This divergence might be explained by different features of the target populations and the age ranges. Moreover, probably the emergence of diseases following an increase in age and prohibited use and a better understanding of risks associated with drug abuse or other forms of TU lowered the rate of consumption.
As the present findings showed, HS showed to prevail more among widows and divorcees than the single. Some other studies reported similar findings too (49, 50). As reported in some work of research, perceived family norms among the married can be effective in intention to cease TU (51). Similarly, in another study, married women showed to be encouraged to cease TU more than the single. This finding can be explained by the fact that widows and divorcees might suffer more emotional and social deficiencies due to their loss than others. Thus, they might have appealed to smoking drugs to relieve their mind.
Another finding was that a higher level of education was associated with less cigarette or hookah smoking. In a similar vein, a body of research showed that lower level of education was a key reason for tendency to illicit drugs[49, 50]. Contrary to this finding, in some other works of research, higher education showed no protective effect on the rate of TU [26, 51]. These differences can be partly explained by the quality of items within the questionnaire, participants’ education level and different sociocultural features. In addition, lower level of education can lower health literacy and then result in unawareness of consequences and actual risks of drug abuse which pave the way for the occurrence and continuation of addictive behaviors .
The results also showed that rural residence was a predictor of HS. Another study reported that more than half of rural residents accepted TU at home. Still, some other research reported that rural residence was marked by a twofold rate of cigarette smoking. This higher prevalence can be partly attributed to the existing gap of knowledge in rural areas in comparison to urban counterparts. Another reason might be that tobacco control and regulatory efforts are not implemented as strictly as cities in rural areas. This finding points to the essentiality of greater attention to rural communities as a vulnerable population whole exploring the effective and fair tobacco control and other health-related policies.
The present findings showed that alcohol consumption was a predictor of cigarette and hookah smoking. Other investigations also reported higher chances of hookah and cigarette smoking among alcohol consumers[4, 56]. Occasionally, alcohol consumption and cigarette smoking develop simultaneously. In other words, it seems that alcohol consumption expose people more to cigarette and hookah consumption. As it was expected, lifetime drug abuse correlated with cigarette smoking. Concerning this, a number of studies pointed to the strong association of the history of cigarette smoking and illicit drugs [57, 58]. Moreover, exposure to ETS correlated with hookah or cigarette smoking. Probably, those exposed to ETS showed a stronger tendency to TU. In a similar vein, some investigations found exposure to ETS as a factor involved in TU[18, 56]. Another explanation might be that those exposed to ETS might become more curious to try smoking . Still, another finding was that psychiatric disorders could predict HS among the participants. Similarly, some other researchers reported the prevalence of HS among people of psychiatric disorders such as depression and stress[4, 60]. Furthermore, an increase in BMI was followed by a decrease in the rate of cigarette smoking. Similarly, a body of related research showed that cigarette smokers had a lower BMI than non-smokers. In other words, BMI and cigarette smoking correlated negatively and this correlation was statistically significant [61, 62]. Contrary to the present findings, some other research indicated that a higher BMI was accompanied by more chances of beginning to smoke earlier and more frequently. Yet, the cross-sectional nature of the research limits a causal relation claim among drug abuse, alcohol consumption, ETS, psychiatric disorders, BMI and hookah and cigarette smoking. These interrelations still need more longitudinal and in-depth investigations.