Psycho‑social Needs Impact on Hookah Smoking Initiation among Women: A Qualitative Study from Iran

Background: In Iranian women, the use of hookah is the most common method of tobacco smoking. This study aimed to find the role of psycho‑social needs and gaps as a possible risk factor for hookah smoking initiation in women. Methods: This qualitative study was conducted during 2012–2013 in Tehran, Iran. Thirty‑six women participated in the study. They were current or former users of hookah. Data were collected through in‑depth individual interviews and was analyzed through content analysis. Results: Four main categories were identified from the data. This study focused on the category: Psycho‑social needs and gaps. This category has five sub-categories which explain why women begin to smoke hookah including curiosity; desire for non‑feminine, forbidden, and negative activities; need for amusement and recreation; for others: To show off; attract attention; satisfy and join others and protection. Conclusions: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Keeping young girls and women away from seemingly happy gatherings of hookah smokers; Providing appropriate recreational facilities for young women and training families on how to help their children in the event of a crisis‑like intention to take up smoking behavior, can be some effective ways for reducing hookah smoking initiation among women.