A systematic review of the factors affecting women's tendency to use hookah

Statistics around the world show an increase in hookah smoking among women compared to men. The present review was designed to determine the factors affecting hookah smoking in women around the world.

The present study is a systematic review that was conducted in 2020 by searching in databases including Web of Science, PubMed, Iranian Databases, Elsevier,Scopus, Medline, Google scholar, Magiran, SID, and Iranmedex in both Persian and English language. All published articles from 1990 to 2021 were included in the study.Selection methods for study: Inclusion criteria were articles that targeted women and examined hookah smoking. Exclusion criteria were studies with indivisible reporting of results in men and women, intervention studies, and studies that examined the relationship between demographic information and hookah smoking.

The most common reasons for hookah smoking in women at the individual level included a positive attitude towards hookah smoking, low self-efficacy, hookah dependence, psychological needs and  pleasant taste of tobacco and at the interpersonal level the reasons included hookah innovations and attractiveness, abstract norms, the absence of hookah smoking baning laws, easy access, cultural norms, media propaganda, economic challenges, the influence of powerful actors, the dynamics of the tobacco industry, the non-participatory policies of the government, and the cultural invasion of foreign countries.

Eliminating womenchr('39')s positive attitudes, strengthening the skills of saying no to the friends, and focusing and intervening effectively on out of individualchr('39')s control environmental factors can play an effective role in reducing hookah use.