Waterpipe Tobacco Smoking among Iranian Adults During COVID-19 Pandemic

Background: In the early days of the pandemic, the rise in COVID-19 cases prompted many governments to lockdown the waterpipe-serving venues, which may affect the patterns of use among this centuries-old tobacco product. Here, we studied the pattern of WP smoking among Iranian adults during the COVID-19 epidemic.Methods: In this cross-sectional study, we conducted an online survey among sample of 213 waterpipe(WP) smokers who were selected by convenience sampling method from the Golestan province, in Northern Iran using WP smoking patterns, Lebanese Waterpipe Dependence Scale, 11 (LWDS11), and selected demographic variables. Collected data comprises demographic and WP smoking patterns during COVID-19.Results: About 70% of participants reduced their WP use compared to the time before COVID-19, modestly due to pandemic effects. Around 38.5% of the subjects believed WP bars were covertly operating during the lockdown and continued serving their customers. Singles and less educated adults had lower mean attitude scores regarding the decrease in WP smoking during the COVID-19 pandemic (P<0.05). Structural equation analysis revealed that the immune system improvement with WP smoking had the strongest effect. (0.74). A strong inverse correlation exists between the WP dependence level and the negative belief toward WP smoking during the COVID-19 epidemic (r=-0.66, P<0.001).Conclusion: There is a clear need for appropriate interventions to change the belief of WP smokers regarding the dangers of this practice during the COVID-19 outbreak, particularly among single people and those with lower levels of education. Furthermore, regulatory authorities should exercise stricter controls to ensure the complete closure of WP bars.