Prevalence of Waterpipe Smoking in Iran: A Systematic Review and Meta-analysis

Background: Considering the prevalence of waterpipe smoking (WPS) among the majority of people, it is necessary to identify the cause of this behavior. Therefore, this meta-analysis study aimed at evaluating the prevalence of waterpipe consumption in Iran based on province, education level, and gender subgroups. Materials and Methods: The search was conducted based on the PRISMA guideline. Scopus PubMed, SID, and Irandoc databases were used to retrieve papers related to the prevalence of WPS in Iran from January 1, 2005 to May 10, 2022. The keywords were "air pollution" OR "particulate matter" OR "water-pipe" OR smoking OR "Indoor air" and "Prevalence" OR "Incidence" AND "Iran". The prevalence of WPS was meta-analyzed based on province, gender, and education level subgroups in the random effects model. Results: According to the final included papers (17 articles and 48 data reports), the rank order of provinces based on the prevalence of WPS was Kerman (58.30%)>Tehran (52.38%)>Sistan and Baluchistan (42.29%)>Hormozgan (30.69%)>Yazd (24.13%)>Bushehr (19.47%)>Ardabil (19.00%)>Fars (16.37%)>Khuzestan (11.38%). The rank order of education level of participants based on the prevalence of WPS was college education (55.64%)>Student (43.47%)>University Student (17.69%). Finally, the rank order of gender of participants based on the prevalence of WPS was male (31.75%) ~ female (30.99%). Conclusion: The results demonstrated a high prevalence of WPS. It is a multi-predictor and multilevel phenomenon in several aspects. The impact of geographical location and education levels was clearly visible. There was no difference in the gender-specific gap for WPS. Regarding the substantial effects of WPS prevalence on health, regular surveillance, prevention, intervention, and control are necessary.