Mal J Med Health Sci 13(1): 45-53, Jan 2017 45 Malaysian Journal of Medicine and Health Sciences (ISSN 1675-8544) Original Article Prevalence and Predictors of Water Pipe (Shisha) Use among Iranian High School Children Mahtab Mohammadi 1 , Lekhraj Rampal 1 , Sherina Mohd Sidik 2 , Normala Ibrahim 2 , Hejar Abd. Rahman 1 , Ali Ghaleiha 3 1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia 2 Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia 3 Department of psychiatry, Faculty of Medicine, Hamedan University of Medical Sciences, Iran ABSTRACT Introduction: Water pipe use is becoming increasingly common among Iranian adolescents. This study examined the prevalence and predictors of water pipe use among public high schoolchildren aged 14-17 in Iran. Methods: A cross-sectional study was conducted among 1st, 2nd and 3rd grade public high schoolchildren in Sanadaj City, capital of Kurdistan province of Iran during the academic year 2012-2013. Cluster sampling was used to select a sample from 8 public high schools. The data were collected using validated self-administrated questionnaire that included questions on water pipe use, socio-demographic characteristics, smoking-related knowledge, attitude toward smoking, normative believes regards perceived prevalence water pipe use among peer and adults, perception of harm, self-esteem and refusal skill. A multivariate logistic regression analysis was performed to assess predictors of water pipe use. Results: A total of 1837 students participated in this study. Students’ ages ranged from 14 to 17 years (mean age±15.09; SD±0.82 years). The overall prevalence of ever water pipe use was 36.2% (43.1% in male and 29.2% in female, (p<0.001). Age, gender, living arrangement, pocket money, academic grade, parental history of smoking, attitude, and normative believes regards perceived prevalence water pipe use among peer and adults were predictors of water pipe use among study participants. Conclusions: The overall prevalence of water pipe is high among high school children in Sanandaj. Age, gender, pocket money, academic grade, parents smoking, attitude toward smoking and normative believes were identified as the most important predictors increasing the risk of water pipe use in the studied students. Keywords: Water pipe use, Prevalence, Predictors of Water Pipe, High school children Corresponding Author Mahtab Mohammadi Tel: +98918372349 E-mail: mahtab502@gmail.com INTRODUCTION Tobacco use remains a serious threat to public health globally and smoking-related diseases are considered the world’s most preventable cause of mortality and morbidity (1). Worldwide, tobacco use causes about 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030 (2). The latest worldwide outspread of water pipe use by adolescents and young adults to smoke tobacco poses a new challenge for the tobacco control (3). The increasing water pipe use is a burgeoning public health crisis and is associated with multiple health problems, including addiction, various cancers and pulmonary disease (4, 5). Water pipe is a device used for smoking tobacco involves passing tobacco smoke through water before inhalation (6). The common structure of the device that used for water pipe smoking is shown in Figure 1. One session of water pipe use contains approximately 200 puffs of smoke, which exposes water pipe users to 3- to 6-fold higher levels of carbon monoxide and 46-fold higher levels of tar than from a single cigarette (7). Today water pipe tobacco comes with variety of flavours which results for users to have lots of alternative. These various flavours which are highly popular are used among many people without taking into account its consequences. This popularity of water pipe use might be partially due to misconceptions about the harmful effects of water pipe smoking and social acceptability of the practice, as compared with cigarette smoking (8, 9).