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Arch Iran Med. 2018 Sep 1;21(9):418-424.

The Gap of Cigarette and Hookah Smoking Between Socioeconomic Groups in Iran: Effect of Inequalities on Socioeconomic Position.

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Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
Center for Disease Control, Ministry of Health and Medical Education, Tehran, Iran.



Hookah and cigarette smoking have adverse effects on individuals' health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on cigarette and hookah smoking in Iran.


In this study, secondary analysis of the Iran's sixth national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) was conducted for 10,572 individuals aged 15 to 70 years old. Subjects were categorized into three groups according to their socioeconomic status (low, middle and high) in order to assess their inequalities using principal component analysis. At the end, the gap between the low and high socioeconomic groups was decomposed using Blinder-Oaxaca decomposition technique.


The prevalence of cigarette and hookah smoking in high, middle, and low socioeconomic groups was 11.8%, 13.2%, and 13.1% (P=0.158), and 2.6%, 3.3% and 4.3%, (P<0.001), respectively. Blinder-Oaxaca decomposition technique showed a lower prevalence of hookah smoking in high socioeconomic group compared to low socioeconomic group (P<0.001). The gap between the two mentioned groups was measured to be 1.7%. However, this gap for cigarette smoking (1.5%) was not significant (P=0.093).


The finding indicates the importance of socioeconomic status in hookah smoking. After decomposition of the gap between the 2 socioeconomic groups, age, gender and education level were reported to be the major contributors to the differences observed between the 2 groups.


Adult; Cigarette; Hookah; Smoking; Socioeconomic status

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