| Summary: | Abstact Background There are few if any reports concerning the joint use of waterpipe, cigarette and exposure to second-hand smoking in Tehran, Iran. Here, we simultaneously investigated the prevalence and predictors of smoking habits in Iranian adults. Methods In this population-based cross-sectional study, we recruited 1057 Iranian adults between August 2013 and February 2015, in Tehran, a multi-ethnic city. Participants were selected using random digit dialing. Three separate logistic regression models were applied to estimate the adjusted odds ratios (95% CI). Results Exposure to second-hand smoking was the most prevalent smoking type (37, 95% CI: 35–41%) followed by cigarette (23.9% (95% CI: 21–27%)) and water-pipe smoking (20.25% (95% CI: 18–23%)) in adults in Tehran. Almost 3.3 and 4.5% of adults reported three and two types of lifetime smoking behaviors, respectively. Age, sex, history of depression along with lifetime alcohol intake was the important predictors of all three types of smoking. Lifetime alcohol consumption was associated with increased prevalence of all three types of smoking (p for trend < 0.009). Lifetime drug abuse was also associated with increased prevalence of cigarette smoking (OR = 2.04, 95% CI: 1.61–2.59, p < 0.001). Conclusions Lifetime prevalence of waterpipe, cigarette and exposure to second-hand smoking is moderately high. Dual smoking behaviors are increasing in Iranian adults. An apparent age-related difference in pattern of waterpipe and cigarette smoking was observed. These findings highlight the need for further educational and preventive programs especially for dual smoking in Iranian young adults. This could provide practical information for evaluating and reforming the tobacco control programs and policies in Iran.
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