Background: In Iranian women, the use of hookah is the most common method of tobacco smoking. This study aimed to find the role of psycho ? social needs and gaps as a possible risk factor for hookah smoking initiation in women.Methods: This qualitative study was conducted during 2012–2013 in Tehran, Iran. Thirty ? six women participated in the study. They were current or former users of hookah. Data were collected through in ? depth individual interviews and was analyzed through content analysis.Results: Four main categories were identified from the data. This study focused on the category: Psycho ? social needs and gaps. This category has five sub-categories which explain why women begin to smoke hookah including curiosity; desire for non ? feminine, forbidden, and negative activities; need for amusement and recreation; for others: To show off; attract attention; satisfy and join others and protection.Conclusions: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Keeping young girls and women away from seemingly happy gatherings of hookah smokers; Providing appropriate recreational facilities for young women and training families on how to help their children in the event of a crisis ? like intention to take up smoking behavior, can be some effective ways for reducing hookah smoking initiation among women.
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