Abstract
Tobacco use, including the increasingly popular hookah smoking, remains a significant global health concern. Despite its growing appeal, especially among young people, hookah smoking has been associated with an increased risk of various cardiovascular diseases (CVD). To explore the associations between demographic and behavioral factors and perceived susceptibility to and severity of cardiovascular diseases ; myocardial infarction (MI), stroke, and hypertension (HTN); a convenience sample of 245 current and former hookah users from Southwest Iran was recruited. Participants completed measures assessing hookah smoking risk perception, stage of change, attitudes and beliefs about hookah use along with demographic information.The Health Belief Model was used to assess participants' perceptions, and cluster analysis was employed to identify homogeneous groups of participants. Chi-square and Kruskal-Wallis tests were applied to examine the associations between the identified groups and various demographic and behavioral factors. The average age of the study participants was 28.9 years (SD = 9.2), with 81.2% being male. Participants perceived HTN as the most likely cardiovascular disease and MI as the most severe. Notably, perceived severity consistently outweighed perceived susceptibility across all three cardiovascular diseases (p < 0.05). Cluster analysis identified six distinct groups based on perceived susceptibility and severity. Individuals in Cluster 6, characterized by moderate susceptibility and high severity, were older and less frequent hookah users compared to those in Cluster 1, who exhibited low susceptibility and low severity. Interestingly, those in Cluster 6 showed a significantly higher willingness to quit hookah use (p < 0.001). The findings indicate that individuals who perceive a higher risk of developing cardiovascular diseases are more likely to consider quitting hookah use. However, most participants in this study demonstrated low perceived susceptibility and severity, suggesting that they may be unaware of the potential adverse health consequences associated with hookah use. To effectively address this issue, comprehensive public health interventions are needed to raise awareness about the addictive nature of hookah, the increased risk of cardiovascular diseases, and the potential for reduced life expectancy and disability are necessary.