Background and purpose: Substance abuse is one of the main social problems among young adults. This study aimed at evaluating the prevalence of substance abuse and associated factors in hookah users in Zahedan, Iran.

Materials and methods: This cross-sectional study was carried out on 600 hookah users in Zahedan, 2015.The city was divided into 5 districts (north, south, east, west and center) according to the maps. Then a start point was randomly selected and all individuals in first hookah place were entered into the study. Other cases were studied by referring to next nearest hookah places. The study questionnaires were completed in each districts. Data analyses were performed in Stata.12 using Chi-square, Independent T test and multiple logistic regression. 

Results: The subjects’ mean age was 26.1±5.1 years old. About 53% of the participants used hookah in groups. The ages of first hookah experience in males and females were 17.1±6.13 and 21.2±5.6 years old, respectively (P=0.04). Total prevalence of substance abuse was 70.4%. Using hookah in groups (OR=2.03, P=0.05), using hookah every other days (OR=2.2, P=0.042), living alone (OR=2.27, P=0.046), being university student (OR=3.7, P=0.01), and being male (OR=3, P=0.032) significantly increased the chance of substance abuse among hookah users.

Conclusion: The prevalence of substance abuse in hookah users was found to be more than that in general population.  Use of hookah can play a role in initiation of substance abuse. Also, the situation of hookah use and pattern or levels of consumption are the most important predictors in tendency of hookah users to other tobacco products and addictive industrial materials.