Introduction:
Currently, smoking hookah is the most common method of tobacco smoking among Iranian women and its rate has significantly increased over the past few decades. Many factors influence the start of hookah smoking among women. Therefore, this study aimed to determine the factors associated with the start of hookah smoking among women in the city of Gorgan, Iran.

Methods:
This cross sectional study was conducted from March to June 2016 in the city of Gorgan. The participants consisted of 206 hookah smoking women who were selected by convenience and snowball sampling methods. The tool used in this study was the Bahiraei et al (2014) questionnaire to determine the factors that facilitate the start of hookah consumption among women.

Results:
Positive attitudes towards hookah and its availability accounted for the most frequency (9/87%). Curiosity to experience hookah (80.1%), and hookah smoking among family members and relatives (78.5%) were among important cause of hookah smoking among women. Among different factors, the highest amount was related to "the availability of hookah" and the lowest amount was related to "attracting other’s attention and cooperation".

Conclusions:
Positive attitude, availability, curiosity and hookah smoking among family members and relatives were the most important factors that facilitated the start of hookah smoking among women. Initiating intervention to change the attitude of women towards hookah and reducing the access to hookah in family and friend gatherings are recommended to prevent the initiation of hookah smoking among women.

Funding:
Golestan University of Medical Sciences, Gorgan, Iran.