Background This study aimed to investigate cigarette and hookah smoking in a population of Eastern-Mediterranean adults in relation to their perceived social well-being (social integration, coherence, acceptance, contribution, and actualization). Methods Data of 2592 adults who participated in the 6th phase (2014–2016) of the Tehran Lipid and Glucose Study (TLGS) was used. After excluding those with missing data (n = 235), 2357 remained for the sex-specific logistic regression to investigate the association between social well-being and current smoking (cigarette and hookah). The final model (model 3) was adjusted for age, marital status, education, occupation, physical activity, and chronic disease history. Results Participants' mean age was 46 ± 14 years (45% men). Compared to cigarette and hookah smokers, the mean scores of social well-being and all its dimensions were higher in non-smokers. While in men, cigarette smoking was significantly related to social well-being and all its dimensions, only women with higher social well-being (OR:0.97, CI:0.95–0.99, P:0.001), social integration (OR:0.93, CI:0.87–0.99, P:0.019), and coherence (OR:0.92, CI:0.87–0.98, P:0.013), were further at risk of cigarette smoking. Unlike men, whose hookah smoking was not at all related to their social well-being, women's hookah consumption was associated with social well-being (OR: 0.97, CI:0.95–0.99, P:0.002), social integration and acceptance; one unit increase in the mean scores of social integration and acceptance in women reduced the risk of hookah use by 8%. Conclusion Social well-being and tobacco smoking are related, and evident sex differences in this relationship should not be ignored in future tobacco control efforts.

Background: This study aimed to investigate cigarette and hookah smoking in a population of Eastern-Mediterranean adults in relation to their perceived social well-being. Methods: Data of 2592 adults who participated in the 6th phase (2014-2016) of the Tehran Lipid and Glucose Study (TLGS) was used. After excluding those with missing data (n=235), 2357 remained for the sex-specific logistic regression to investigate the association between social well-being and current smoking (cigarette and hookah). The final model was adjusted for age, marital status, education, occupation, physical activity, and chronic disease history. Results: Compared to cigarette and hookah smokers, the mean scores of social well-being and all its dimensions were higher in non-smokers. While in men, cigarette smoking was significantly related to social well-being and all its dimensions, only women with higher social well-being, social integration, and coherence, were further at risk of cigarette smoking. Unlike men, whose hookah smoking was not at all related to their social well-being, women's hookah consumption was associated with social well-being, social integration and acceptance; one unit increase in the mean scores of social integration and acceptance in women reduced the risk of hookah use by 8%. Conclusion: Social well-being and tobacco smoking are related, and evident sex differences in this relationship should not be ignored in future tobacco control efforts.