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Introduction: Hookah use has been increasing among students in recent years. Despite the effect of health literacy skills on smoking prevention and cessation, investigating the relationship between health literacy skills and hookah use is still neglected. Therefore, the present study aimed at determining the relationship between hookah use and health literacy skills among university students. Materials and methods: This was a descriptive-cross-sectional study conducted at Esfarayen Medical Sciences University in 2022, in which 214 university students were selected by a simple random sampling method. The data collection instrument was a questionnaire that had two parts: the first part was related to demographic and background characteristics and determined using or not using hookah. The second part was an adult health literacy questionnaire (HELIA). The data were analyzed using SPSS 23 software and descriptive statistics and logistic regression. Findings: The frequency of hookah use was 17.3% (37 people). Among the five health literacy skills, the two skills of comprehension and access had the highest average score and the two skills of decision-making and application of health information and reading had the lowest average score. According to the results of the logistic regression, gender, amount of physical activity per week, smoking, decision-making skills, and the use of health information, understanding and evaluation were the factors affecting the use of hookah. Conclusion: The use of hookah was more among male students, students with less physical activity, smoking students, students who had weaker decision-making skills, and those who used less health information, understanding, and evaluation. Therefore, it is necessary to pay more attention to these students in designing educational programs to prevent and quit hookah use. |