Introduction:
Waterpipe use (WP) has become a major contributor to female tobacco use in the Middle East and other regions of the world. In recent reports, WP use was considered a symbol of female emancipation, where women smokers reported feeling social, attractive, and defiant of traditional gender norms when smoking WP. This study aims to examine changes in WP smoking over three points of time before, during, and after Ramadan among a sample of Jordanian women.

Material and Methods:
A repeated measure design was used to assess differences in a 109 Jordanian women’s waterpipe smoking before, during and after Ramadan. Using the Women Tobacco Smoking Questionnaire, participants recruited from two hospitals maternal outpatients clinics were asked about their tobacco smoking status over three periods of time (i.e., before, during, and after Ramadan). Their nicotine dependence level was also assessed using a nicotine dependence scale.

Results:
Age ranged between 17-56 years (m= 25.97, SD ± 9.02) and the majority held a university degree. The percentage of women who smoked WP daily increased significantly between the study’s three time points 19%, 32.1%, and 39.5% for before, during, and after Ramadan respectively. Smoking one "head" of WP tobacco also significantly increased from 56.9% for during to 67.9% for after Ramadan. While almost half (48.6%) the participants scores reflected mild nicotine dependency while 23.9% showed a sever level of dependence.

Conclusions:
This is the first study to report change in WP smoking habits, also it is the first to report nicotine dependence level among women within this Jordanian context.

Funding:
The current study was funded by the Hashemite University [HU] Deanship of Research.