Background: Based on previous studies, tobacco smoking generally and water pipe smoking particularly, have high prevalence in Bushehr province. This study is a new analysis of the Persian Gulf healthy heart study with goal of determination of prevalence and pattern of cigarette and water pipe smoking in Bushehr province. Materials and methods: A total of 3735 men and women aged 25 years old or higher from three districts of Bushehr province (Bushehr, Genaveh, and Deylam) were participated in the study phase I in 2003, from which 1833 persons (49.7%) were participated in the phase II 6 years later in 2009. Demographic data and pattern of smoking, either cigarette or water pipe, were collected with personal interview. Gender specific crude and directly standardized prevalence of cigarette and water pipe smoking was calculated for both phases of the study. Results: Prevalence of cigarette smoking were 11.9% and 7.5% for the firstand second phase, respectively. 21.6% of men and 0.4% of women in the first phase and 13% of men and 0.7% of women in the second phase were cigarette smokers. Prevalence of water pipe smoking were 17.9% and 12.9% in the first and second phase, respectively. 10.7% of men and 25.8% of women in the first phase and 7.1% of men and 19.05% of women in second phase were water pipe smokers. Conclusion: Water pipe smoking in women in Bushehr province was significantly higher than other non-southern areas of Iran. More studies are needed to determine main causes of women tendency in water pipe smoking in southern provinces of Iran.