Waterpipe use among Iranian adolescents has become a matter for concern. A descriptive, cross-sectional community-based survey was performed in 2010 to determine the prevalence of waterpipe use and associated factors among Iranian adolescents in Tehran, Islamic Republic of Iran. After multi-stage, random cluster sampling 1201 adolescents aged 15–18 years old responded to a questionnaire based on the Youth Risk Behavior Surveillance. The prevalence of current waterpipe smoking (at least once in the previous 30 days) was 28.0%, significantly higher among males (34.8%) than females (21.4%). A total of 45.1% of adolescents reported lifetime use (ever use) of waterpipes and 34.2% had ever shared a waterpipe. In multivariate logistic regression analysis the significant correlates of current waterpipe use for both males and females were having smokers among friends and family members, while for males, older age and educational failure were also risk factors.