Determinants of Tobacco and Hookah Smoking in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

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Abstract

Background

The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking.

Objectives

The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents.

Patients and Methods

This study was conducted as part of the fourth cross-sectional survey of a national school-based program. Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14,880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran.

Results

The final study group consisted of 13,486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47 ± 3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking.

Conclusions

Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.

Related collections

Most cited references 39

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Waterpipe (hookah) tobacco smoking among youth.

Mary P Martinasek, Timothy R. McDermott, L. Martini (2011)

Waterpipe tobacco smoking is a centuries old practice, influenced by cultural tradition in Eastern Mediterranean countries, the Middle East, and parts of Asia. It historically has been an activity enjoyed primarily by men. In the past 2 decades, however, this method of tobacco smoking has increased in popularity in other parts of the world, including the USA. Growing interest in this form of smoking can be traced, in part, to the advent of a flavored tobacco, called maassel. The combination of flavoring agents and the paraphernalia itself used in the smoking process, along with its mystic appeal, novelty, affordability, and the social atmosphere in which smoking often occurs, has made waterpipe smoking attractive to women as well as men, cigarette smokers and nonsmokers alike, and particular groups, including persons of college age and younger adolescents. Although waterpipe smoking is perceived by its new generation of users to be less addictive and hazardous to health than cigarette smoking, researchers draw diametrically opposed conclusions. Research demonstrates that numerous toxic agents, including carcinogens, heavy metals, other particulate matter, and high levels of nicotine, are efficiently delivered through waterpipes. Moreover, sidestream smoke exposes others in the vicinity of waterpipe smokers to the risk of respiratory diseases and other conditions. In addition, persons sharing waterpipe mouthpieces may share infectious agents as well. Waterpipe tobacco smoking has been declared a public health problem by the World Health Organization and other authorities. Recognition of the deleterious effects of waterpipe smoking has led to initial attempts to expand regulatory control. Because waterpipe tobacco is not directly burned in the smoking process, many existing control measures do not apply. Public health authorities should monitor waterpipe tobacco use carefully. Finally, pediatricians and other healthcare providers should discourage experimentation and continued use among their adolescent patients. Copyright © 2011 Mosby, Inc. All rights reserved.

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Family influences on the risk of daily smoking initiation.

Jie Guo, Robert G. Hill, R Abbott … (2005)

To examine developmental patterns and family influences on the risk of daily smoking initiation from adolescence to young adulthood. A gender-balanced, ethnically diverse urban sample of 808 children aged 10-11 years was surveyed in 1985 and followed prospectively to age 21 in 1996. Discrete-time survival analysis was used to assess the hazard of initiation of daily smoking during this time period, as well as the effects of family factors on the risk of daily smoking initiation. Less parental smoking, more strict family monitoring and rules, and stronger family bonding predicted a significantly lower risk of daily smoking initiation controlling for socio-demographic background. The decline in the impact of family bonding over time was marginally significant; however, none of the interactions between family factors and time were significant, indicating generally consistent family influences on daily smoking from age 10 to 21. The present findings indicate that parent smoking contributes to the onset of daily smoking in their teenagers even if parents practice good family management, hold norms against teen tobacco use, and do not involve their children in their own tobacco use. Smoking prevention programs should include components focused on parents of adolescents. To reduce risks for daily smoking among adolescents, it is important to encourage parents to stop or reduce their own smoking. In addition, these data indicate that parents can reduce their children's risk of daily smoking initiation by reducing family conflict, by maintaining strong bonds with their children, by setting clear rules, and by closely monitoring their children's behaviors.

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Peer and parent influences on smoking and drinking among early adolescents.

B Morton, Drew K. Saylor, John Crump … (2001)

Social influences can promote or discourage adolescent substance use. The authors surveyed 4,263 sixth- to eighth-grade students to assess the effect of peer and parent influences on adolescent substance use. The authors conducted separate multiple logistic regression analyses for smoking and drinking, controlling for grade, sex, and race. Positive independent associations with smoking and drinking were found for direct peer pressure and associating with problem-behaving friends. Independent negative associations with smoking and drinking were also found for parent involvement, parent expectations, and parent regard. In an analysis of interactions, peer pressure was positively associated with drinking for girls but not for boys and problem-behaving friends was positively associated with drinking for both boys and girls. The findings are consistent with the hypothesis that associating with deviant peers promotes and that authoritative parenting protects against smoking and drinking.

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Author and article information

Journal

Journal ID (nlm-ta): Iran Red Crescent Med J

Journal ID (iso-abbrev): Iran Red Crescent Med J

Journal ID (doi): 10.5812/ircmj

Journal ID (publisher-id): Kowsar

Title: Iranian Red Crescent Medical Journal

Publisher: Kowsar

ISSN (Print): 2074-1804

ISSN (Electronic): 2074-1812

Publication date (Electronic): 08 June 2016

Publication date Collection: August 2016

Volume: 18

Issue: 8

Electronic Location Identifier: e31099

Affiliations

[1 ]Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, IR Iran

[2 ]Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IR Iran

[3 ]Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran

[4 ]Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran

[5 ]Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, IR Iran

[6 ]Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran

[7 ]Department of Medical Emergency, Qom University of Medical Sciences, Qom, IR Iran

[8 ]Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, IR Iran

Author notes

[* ]Corresponding Author: Mostafa Qorbani, Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, IR Iran, E-mail: mqorbani1379@ 123456yahoo.com

Article

DOI: 10.5812/ircmj.31099

PMC ID: 5065714

SO-VID: ef8e22ce-7730-48d4-bf60-2451138b34ea

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

History

Date received : 28 June 2015

Date revision received : 31 October 2015

Date accepted : 19 December 2015

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Determinants of Tobacco and Hookah Smoking in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

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Abstract

Background

Objectives

Patients and Methods

Results

Conclusions

Related collections

Tobacco Prevention & Cessation

Most cited references 39

Waterpipe (hookah) tobacco smoking among youth.

Family influences on the risk of daily smoking initiation.

Peer and parent influences on smoking and drinking among early adolescents.

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Journal

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Author notes

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Cited by 8

Most referenced authors 318