Int J Adolesc Med Health 2015; 27(3): 291–298
Sakineh Mohammad-Alizadeh-Charandabi, Mojgan Mirghafourvand, Nikta Tavananezhad* and Mahsa Karkhaneh
Prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents Abstract Introduction: Widespread tobacco use, along with its induced diseases and subsequent deaths, comprise one of the biggest threats to public health in the world. Thus, we aimed to investigate the prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents. Materials and methods: A total of 1524 adolescent students aged 14–18 years (764 boys and 760 girls) were randomly selected. The participants attended governmental, semi-governmental, and non-governmental schools in the city of Sanandaj, Iran in 2013. Data were collected using the “Sherer General Self-efficacy” and demographic questionnaire. Multivariate Logistic binary regresion analysis was conducted to determine the predictors. Results: The prevalence rates of cigarette and water pipe smoking were 9.5% and 10.4%, respectively. About 3.7% of the adolescents used both cigarette and water pipe and 16% used at least one of these. Compared with girls, prevalence of both cigarette (13.1% vs. 6.4%) and water pipe (13.7% vs. 7.1%) smoking was higher among the boys. Male sex, father’s education of secondary school, and use of water pipe were identified as cigarette smoking risk factors, while technical and commercial educational fields and attending non-governmental school were its protective factors. Risk factors of the use of water pipe were currently working, higher age and cigarette smoking, father’s education of high school, father’s occupation of employee and mother’s education of a diploma degree, while higher self-efficacy and attending non-governmental school were its protective factors. Conclusion: The high prevalence of cigarette and water pipe smoking in adolescents continues to rise. Therefore, *Corresponding author: Nikta Tavananezhad, MSc in Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, E-mail: [email protected] Sakineh Mohammad-Alizadeh-Charandabi: Research Center of Social Determinants of Health, Faculty of Nursing and Midwifery, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran Mojgan Mirghafourvand and Mahsa Karkhaneh: Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
it is necessary to conduct further studies on effective factors on the onset and continuation of tobacco use. Keywords: adolescents; cigarette; self-efficacy; water pipe. DOI 10.1515/ijamh-2014-0028 Received July 20, 2014; accepted October 17, 2014; previously published online December 3, 2014
Introduction The epidemic of tobacco use and its morbidity and mortality comprises one of the major threats to public health in the world (1). According to 2009 statistics, 26% of men and 2% of women 15 years and older in Iran use one of the various tobacco products being sold in the market (2). In addition, according to the World Health Organization (WHO), the rates of daily use of tobacco in Iran were 20.4% in men and 1.0% in women (3). Two most common varieties of the tobacco products are cigarettes and water pipes. There are over 4000 chemicals in cigarette smoke, with at least 250 harmful substances and over 50 known carcinogens, such as Arsenic, Beryllium and Acetaldehyde. According to WHO, almost one person dies every 6 s due to tobacco use. Over half of the users die due to diseases induced by it (1). Tobacco use is one of the main causes of chronic diseases, such as cancers, cardio-vascular diseases (4) and lung diseases, such as asthma (5). In a review study on the harms of secondhand smoke in 192 countries, many complications (e.g., deaths caused by cardiovascular diseases, lung cancer, and lower respiratory infections) were cited for secondhand smokers. That study also reported that 1% of deaths worldwide in 2004 occurred in non-smokers exposed to secondhand cigarette smoke (6). Consequences of tobacco use also involved the family and community because those tobacco users who died early deprived their families of their income, incurred increased health care costs, and eventually delayed the development of their community (1).
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292 Mohammad-Alizadeh-Charandabi et al.: Cigarette and water pipe smoking among Iranian adolescents According to the latest national census in 2011, there are nearly 7 million adolescent girls and boys (10–19 years) in Iran (7). It should be noted that many of the serious diseases in adulthood have their roots in adolescence (8). For instance, tobacco use as a risk factor of most of the diseases usually starts before the age of 18 years (9). Adolescents’ success in facing many risks during adolescence is related to their self-efficacy (10). Self-efficacy is the person’s belief in his or her ability to face particular situations, which can affect people’s attitude, behavior, and emotions (11). Some studies showed that self-efficacy affects all dimensions of addictive behavior, including continuing, quitting, and perseverance in quitting behavior (12). Considering the increasing prevalence of tobacco use, importance of adolescence, the effect of self-efficacy and living conditions on risks and adolescents’ coping styles, this study was conducted with the aim to investigate prevalence of tobacco and water pipe use and their predictors among adolescents aged 14–18 years in Sanandaj City, Iran.
Data were collected using the “Sherer General Self-efficacy” and socio-demographic questionnaire. This Scale was first presented in 1982 by Sherer. It consists of 17 items based on a Likert scale with scores ranging from “1” to “5”. This Scale measures self-efficacy in every item, in which a higher total score shows higher self-efficacy. The Persian version of this questionnaire was validated by Barati in 1997 (15). Content and face validity were determined using expert opinion; 10 faculty members evaluated the questionnaires and some corrections were made to the questionnaires afterwards according to the feedbacks. In addition, pre-test and post-test were implemented on 30 adolescents to determine the questionnaire’s reliability and internal consistency. For self-efficacy, intraclass correlation coefficient (95% CI) and Cronbach’s α values were 0.86 (0.70–0.93) and 0.84, respectively. SPSS version 13 (Parnian, www.parnianpc.com) was used for data analysis. At first, we implemented bivariate statistical tests, such as t-test and X2 to determine the unadjusted relationship between self-efficacy and socio-demographic characteristics of cigarette and water pipe use. Then, the independent variables that had p-values
Sakineh Mohammad-Alizadeh-Charandabi, Mojgan Mirghafourvand, Nikta Tavananezhad* and Mahsa Karkhaneh
Prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents Abstract Introduction: Widespread tobacco use, along with its induced diseases and subsequent deaths, comprise one of the biggest threats to public health in the world. Thus, we aimed to investigate the prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents. Materials and methods: A total of 1524 adolescent students aged 14–18 years (764 boys and 760 girls) were randomly selected. The participants attended governmental, semi-governmental, and non-governmental schools in the city of Sanandaj, Iran in 2013. Data were collected using the “Sherer General Self-efficacy” and demographic questionnaire. Multivariate Logistic binary regresion analysis was conducted to determine the predictors. Results: The prevalence rates of cigarette and water pipe smoking were 9.5% and 10.4%, respectively. About 3.7% of the adolescents used both cigarette and water pipe and 16% used at least one of these. Compared with girls, prevalence of both cigarette (13.1% vs. 6.4%) and water pipe (13.7% vs. 7.1%) smoking was higher among the boys. Male sex, father’s education of secondary school, and use of water pipe were identified as cigarette smoking risk factors, while technical and commercial educational fields and attending non-governmental school were its protective factors. Risk factors of the use of water pipe were currently working, higher age and cigarette smoking, father’s education of high school, father’s occupation of employee and mother’s education of a diploma degree, while higher self-efficacy and attending non-governmental school were its protective factors. Conclusion: The high prevalence of cigarette and water pipe smoking in adolescents continues to rise. Therefore, *Corresponding author: Nikta Tavananezhad, MSc in Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, E-mail: [email protected] Sakineh Mohammad-Alizadeh-Charandabi: Research Center of Social Determinants of Health, Faculty of Nursing and Midwifery, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran Mojgan Mirghafourvand and Mahsa Karkhaneh: Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
it is necessary to conduct further studies on effective factors on the onset and continuation of tobacco use. Keywords: adolescents; cigarette; self-efficacy; water pipe. DOI 10.1515/ijamh-2014-0028 Received July 20, 2014; accepted October 17, 2014; previously published online December 3, 2014
Introduction The epidemic of tobacco use and its morbidity and mortality comprises one of the major threats to public health in the world (1). According to 2009 statistics, 26% of men and 2% of women 15 years and older in Iran use one of the various tobacco products being sold in the market (2). In addition, according to the World Health Organization (WHO), the rates of daily use of tobacco in Iran were 20.4% in men and 1.0% in women (3). Two most common varieties of the tobacco products are cigarettes and water pipes. There are over 4000 chemicals in cigarette smoke, with at least 250 harmful substances and over 50 known carcinogens, such as Arsenic, Beryllium and Acetaldehyde. According to WHO, almost one person dies every 6 s due to tobacco use. Over half of the users die due to diseases induced by it (1). Tobacco use is one of the main causes of chronic diseases, such as cancers, cardio-vascular diseases (4) and lung diseases, such as asthma (5). In a review study on the harms of secondhand smoke in 192 countries, many complications (e.g., deaths caused by cardiovascular diseases, lung cancer, and lower respiratory infections) were cited for secondhand smokers. That study also reported that 1% of deaths worldwide in 2004 occurred in non-smokers exposed to secondhand cigarette smoke (6). Consequences of tobacco use also involved the family and community because those tobacco users who died early deprived their families of their income, incurred increased health care costs, and eventually delayed the development of their community (1).
Brought to you by | UCL - University College London Authenticated Download Date | 3/7/16 7:57 PM
292 Mohammad-Alizadeh-Charandabi et al.: Cigarette and water pipe smoking among Iranian adolescents According to the latest national census in 2011, there are nearly 7 million adolescent girls and boys (10–19 years) in Iran (7). It should be noted that many of the serious diseases in adulthood have their roots in adolescence (8). For instance, tobacco use as a risk factor of most of the diseases usually starts before the age of 18 years (9). Adolescents’ success in facing many risks during adolescence is related to their self-efficacy (10). Self-efficacy is the person’s belief in his or her ability to face particular situations, which can affect people’s attitude, behavior, and emotions (11). Some studies showed that self-efficacy affects all dimensions of addictive behavior, including continuing, quitting, and perseverance in quitting behavior (12). Considering the increasing prevalence of tobacco use, importance of adolescence, the effect of self-efficacy and living conditions on risks and adolescents’ coping styles, this study was conducted with the aim to investigate prevalence of tobacco and water pipe use and their predictors among adolescents aged 14–18 years in Sanandaj City, Iran.
Data were collected using the “Sherer General Self-efficacy” and socio-demographic questionnaire. This Scale was first presented in 1982 by Sherer. It consists of 17 items based on a Likert scale with scores ranging from “1” to “5”. This Scale measures self-efficacy in every item, in which a higher total score shows higher self-efficacy. The Persian version of this questionnaire was validated by Barati in 1997 (15). Content and face validity were determined using expert opinion; 10 faculty members evaluated the questionnaires and some corrections were made to the questionnaires afterwards according to the feedbacks. In addition, pre-test and post-test were implemented on 30 adolescents to determine the questionnaire’s reliability and internal consistency. For self-efficacy, intraclass correlation coefficient (95% CI) and Cronbach’s α values were 0.86 (0.70–0.93) and 0.84, respectively. SPSS version 13 (Parnian, www.parnianpc.com) was used for data analysis. At first, we implemented bivariate statistical tests, such as t-test and X2 to determine the unadjusted relationship between self-efficacy and socio-demographic characteristics of cigarette and water pipe use. Then, the independent variables that had p-values
