The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

Prevalence of substance use among Iranian male adolescents: Systematic review and meta-analysis

Background and aims

Substance use among adolescents is one of the most challenging behavioral disorders with direct consequences. It is of the essence (that) the prevalence of substance use is investigated among Iranian male adolescents.

Methods

The present study is a systematic review and meta-analysis. All published articles titled "prevalence of substance use among Iranian adolescents" authored in Persian and English from 2004 to 2020 on Pub Med, Scopus, SID, and Google Scholar, a top list of academic research databases, were reviewed. Thirty-three out of 805 articles, hinge on the inclusion and exclusion criteria, were eligible. Statistical analysis carried out in STATA 14.0.Q index, I2 index, and χ 2 test were applied.

Results

Overall prevalence reported with (95% confidence interval) for substance use 7% (4%-11%), methamphetamine 4% (3%-6%), tobacco 10% (3%-19%), and any addictive substances 4% (2%-7%) among male adolescents respectively. Besides, overall prevalence of alcohol consumption reported 10% (8%-11%).

Conclusion

The prevalence of substance use among male adolescents is high, so it is indispensable for researchers to pay special attention to this issue.

The prevalence and correlates of physical activity/inactivity and sedentary behaviour among high-school adolescents in Iran: a cross-sectional study

Background

Physical inactivity and sedentary behaviour are the main risk factors for non-communicable diseases in all stages of life. However, there is a lack of reliable data regarding the recommended level of physical activity and its correlates related to physical inactivity and sedentary behaviour among school students in Iran. The aim of the present study was to report the prevalence and correlates of physical activity/inactivity and sedentary behaviour among Iranian high school adolescents.

Methods

The Global School-based Student Health Survey (GSHS) was used for data collection. Related data comprising socio-demographics, health risk behaviour and protective factors were obtained from 1517 high school students. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (physical inactivity/sedentary behaviour).

Results

The prevalence of recommended physical activity by WHO was 27.8%, physical inactivity 72.2% and sedentary behaviour 71.4%. Being female, being overweight or obese, walking/cycling to or from school on 1–4 days, sitting 3 or more hours/day (sedentary behaviour), insufficient vegetable intake, being bullied and lack of parental support, peer support and parental connectivity (protective factors) were positively associated with physical inactivity. On the other hand, walking/cycling to or from school on 5–7 days and inadequate fruit intake were negatively associated with physical inactivity. Walking/cycling to or from school on 1–4 days, being physically inactive, inadequate fruit intake and being bullied were positively associated with sedentary behaviour.

Conclusion

The prevalence of physical inactivity and sedentary behaviour was high in our studied sample. Interventions that address the issue of active school transport, sedentary behaviour, fruit and vegetable intake, family and peer support and bullying should be given more priority by the public health authorities.

Sociocultural factors contributing to waterpipe tobacco smoking among adolescents and young adult women: a qualitative study in Iran

Purpose: Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods: This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13-30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants' preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results: The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion: A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS.Abbreviation WTS: Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco.

Geographic distribution and time trends of water-pipe use among Iranian youth and teenage students: A meta-analysis and systematic review

Water-pipe tobacco smoking is harmful to health, yet its rate of prevalence remains uncertain. Recent evidence has shown that the prevalence of water-pipe smoking among students is higher than in the general population. In this study, a systematic review of related literature on water-pipe use was conducted, and for this purpose, 76 articles were examined in the study. In this vein, geographic distribution and time trends of water-pipe consumption in Iran were considered. The results of this study showed that lifetime, last-year, and last-month prevalence of water-pipe smoking use among Iranian students were 28.78 (25.07-32.49), 20.84 (16.01-25.66), and 16.36 (11.86-20.85), respectively. The results also showed a wide variation by the region and sex in Iran. This study has shown the importance of addressing public prevention and alerting programs in schools and universities.

Determinants of Waterpipe Smoking Among Women: A Systematic Review

Background

The present study aimed to assess the determinants of waterpipe smoking among women based on a systematic review regarding the increasing prevalence of waterpipe smoking in women and the tendency of them to this type of tobacco.

Methods

The present study was a systematic review. The search strategies were based on using a combination of MeSH and free-text terms. Searches were performed inIranian databasesand PubMed, ScienceDirect, Web of Science, EMBASE, Scopus and Medline. Databases inclusion criteria included articles and gray literature in English or Persian, published between January 2000 and December 2018. The keywords were related to women and waterpipe and related terms. The quality of the articles was assessed using the EPHPP tool.

Results

In the initial search, out of 1027 articles, 15 articles were studied. Inclusion criteria in this study were the target population of women and girl and descriptive and qualitative studies on waterpipe use among women. The mean prevalence of waterpipe smoking in quantitative studies was 13.980/0. Studies have shown that waterpipe smoking in women is influenced by several individual (awareness, favorable attitudes, and positive prototype), interpersonal (role of family and friends), and socio-political factors.

Conclusions

Due to the influence of various determinants on women's inclination to waterpipe smoking, there is a necessity to act and impose interventions such as lessening women's favorable attitude toward waterpipe, increasing women's awareness, encouraging negative prototype about waterpipe smoking, and restricting access to tobacco products that can be useful. Interpersonal factors such as the role of family and friends are one of the major determinants in waterpipe smoking. It seems that developing the skill of saying "no" to the pressure of friends can help prevent waterpipe use. Furthermore, educating the family about the risks of waterpipe use is an effective strategy in this respect.

Cigarette and Hookah Smoking in Adolescent Students using World Health Organization Questionnaire Global Youth Tobacco Survey (GYTS): A Pilot Study in Varamin City, Iran in 2016

BACKGROUND AND OBJECTIVES

Clues show that a large number of toxic agents, including carcinogenic, heavy metals, other particles, and high levels of nicotine, are effectively delivered through cigarette and hookah smoking. A pilot study was carried out in Varamin city, Iran in 2016 aimed to determine status of cigarette and hookah smoking in adolescent students using, Global Youth Tobacco Survey (GYTS) questionnaire.

METHODS

It was a cross-sectional study. At the first, of 63 Varamin city schools' using cluster sampling, 48 schools were considered as primary clusters and 4 schools were selected randomly as sample clusters and students with 7, 8 and 9 years of education were studied. The total number of registered students was 1,108 and 1,075 responded to the study questionnaire. The main tool for collecting information used in this study was the GYTS questionnaire developed by the World Health Organization, was completed by subjects.

RESULTS

Totally, 479 (44.6%) students were boys and 596 (55.4%) were girls. Of 1,075 subjects the number of students at 7, 8 and 9 years education was 369 (34.3%), 362 (33.7%) and 344 (32.0%) respectively. The cigarette and hookah smoking using experience among the population was 9.2% and 25.5 respectively. Regarding the averages of the total score, although students have a relatively good attitude and specially behavioral intention (72% and 88% of the total score respectively), but only 47% of the total knowledge score by boys and 51% by girls, shows the average level of students' awareness related the undesirable effects of smoking.

CONCLUSIONS

Considering that one out of four students experienced cigarette and hookah smoking. Nearly half of the students are exposed to cigarette smoke at home or outdoors. The state of cigarette and hookah smoking in the country is alarming among school students.

Development of a Hookah Smoking Obscenity Measurement Scale for Adolescents

Background

The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents.

Methods

In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability.

Findings

The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ²/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively.

Conclusion

We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking prevention/cessation interventions among adolescents.

Prevalence, Predictors, and Characteristics of Waterpipe Smoking Among Jazan University Students in Saudi Arabia: A Cross-Sectional Study

Background

Waterpipe smoking (WPS), also called shisha, has considerable short and long-term effects on human health. WPS has become increasingly popular among the youth in Jazan society. Hence, this study is aimed to assess the prevalence, predictors, and characteristics (knowledge and attitude) of WPS among male and female students at Jazan University.

Methods and materials

A descriptive, cross-sectional study was conducted among 405 students. Data were collected using a self-administered validated questionnaire. The prevalence and predictors of WPS and the association between important socio-demographic factors (sex, type of college, parents smoking, home mate smoking and close friend smoking) were studied.

Results

The prevalence of WPS among students was high, approximately 34.0%. The prevalence rate was significantly higher in males (42.5%, n = 74) than in females (27.0%, n = 57) (p = 0.001). The main predictors of WPS were: being male (OR = 1.99, 95% CI [1.30, 3.06], p = 0.001), believing that shisha smoking is less harmful & addictive than cigarettes (OR = 3.84, 95% CI [1.88, 7.83], p < 0.001 and 3.80, 95% CI [2.0, 7.11], p < 0.001, respectively), and having a close friend who smokes (OR = 6.85, 95% CI [3.84, 12.22], p < 0.001).

Conclusions

WPS prevalence among Jazan University students was high, and the most influential factors were being male, having smoker housemates and friends, and having incorrect thoughts and beliefs.

Male students' experiences on predictors of waterpipe smoking reduction: A qualitative study in Iran

INTRODUCTION

In recent years, waterpipe smoking (WPS) has increased among adolescents in Iran. This study aimed to explain the experiences of high school students in Iran on predictors of WPS reduction based on a multi-theory model (MTM) of health behaviour change.

METHODS

This study was a qualitative study of directed content analysis that was conducted in high school male students in Hamadan, Iran, in 2017. In this study, 34 students who had smoked waterpipe (WP) in the last month were recruited through snowball sampling that was continued until data saturation. The data were collected through semi-structured, individual interviews and were then analyzed using directed qualitative content analysis.

RESULTS

The data analysis resulted in the extraction of 104 final codes around the six themes of predetermined MTM constructs consisting of participatory dialogue, behavioural confidence, changes in the physical environment, emotional transformation, practice for change, and changes in the social environment. The findings of this study showed that this model has the potential to explain the behaviour of WPS reduction. The main predictors of reduction in WPS are behavioural confidence, social environment change, and participatory dialogue.

CONCLUSIONS

Findings of the research showed that the belief in an individual’s ability, support from friends and the benefits of WPS reduction are the most important factors in reducing WPS among students. Therefore, it is suggested that comprehensive interventions be developed to improve the individual and social factors that are effective in WPS reduction.

Increasing trends of lung cancer in Golestan province, Northern Iran (2004-2016)

INTRODUCTION

We aimed to present the time trends and geographical distribution of lung cancer in Golestan province, a high-risk area for pulmonary tuberculosis (TB) in Northern Iran (2004-2016).

METHODS

Data on incident primary lung cancers were obtained from the Golestan population-based cancer registry. The data were analyzed by CanReg-5 software to calculate the age-standardized incidence rates (ASRs). We used Joinpoint software for time trend analysis. Average annual percent changes were calculated. The contribution of population aging, population growth and risk to the overall changes in incidence of lung cancer were determined using partitioning analysis.

RESULTS

Overall, 1829 cases of lung cancer were registered by the GPCR during 2004-2016, of which 1274 (69.7%, ASR in 2016 = 21.3) were men and 555 (30.3%, ASR in 2016 = 11.4) were women. The results of Joinpoint regression suggested a significant increasing trend in incidence of lung cancer in Golestan province during 2004 and 2016 (AAPC = 3.74; p-value = 0.01) with more prominent increasing in rural population (AAPC = 4.93; p-value<0.01). The number of new cases of lung cancer increased by 131.6% (from 98 in 2004 to 227 in 2016), of which 34.1%, 22.3% and 75.3% were due to population size, population aging and risk, respectively. Hot points of lung cancer were found in western parts of the Golestan.

CONCLUSION

With high incidence rates and increasing trends of lung cancer, further studies are warranted to clarify the role of TB and other risk factors on its burden in this population.

Fruit and vegetable intake and its correlates among high-school adolescents in Iran: a cross-sectional study

Background

Two important components of a healthy diet are fruits and vegetables (F&V), which are essential for maintaining physical health. The aim of the present study was to assess the prevalence and correlates of F&V intake among high school adolescents in the city of Tabriz.

Methods

The Global School-based Student Health Survey self-administered questionnaire was used for data collection among 1517 adolescents.

Results

The prevalence of fruit intake was 76.1% (≥ 2 times/day) and vegetable intake 23% (≥ 3 times/day). Being at the third level of high school and having sedentary behavior, low intake of vegetables, low or lack of parental support, lack of peer support and lack of enough food at home were significantly associated with low consumption of fruit among students. Also, being overweight or obese and having low intake of fruit, low or lack of peer support, and being physically inactive were significantly associated with low intake of vegetables.

Conclusion

Results suggest that interventions targeting personal, interpersonal and environmental factors for increased F&V consumption should be given more priority by the public health authorities.

Cigarette and hookah smoking and their relationship with self-esteem and communication skills among high school students

Background: Tobacco smoking is one of the most important public health problems that may be prevented. There is limited information about its relationship with communication skills. Findings on the relationships between self-esteem and cigarette/hookah smoking are inconsistent. The aim of this study was to investigate the relationships between cigarette and hookah smoking,self-esteem and communication skills among a representative sample of high school students.

Methods: In this cross-sectional study, a sample of 1321 tenth-grade students (14-17 years) was selected through multi-stage proportionally cluster sampling in Tabriz, 2017. The participants completed a self–administered multiple choice questionnaire including questions about cigarette smoking, hookah smoking, self-esteem, and communication skills.

Results: After controlling for potential confounders, the results demonstrated that higher score of self-esteem protects students against being in advanced stages of cigarette smoking (odds ratio [OR] = 0.95, 95% CI: 0.92-0.99, P=0.012). However, there was no significant association between self-esteem score and the hookah smoking. Also, there was no significant association between communication skills score and cigarette and hookah smoking.

Conclusion: According to our findings, self-esteem was associated with cigarette smoking, but not with hookah smoking. Furthermore, there was no statistically significant association between communication skills score and cigarette and hookah smoking.

The role of sociodemographic factors associated with waterpipe smoking among male adolescents in western Iran: A cross-sectional study

INTRODUCTION

Waterpipe smoking (WPS) is an increasingly popular leisure activity among young people in Iran. The purpose of this study was to identify the role of sociodemographic factors associated with WPS among male adolescents in Iran.

METHODS

The study used a cross-sectional design. It included 730 high school male students (Grades 10–12) recruited through multistage random sampling conducted in 2017 in Hamadan city, western Iran. The self-administered questionnaires included information on demographic variables and behavioral risk factors related to WPS. Descriptive statistics and multinomial logistic regression modeling were conducted using SPSS.

RESULTS

The student mean age, and standard deviation (SD), and age at WPS initiation were 16.41 (0.84) and 13.31 (2.43) years, respectively. The percentages of never, former and current WPS were 37.3%, 36.4% and 26.3%, respectively. We found that ever cigarette smoking (OR=5.14, 95% CI: 2.56–10.32) and WPS family (OR=2.55, 95% CI: 1.40–4.64) were significantly associated with former WPS. Furthermore, being 18 years, studying in technical fields, reporting ever and current smoking of cigarettes and family usage of WP were significantly associated with current WPS. Friends with WPS (OR= 0.50, 95% CI: 0.34–0.72) however played a protective role on former WPS.

CONCLUSIONS

The results indicate that the prevalence of former and current WPS was high in Hamadan city. Thus, designing and implementing interventions for increasing students’, friends’ and family’s awareness regarding the harms of WPS and cigarette smoking are necessary to facilitate behavior change.

The prevalence and trends of waterpipe tobacco smoking: A systematic review

INTRODUCTION

Waterpipe tobacco smoking is harmful to health however its prevalence estimates remain uncertain. We aimed to systematically review the medical literature on waterpipe tobacco prevalence and trends.

METHODS

We searched Medline, Embase and ISI Web of Science for 'waterpipe' and its synonyms, without using language or date restrictions. We included any measure of waterpipe tobacco smoking prevalence in jurisdictionally representative populations. We stratified findings by prevalence measure (past 30 day, ever, regular or occasional, daily, other or unspecified) and age (adults or youth).

RESULTS

We included 129 studies reporting 355 estimates for 68 countries. In general, prevalence estimates among adults were highest in the Eastern Mediterranean, and among youth were about equal between Eastern Mediterranean and European regions. Past 30 day use was highest among Lebanese youth (37.2% in 2008), ever use was highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%), regular or occasional use was highest in among Iranian university students (16.3% in 2005), and daily use was highest among Egyptian youth (10.4% in 2005). Trend data were limited but most studies reported increased use over time, ranging from 0.3-1.0% per year among youth in the US to 2.9% per year among youth in Jordan (both for past 30 day use). Results were similar for ever use trends. Turkey (2.3% in 2008 to 0.8% in 2010) and Iraq (6.3% in 2008 and 4.8% in 2012) both witnessed decreased waterpipe use.

CONCLUSION

Waterpipe tobacco smoking is most prevalent in Eastern Mediterranean and European countries, and appears higher among youth than adults. Continued surveillance will be important to assess and inform policy measures to control waterpipe tobacco use.

Suicidal ideation and its correlates among high school students in Iran: a cross-sectional study

BACKGROUND

Globally, the second leading cause of death among adolescents is suicide and in middle-income countries adolescents' suicidal ideation is a neglected public health area. The present study was conducted to determine the prevalence and correlates of suicidal ideation among 15-17-year-old high school students in Iran.

METHODS

Self-administered, Global School-based Student Health Survey (GSHS) questionnaires were distributed to a representative sample (N =1517) of high-school students aged 15-17 in the city of Tabriz. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (suicidal ideation in the past 12 months).

RESULTS

Overall, 62 (4.1%, 95% CI= 3.1, 5.2) of 1,517 students had thoughts of suicide. Three hundred and thirteen (20.6%, 95% CI= 18.6, 22.7) students reported being bullied in the previous 30 days. In addition, 134 (8.8%, 95% CI= 7.5, 10.3) students reported having been sexually abused. Being worried that they could not eat or did not feel hungry (Adjusted Odds Ratio (AOR) = 4.15; 95% Cl [1.71, 10.07]; current cigarette smoking (AOR = 3.00; 95% CI [1.69, 5.30]; thinking about using alcohol or other drugs (AOR = 4.28; 95% CI [2.41, 7.59]; and being sexually abused (AOR = 2.63; 95% CI [1.32, 5.24]) were all factors positively associated with suicidal ideation.

CONCLUSION

The prevalence of suicidal ideation was lower in our school students than in earlier studies. Interventions that address the issue of current cigarette smoking, worries, thinking about using alcohol or other drugs and sexual abuse should be given more priority by the public health authorities.