Refusal self efficacy, self esteem, smoking refusal skills and water pipe (Hookah) smoking among iranian male adolescents

A Cross-Sectional Survey on the Use of Tobacco, Attempts on Cessation, and Locus of Control Among College Students

Background Socio-cultural considerations (such as drug availability) and psychological traits play a significant role in predicting whether a person will use drugs in the future and dependency on the drugs. Second-, third-, and fourth-hand smoking and E-cigarettes are influencing factors for the use of tobacco in college students. This study conducted research to ascertain whether there is a potential relationship between tobacco consumption and various factors, including internal and external control sites and demographics. Materials and methods Participants in the study were found by walk-up distribution at multiple campus-wide smoking places, department announcements, and on-campus advertisements. Social media and participant references were also used in this study as recruitment tools. In addition, the locus of control questionnaire also identifies if the participating individual had extrinsic or intrinsic reinforcing routines. The classification of the participating individuals into respective internal and external locus of control was in accordance with their response survey after which a statistical analysis was done. Results This study found an association between smoking on campus and reported attempts to quit. Additionally, there is a strong association (r(85) = 0.31, p < 0.01) between reported tobacco use status and cigarette use on campus. Participants' gender and smoking status also had r(85) = 0.39, p-value < 0.01 correlation. The bulk of respondents indicated that they were seniors and off-campus living concluding for 36% (n = 34) and 60% (n = 51) of the total. Twenty-seven percent (n = 24) of the respondents were first-year college students and the rest 33% (n = 29) said their parents had no college education at all or incomplete college education. Conclusion Whenever there is a strong perception of organizational support for anti-tobacco policies, and improving compliance, there is a drastic increase in cigarette cessation and a drop in tobacco usage among those who still smoke. Perceived organizational support is strongly and positively connected with cessation among the organization's members.

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.

Exploration factors on smoking among female adolescents based on the viewpoints of Iranian adolescent girls

Background

In recent years, the prevalence of smoking in women has increased significantly. This study aimed to explain the effective factors in the tendency to smoke in female adolescents, employing a qualitative method of content analysis in Mashhad, Iran.

Methods

The data for this conventional content analysis were obtained by conducting semi‑structured interviews with 20 female adolescent smokers. For open coding, integrating codes, creating main category and subcategories, and extracting quotation associated with codes and subcategories, MAXQDA software version 10 was used.

Results

Based on the results of the study, one main category and six subcategories were identified to influence the decision to smoke. The main category was interconnection of psychological and gender experiences. The subcategories included self-management weakness, ignoring the side effects, gender orientation, negative psychological experiences, the attraction of cigarettes, and positive psychological experiences.

Conclusion

Psychological and gender factors play an important role in initiating people's behavior and tendency to smoke and smoking prevention programs in educational settings need to focus efforts around what is known about young women smokers.

Prevalence of water pipe smoking and associated risk factors among female adolescents

BACKGROUND

The prevalence of water pipe smoking is increasing among young people, but there are limited data on its use among adolescents in Iran. The aim of this study is to investigate the prevalence of WP smoking and associated risk factors among female adolescents in Western Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted in schools. It included 1302 middle school (48.1%) and high school (51.9%) female students (grades 7-12) recruited through stage random sampling and conducted in 2019 in the western city of Kermanshah, Iran. The data collection tool was a researcher-made questionnaire. Logistic regression analyses and descriptive statistics were executed using SPSS version 22.

RESULTS

The mean (standard deviation) ages of the students and the ages when the participants started WP smoking were 15.22 ± 1.85 and 13.64 (1.64), respectively. Nearly 32.2% had a single experience of WP smoking during their lifetime and 20.4% were current consumers of WP. Most of the subjects smoked WPs at their friends' home (45.8%) and with their friends (47.4%). The significantly important factors that affect WP smoking in these age groups are the father's and mother's occupation, family size, living with others, father's education, having a friend who smokes WPs, friends' encouragement to smoke WP, and being in a family that smoke WPs.

CONCLUSIONS

Considering the increasing popularity of WP among adolescent females and its increasing prevalence, the results showed that Water pipe smoking with friends played a key role in WP smoking among female adolescents. There is a need to design interventional studies to increase people's skills and to design and implement programs to prevent water pipe.

Aspects associated with waterpipe smoking in Iranian youths: a qualitative study

BACKGROUND

Waterpipe is one of the oldest methods of tobacco smoking, which has become the public health challenge, especially in the Eastern Mediterranean countries such as Iran. This study aimed to investigate the waterpipe smoking (WPS) in the young people of Kermanshah in 2020, using a qualitative method.

METHODS

This was a qualitative study conducted with the approach of content analysis. Participants were young waterpipe user aged 17 to 25 years selected by purposeful sampling method in Kermanshah city, located in the west of Iran. Data were collected through semi-structured interviews in face-to-face and audio-recorded methods based on an interview guideline during June to August 2020. Then researchers transcribed verbatim and analyzed the content of the interviews thematically.

RESULTS

In this study, 23 young people who were waterpipe users at the time of the study participated. The results showed that social aspects in three sub-categories were involved in WPS including "socio-cultural aspects", "socio-environmental aspects", and "social relations". Individual aspects of waterpipe use as second category also consisted of two sub-categories including "motivational aspects" and "lack of psycho-protective aspects".

CONCLUSIONS

It seems that the implementation of the policy of reducing access to waterpipe in public environments is effective in reducing waterpipe consumption. It is suggested that educational and interventions, based on targeted models and theories be implemented in order to increase young people's belief and perception on dangers of WPS, and to improve their self-efficacy to smoking cessation.

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.

Cigarettes versus water-pipes: Differences and similarities in factors predicting the use of cigarettes and water-pipes among young male adults according to the planned-behaviour theory

Cigarette and water-pipe smoking are responsible for substantial harmful health consequences. However, studies have often examined these two types of smoking in separate study samples. Thus, this study examined differences and similarities among factors predicting cigarette and water-pipe smoking according to planned-behaviour theory within the same sample. Two hundred and twenty-one young Arab Israeli male adults (N = 221) completed demographic, self-esteem and planned-behaviour questionnaires. The study findings demonstrated that perceived ability to control one's water-pipe use was significantly higher than perceived ability to control one's use of cigarettes. With regard to attitudes, norms and intentions, no significant differences were found between cigarette and water-pipe use. Hierarchal multiple regressions showed that being Muslim, self-esteem, negative attitudes and negative norms contributed to the explained variance of both cigarette and water-pipe smoking. Self-control contributed to the variance in cigarette smoking, but not water-pipe smoking. The findings make an important contribution to our understanding of the differences and similarities in the factors predicting cigarette and water-pipe use among young male adults. Theoretical and clinical implications are discussed.

The Effectiveness of Smoking Prevention Module Towards Knowledge and Smoking Refusal Skills among Adolescents in Kota Bharu, Kelantan, Malaysia

Objective:

To study the effectiveness of the smoking prevention module towards knowledge on smoking and its harmful effects and smoking refusal skills among secondary school students in Kelantan, Malaysia.

Methods:

A quasi experimental interventional study involving 166 non-smokers adolescents, aged 13 to 14 years old were carried out in two schools located in two different suburbs. Both schools had equal number of participants. One school was given the smoking prevention module for intervention while the control school only received the module after the study had been completed. The knowledge on smoking and its harmful effects and smoking refusal skill score were assessed using a set of validated Malay questionnaires at baseline, two weeks and eight weeks after the intervention. Repeated measure ANCOVA was used to analyse the mean score difference of both groups at baseline and after intervention.

Result:

Baseline analysis shows no significant difference in knowledge score between the study groups (p = 0.713) while post intervention, it shows significant inclination of knowledge score in intervention group and the difference was significant after controlling the gender [F(df) = 15.96(1.5), p <0.001]. The mean baseline for refusal skills score in the control and intervention groups were 30.89(6.164) and 28.02(6.241) respectively (p= 0.003). Post intervention, there is a significant difference in the crude mean and the estimated marginal means for smoking refusal skills score between the two groups after controlling for sex [F(df) = 5.66(1.8), p = 0.005].

Conclusion:

This smoking prevention module increased the level of knowledge on smoking and its harmful effects and smoking refusal skill among the secondary school students. Thus, it is advocated to be used as one of the standard modules to improve the current method of teaching in delivering knowledge related to harmful effects of smoking and smoking refusal skill to the adolescents in Malaysia.

Factors associated with hookah smoking among women: A systematic review

INTRODUCTION

The present study aimed to determine factors associated with hookah smoking among women on a global scale based on a systematic review of related literature. Intervention Mapping was the guiding framework for this review.

METHODS

Searches were performed in Web of Science, PubMed, Iranian databases, Elsevier, Embase, Scopus, Medline, Google Scholar, and the World Health Organization (WHO) website, using keywords related to hookah and associated terms. Studies in English or Persian, published between 1990 and 2018, were included in this review if they were available in full text and had a target population of women. Determinants of hookah smoking at the intrapersonal, interpersonal, institutional/organizational, community, and political levels, were extracted.

RESULTS

Positive attitude, social-psychological needs, low perceived risk, social-cultural acceptance of hookah, easy access and lack of laws were among the reasons given for consuming hookah. Because hookah smoking is a multifactorial issue, the qualitative method alone was not sufficient to identify the determinants of hookah smoking among women. The opinions of experts in the field of smoking control had been largely neglected in the obtained studies, and most quantitative studies lacked a theoretical framework.

CONCLUSIONS

To reduce the rate of hookah consumption, actions to be taken include changing women’s positive attitude toward hookah, learning to resist friends’ pressure to smoke, highlighting the unpleasantness of hookah smoking by segregating places with transparent walls within public places, showing in the virtual world that hookah smoking is socially unacceptable, limiting access to hookah tobacco products, and effectively implementing rules that restrict hookah smoking in public places.

Effectiveness of a Peer-Led Behavioral Intervention Program on Tobacco Use-Related Knowledge, Attitude, Normative Beliefs, and Intention to Smoke among Adolescents at Iranian Public High Schools

BACKGROUND

Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14-17 years old.

METHODS

A school-based cluster randomized controlled intervention study was conducted among 1st, 2nd, and 3rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students' smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire.

RESULTS

The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention.

CONCLUSIONS

Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.

Alternative Tobacco Products Use among Late Adolescents in Kelantan, Malaysia

BACKGROUND

The rising prevalence of alternative tobacco and nicotine products (ATNPs) use among adolescents is a global concern that has been attributed to the reemergence of preexisting alternative tobacco products and emergence of new ones in the market. This study examined ATNP use among late adolescents. The association between ATNP use and reasons for using them was explored.

METHODS

This cross-sectional study conducted in 2016 involving 388 late adolescents from six government colleges in Kelantan, Malaysia, aged 18 to 19 years. They were requested to answer self-directed questionnaires with items on sociodemographic information and types of ATNP used. Other variables obtained include the environmental influence and reasons for using the products. Regression analyses between the dependent and independent variables were conducted using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The prevalence of ATNP use among late adolescents was 14.4%. The male sex, cigarette smoking status, and peer use were significantly associated with ATNP use. Several reasons for use were not significantly associated with ATNP use: perception of ATNP being less harmful and less addictive compared with cigarettes, curiosity, less expensive than cigarettes, to aid smoking cessation, and pleasurable flavors and taste.

CONCLUSION

The prevalence of ATNP use among late adolescents studying in government colleges in Kelantan is significant. There is higher perception on ATNP being less harmful and addictive than the conventional cigarette among the users compared with non-users. Significant associations are seen for the male sex, peer use, and concurrent cigarette smoking.

Psychometric Properties of the Iranian Brief Version of the Transtheoretical Model Instrument in Terms of Hookah Tobacco Smoking Cessation

Background

Transtheoretical model (TTM) has been recognized as a common theoretical model in researches in terms of addictive behaviors. The aim of this study was to examine the psychometric properties of the Persian brief version of the TTM for hookah tobacco smoking cessation in a sample of Iranian rural adults who were in the preparation stage for hookah cessation.

Methods

This was a validation study on Iranian rural adult hookah smokers by the TTM instrument. First, to translate the questionnaire items from English to Persian, backward-forward procedure was used. Face and content validity of the instrument items were assessed. Confirmatory factor analysis (CFA) was performed to determine the construct validity of the instrument. For this aim, 300 participants completed the instrument. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were calculated to examine the internal consistency and reliability of the subscales of the instrument.

Findings

The content validity index (CVI) and content validity ratio (CVR) of the items were ≥ 0.80 and ≥ 0.60, respectively. Based on CFA, the data fitted the TTM model. root mean square error of approximation (RMSEA), the goodness of fit index (GFI), adjusted GFI, and comparative fit index (CFI) were 0.037, 0.960, 0.910, and 0.950, respectively. At this stage, 6 items were deleted. The ICC and Cronbach's alpha of the subscales ranged between 0.60-0.74 and 0.71-0.86, respectively. The final instrument with 29 items was confirmed.

Conclusion

The findings suggest that translating Persian brief version of the TTM instrument was a reliable and valid tool to identify the determinants of hookah smoking cessation among Iranian rural adults.

Locus of control is associated with tobacco and alcohol consumption in young adults of the Avon Longitudinal Study of Parents and Children

Individuals appraise events as a consequence of their own actions (i.e. internal locus of control, LoC) or as the outcome of chance or others' will (i.e. external LoC). We hypothesized that having a more external LoC would be associated with higher risk of tobacco and alcohol use. Few studies have examined this association using large prospective data. We evaluated within the Avon Longitudinal Study of Parents and Children (ALSPAC) the associations between LoC at 16 and tobacco and alcohol consumption at 17 and 21 years using logistic regression. A more external LoC at age 16 (N = 4656) was associated with higher odds of being a weekly smoker at age 17 (OR 1.18, 95% CI 1.10-1.25) and 21 (OR 1.14, 95% CI 1.07-1.21) and with dependence measured using the Fagerström Test of Nicotine Dependence at age 17 (OR 1.26, 95% CI 1.05-1.51) and 21 (OR 1.25, 95% CI 1.05-1.49). Individuals with external LoC at age 16 were more likely to be hazardous drinkers according to the Alcohol Use Disorders Identification Test at age 17 (OR 1.09, 95% CI 1.04-1.15) but not at 21 (OR 1.01, 95% CI 0.96-1.06). Having a more external LoC at age 16 is associated with increased tobacco consumption at age 17 and 21 and alcohol consumption at 17 years. LoC may represent an intervention target for preventing substance use and dependence.

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 association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior

OBJECTIVES

Diabetes is a chronic illness which requires lifelong self-care behaviors. The objective of the present research was to investigate the association of self-efficacy, attitude and social support with adherence to diabetes self-care behavior.

MATERIALS AND METHODS

In this cross-sectional study conducted in 2017, 403 diabetic patients of Zarandieh, Iran participated. They were evaluated by valid and reliable questionnaires comprised of items on diabetes self-care, self-efficacy in dealing with problems, social support and attitude towards self-care. Data were analyzed using SPSS 18 applying t test, ANOVA, and multiple regression analysis.

RESULTS

The results indicated that patients with higher self-care scores had better self-efficacy, social support, and attitude towards self-care. Moreover, self-efficacy, social support, and attitude towards self-care variables accounted for 39.5% of the total variance of self-care behavior. Furthermore, social support (β = 0.87), self-efficacy (β = 0.52), and attitude towards self-care (β = 0.42) were respectively the most important predictors of self-care behaviors.

CONCLUSION

Social support, self-efficacy and attitude towards self-care behaviors were associated with self-care behaviors in patient with diabetes. They might suggest that educational programs specifically target these factors.

Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015)

OBJECTIVE

To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth.

STUDY DESIGN

The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?'

METHODS

Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review.

RESULTS

This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth.

CONCLUSION

This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use.

Comparison of the effect of educational methods on students' knowledge, attitude and behavior about hookah smoking

INTRODUCTION

Smoking tobacco by hookah may seriously affect the health of smokers and those exposed to smoke. This study aimed to compare the effect of educational digital media versus pamphlets on the reduction of hookah use among male high school students in Zahedan, Iran.

METHODS

A semi-experimental study was conducted on 200 male high school students of Zahedan using multi-stage random sampling for three months in 2014. The samples were divided into two groups - the test (educated using digital films) and the control (educated using pamphlets) groups, and measurement was performed before and after intervention. The data collection instrument was a 53-item questionnaire consisting of demographic, knowledge, attitude, behavior and self-efficacy questions. Its validity and reliability were confirmed. The results before and after the intervention were analyzed using SPSS version 18, Mann-Whitney U test, Pearson-product moment correlation coefficient and Chi square test as well as one directional variance analysis.

RESULTS

There was no significant relation between demographic and basic variables before intervention (p>0.05); however, the mean scores of knowledge, attitude, self-efficacy, and hookah using preventive behavior were significantly different between the two groups after the intervention (p<0.05). Moreover, there was a meaningful relation among the demographic characteristics including age and attitude- the previous educational year's GPA and self-efficacy; and there was a significant relation between father education and self-efficacy. Moreover, there was a significant relation between the main variables of the study, concerning the relation of knowledge and attitude- knowledge and self-efficacy, and attitude and self-efficacy.

CONCLUSION

Educational digital media is more efficient than the pamphlet in the reduction of hookah use among the students; and that the media may be applied to prevent of hookah use among students.

Correlates of nicotine dependence among adolescent waterpipe smokers

INTRODUCTION

Waterpipe smoking is addictive and its use is increasing globally among youth, yet little is known about the factors associated with nicotine dependence (ND) among waterpipe smokers. We investigated the factors associated with ND symptoms among a sample of Lebanese adolescents who smoke a waterpipe.

METHODS

We collected data on factors potentially associated with ND (individual, socio-demographic, environmental, smoking patterns) among 160 current (past 30days) waterpipe smokers recruited from 8th and 9th school grades in Lebanon. We assessed the loss of autonomy over tobacco using the Hooked on Nicotine Checklist (HONC), ND using the International Classification of Diseases, 10th revision (ICD-10), and the number of ND symptoms endorsed.

RESULTS

Depressive symptoms, lower self-esteem, and having at least one sibling who smokes a waterpipe were associated with the presence of ND symptoms, while enrollment in public schools, smoking a waterpipe ≥30min per session, and believing that cigarette smoking is harmful to health were associated with endorsement of a higher number of ND symptoms. Smoking a whole waterpipe head without sharing and being in 9th grade in this study were associated with the presence and endorsement of a higher number of ND symptoms.

CONCLUSIONS

We identified specific social and psychological characteristics, waterpipe smoking patterns, and beliefs about harmful effects of smoking associated with the presence of ND among adolescent waterpipe smokers. Considering these factors when planning policies to prevent ND among waterpipe smokers is warranted.

Being lonely or using substances with friends? A cross-sectional study of Hungarian adolescents' health risk behaviours

BACKGROUND

Studying adolescents' health risk behaviours is oddly significant in Central and Eastern European countries, where the prevalence of smoking and drinking among 14-18 year old students is significantly high. The goal of our study is to examine the role of social psychological and social behavioural variables in health risk behaviours among Hungarian adolescents.

METHODS

Our sample was comprised of three high schools of Debrecen (the second largest city of Hungary). In all, 501 students filled in the questionnaire from 22 classes (14-22 years old). Students aged above 18 years were excluded for the purpose of the study, giving a total sample size of 471 high school students. Descriptive statistics and binary logistic regression analyses were conducted.

RESULTS

According to our results (1) social behavioural factors (namely, smoking and alcohol use of the best friend and peer group) proved to be better predictors of adolescents' health risk behaviours as compared to the included social psychological attributes (2); among the latter ones, loneliness and shyness were negatively related with both smoking and drinking, while competitiveness was a predictor of drinking prevalence among boys.

CONCLUSIONS

The findings suggest that social behavioural factors, including smoking and drinking of friends, are oddly important predictors of Hungarian adolescents' health risk behaviours. According to our results, health policy should pay more attention to peer norms related to smoking and drinking during school health promotion. Developing health protective social norms may be an indispensable component of effective health promotion in high schools.

An Extended Theory of Planned Behavior (TPB) Used to Predict Smoking Behavior Among a Sample of Iranian Medical Students

BACKGROUND

Smoking among the youth is an important public health concern. Although several studies have investigated the correlates of smoking behavior, no theory-based study has particularly assessed this problem among medical students.

OBJECTIVES

This study aimed to evaluate the efficacy of the extended theory of planned behavior (TPB) to predict smoking behavior among a sample of Iranian medical students.

PATIENTS AND METHODS

This is a cross-sectional study carried out in Ahvaz, Iran, 2014. The data were collected through a self-administered questionnaire, which included items on demographics, smoking behavior, and components of the TPB model (attitude, subjective norms, perceived behavior control, and intention), and an added construct on smoking refusal skill. Data were analyzed using descriptive correlation, and linear regression statistics by SPSS, version 16.

RESULTS

One hundred and seventy medical students with a mean age of 21.25 (SD = 2.9) years were enrolled in the study. Of them, 24 (13.5%) students were smokers. All components of the TPB model and smoking refusal skill were statistically significant as to intention to smoke (P < 0.001). The TPB constructs with and without smoking refusal skill accounted for 77% (adjusted R2) and 78% of the variance observed for intention to smoke, respectively. The results also revealed the highest weight for perceived behavior control (β= -0.40).

CONCLUSIONS

The findings of this study indicated that all TPB variables are useful tools for prediction of the smoking behaviors among students. Particularly, students' perceived behavioral control and attitudes towards smoking were found to be important determinants of smoking intentions. Thus, the findings could be used for planning effective tobacco control programs targeting University students.

Effect on smoking quit rate of telling smokers their health risk appraisal in terms of health age: a randomized control trial

BACKGROUND

We evaluated whether providing health risk appraisal for Koreans (KHRA) in terms of 'health age' during smoking cessation program would effectively help smokers quit smoking or not.

MATERIALS AND METHODS

A total of 332 male smokers aged between 30-65 years old, registered for a smoking cessation program in a public health center in a city, were recruited and underwent a baseline survey from January 2010 to February 2011. They were then prospectively randomized to a conventional counseling group (n=165) or a KHRA group (n=167), and received conventional counseling or KHRA-based counseling for six months. Abstinence rates were identified through carbon monoxide measurement (at the 4th and 24th weeks) or urinary cotinine level (at the 12th week).

RESULTS

The abstinence rate confirmed by exhaled carbon monoxide was significantly higher in the KHRA group (61.1%) than the control group (49.1%) at the 4th week (absolute difference 12.0%, 95% CI: 1.4%-22.6%). However, there was no difference in abstinence rates between the two groups at the 12th and 24th weeks. The predicting factors of 24 week's smoking cessation success were age, older than 50 years old (OR 2.02, 95% CI: 1.16-3.52), lower Fagerstrom Test for Nicotine Dependence score less than 4 (OR 1.84, 95% CI: 1.03-3.29), and higher Self Efficacy/Temptation score (OR 1.79, 95% CI: 1.05-3.06).

CONCLUSIONS

Smoking cessation counseling with KHRA could be effective compared to conventional counseling in the short period of smoking cessation. Further study is needed to evaluate the long-term efficacy of KHRA in tobacco dependence treatment and to establish the indication and target population of this tool.

The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally

Objective

The objective of this narrative review is to highlight the determinants of the epidemic rise in waterpipe tobacco smoking (WTS) among youth globally. The Ecological Model of Health Promotion (EMHP) was the guiding framework for the review.

Data sources

The following electronic databases were searched: Cochrane library, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL Plus with Full Text. Search terms included waterpipe and its many variant terms.

Study selection

Articles were included if they were published between 1990 and 2014, were in English, were available in full text and included the age group 10–29 years.

Data extraction

Articles which analysed determinants of WTS at any of the levels of the EMHP were retained regardless of methodological rigour: 131 articles are included. Articles were coded in a standard template that abstracted methods as well as results.

Data synthesis

The review found that methodologies used to assess determinants of WTS among youth were often conventional and lacked rigor: 3/4 of the studies were cross-sectional surveys and most enrolled non-representative samples. Within the framework, the review identified determinants of WTS at the intrapersonal, interpersonal, organisational, community and policy levels.

Conclusions

The review suggests potential interventions to control WTS among youth, with emphasis on creative utilisation of social media, and tobacco control policies that include the specificities of WTS. The review further suggests the need for rigorous qualitative work to better contextualise determinants, and prospective observational and experimental studies that track and manipulate them to assess their viability as intervention targets.