Factors associated with smoking contemplation and maintenance among Iranian adolescents

Background: Evidence is scarce on which factors contribute to cigarette and waterpipe contemplation and no previous study has examined the factors associated with waterpipe maintenance.

Aims: This study aimed to determine the factors associated with cigarette and waterpipe smoking contemplation and maintenance among Iranian adolescents.

Methods: Factors including depression, risky behaviour, family conflict, attitude to smoking acceptability and self-efficacy were examined using a questionnaire for 5500 adolescents at the smoking contemplation or maintenance stage.

Results: Students with depression had nearly double the chance [95% confidence interval [CI]: 1.41–2.72] of cigarette smoking contemplation. Risk takers had odds of 2.13 [95% CI: 1.51–2.94] and 1.49 [1.22–1.85] of cigarette and waterpipe [hookah] smoking contemplation, respectively. Those facing family conflict had odds of 1.87 [95% CI: 1.38–2.53] and 1.53 for cigarette and waterpipe smoking contemplation, respectively. The contemplation odds for students with more positive attitude to smoking acceptability were 2.12 [95% CI: 1.51–2.97] and 1.72 for cigarette and waterpipe smoking, respectively. Higher self-efficacy was associated with lower cigarette and waterpipe smoking contemplation. Risky behaviour was related to smoking maintenance. A more positive attitude to smoking acceptability was related to higher waterpipe maintenance [odds ratio = 1.57 95% CI: 1.03–2.40].

Conclusions: Depression, attitude to smoking acceptability and risky behaviour are factors associated with smoking contemplation and maintenance.