RESUMO
INTRODUCTION: This study assess the prevalence and potential determinants (attitudes, behavioral and emotional conditions) associated with waterpipe tobacco smoking (WTS) and cigarette smoking in adolescents in public compulsory secondary schools. METHODS: This was a cross-sectional study conducted in October 2017 in three secondary schools from Seville, Spain, among adolescents aged 12-18 years. We administered an ad hoc questionnaire to explore the demographic and clinical characteristics of students; in addition, it included questions on consumption of tobacco (waterpipe and/or cigarette), alcohol (usual consumption and/or drunkenness) and/or cannabis, and attitudes towards waterpipe tobacco smoking. We also administered a validated version of the Strengths and Difficulties Questionnaire (SDQ), which is used to screen children and adolescents with emotional and behavioral problems. An established usage of a substance was defined as weekly or daily use. A multivariate analysis was performed using binary logistic regression methods to determine the probability of established usage. RESULTS: Of the 1135 adolescents, 72.1% lived with at least one smoker; the established usage was 13.4% for waterpipe; 9.2% for cigarettes and 3.2% for dual use. Of those with established usage of waterpipe, 38.2% had established alcohol usage, 12.7% were drunk weekly or daily, and 27.4% used cannabis. Students consolidating the consumption of waterpipes were three times more likely to have established cigarette use than those not having an established usage (OR=3.7; p=0.0005). The overall SDQ score increased the likelihood of established usage of both waterpipes and cigarettes (p=0.0005). CONCLUSIONS: The probability of established usage of cigarettes (multivariate analysis) is associated with increasing age (course), cohabitation with smokers, established usage of waterpipe, established use of alcohol and a borderline score in the behavioral dimension (SDQ). Addiction to waterpipes among teens is significantly associated with their behavioral and emotional difficulties.
