Rana Jaber1, Purnima Madhivanan2, Yousef Khader3, Fawaz Mzayek4, Kenneth D Ward5, Wasim Maziak6. 1. Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States. Electronic address: rjabe001@fiu.edu. 2. Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States. Electronic address: pmadhiva@fiu.edu. 3. Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan. Electronic address: yskhader@just.edu.jo. 4. Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States. Electronic address: fmzayek@memphis.edu. 5. Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States. Electronic address: kdward@memphis.edu. 6. Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States; Syrian Center for Tobacco Studies, Aleppo, Syria. Electronic address: wmaziak@fiu.edu.
Abstract
BACKGROUND: The predictors of waterpipe smoking progression are yet to be examined using a longitudinal study that is guided by a theoretical model of behavioral change. This study identifies the gender-specific predictors of waterpipe smoking progression among adolescents in Irbid, Jordan. METHODS: This study uses data from a school longitudinal study of smoking behavior in Irbid, Jordan. A random sample of 19 schools was selected by probability proportionate to size. A total of 1781 seventh graders were enrolled at baseline, and completed a questionnaire annually from 2008 through 2011. Students who reported ever smoking waterpipe (N=864) at any time point were assessed for progression (escalation in the frequency of waterpipe smoking) in the subsequent follow-up. Grouped-time survival analysis was used to identify the risk of progression. RESULTS: During the three years of follow-up, 29.6% of students progressed in waterpipe smoking. Predictors of waterpipe smoking progression were higher mother's education, enrollment in public school, frequent physical activity, and low refusal self-efficacy among boys, having ever smoked cigarettes, and having friends and siblings who smoke waterpipe among girls. Awareness of harms of waterpipe was protective among boys and seeing warning labels on the tobacco packs was protective among girls. CONCLUSIONS: Even at this early stage, about a third of waterpipe smokers progressed in their habit during the 3 year follow up. Factors predicting progression of use differed by gender, which calls for gender-specific approaches to waterpipe interventions among Jordanian youth.
BACKGROUND: The predictors of waterpipe smoking progression are yet to be examined using a longitudinal study that is guided by a theoretical model of behavioral change. This study identifies the gender-specific predictors of waterpipe smoking progression among adolescents in Irbid, Jordan. METHODS: This study uses data from a school longitudinal study of smoking behavior in Irbid, Jordan. A random sample of 19 schools was selected by probability proportionate to size. A total of 1781 seventh graders were enrolled at baseline, and completed a questionnaire annually from 2008 through 2011. Students who reported ever smoking waterpipe (N=864) at any time point were assessed for progression (escalation in the frequency of waterpipe smoking) in the subsequent follow-up. Grouped-time survival analysis was used to identify the risk of progression. RESULTS: During the three years of follow-up, 29.6% of students progressed in waterpipe smoking. Predictors of waterpipe smoking progression were higher mother's education, enrollment in public school, frequent physical activity, and low refusal self-efficacy among boys, having ever smoked cigarettes, and having friends and siblings who smoke waterpipe among girls. Awareness of harms of waterpipe was protective among boys and seeing warning labels on the tobacco packs was protective among girls. CONCLUSIONS: Even at this early stage, about a third of waterpipe smokers progressed in their habit during the 3 year follow up. Factors predicting progression of use differed by gender, which calls for gender-specific approaches to waterpipe interventions among Jordanian youth.
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