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Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis.

ABSTRACT: Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.A school-based cohort of all 7th grade students (N=1781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1243).During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: odds ratio 7.41; 95% confidence interval 4.05-12.92 and girls: 8.48; 4.34-16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80-51.53 and girls: 11.49; 6.42-20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14-4.64) or teachers (2.07; 1.12-3.84) who smoked and girls if they had friends (2.96; 1.59-5.54) who smoked.There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.

SUBMITTER: McKelvey K

PROVIDER: S-EPMC4138134 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis.

McKelvey Karma K Attonito Jennifer J Madhivanan Purnima P Jaber Rana R Yi Qilong Q Mzayek Fawaz F Maziak Wasim W

Drug and alcohol dependence 20140709

<h4>Objective</h4>Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.<h4>Methods</h4>A school-based cohort of all 7th grade students (N=1781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1243).<h4>Results</h4>During the 3-year st ...[more]

PMID: 25060962

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Project description:BackgroundMaternal tobacco use is a global public health problem. In the literature, the focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored dual use among pregnant women. We estimated the prevalence of current maternal tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of ten years (2007 to 2017), and examined the socio-demographic patterning of maternal tobacco use.MethodsA secondary analysis of Jordan DHS four data waves was conducted for women who reported to be pregnant at the time of the survey. Current cigarette and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only, waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and waterpipe, regardless of cigarette, were reported. The effect of independent variables on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression models assessed the adjusted effects of socio-demographic variables on cigarette smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted and a time-unadjusted logistic models were conducted.ResultsOver the last decade, the prevalence estimates of current cigarette-only smoking slightly decreased. The prevalence estimates of current waterpipe-only use exceeded those for cigarette-only after 2007 and showed a steady overall increase. Current dual use showed a continuous rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and 5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed an inverse relationship with cigarette and waterpipe smoking. Household wealth demonstrated a positive association with cigarette and waterpipe smoking.ConclusionsTobacco use epidemic is expanding its roots among pregnant women in Jordan through not only waterpipe use but also dual cigarette-waterpipe smoking. Maternal and child services should consider tobacco counseling and cessation.

Project description:BackgroundInvolving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.MethodsA random sample of 40 schools in Doha, Qatar was selected for inclusion in the original intervention. Permission forms were distributed to parents for approval of their child's participation. The permission forms requested that parents indicate their reasons for non-permission if they declined. These were categorized into themes. In order to understand reasons for non-permission, interviews with parents were conducted. Phone numbers of parents were requested from the school administration; 12 of the 40 schools (30%) agreed to provide the contact information. A random sample of 28 parents from 12 schools was interviewed to reach data saturation. Thematic analysis was used to analyze their responses.ResultsReasons for non-permission documented in both the forms and interviews included: poor timing; lack of interest; the child not wanting to participate; and the child living in a smoke-free environment. Interviews provided information on important topics to include in the consent forms, parents' decision-making processes regarding their child's participation, and considerations for communicating with parents. Many parents also indicated that this was the first time they had been asked to give an informed consent for their child's participation in a study.ConclusionsResults indicate that more attention needs to be given to the informed parental consent process. Researchers should consider enhancing both the methods of communicating information as well the specific information provided. Before embarking on recruitment of children for studies, formative research on the parental consent process is suggested.

Dataset Information

Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis.

Publications

Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis.

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