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1.  Predictors of smoking among male junior secondary school students in Riyadh, Saudi Arabia 
Tobacco Control  1996;5(1):26-29.
OBJECTIVE: To determine the prevalence and determinants of cigarette smoking among intermediate (junior secondary) schoolboys in Riyadh, Saudi Arabia. PARTICIPANTS: A sample of 1382 students (ages 12-19 years) in 45 classes randomly selected from 15 schools, using a two- stage stratified cluster sampling scheme. DESIGN: Students in the selected classes were requested to complete an anonymous questionnaire, under the supervision of trained interviewers. Univariate and multivariate statistical analyses of potential risk factors were performed. SETTING: Intermediate schools in Riyadh, Saudi Arabia. MAIN OUTCOME MEASURES: Association between current smoking and socio- demographic variables, history of smoking, age of smoking initiation, smoking behaviour among family members, knowledge of the harmful effects of smoking, and whether smoking is allowed in the presence of relatives and acquaintances. RESULTS: The prevalence of current smokers was 13.2% overall, ranging from 3.2% in those 12-13 years old to 31.1% in those aged 18-19. Some of the variables (nationality, father's education, and smoking allowed in the presence of parents or teachers) found to be associated with current smoking in a univariate analysis were no longer significantly associated with smoking in the multivariate analysis. By multivariate analysis, knowledge of the harmful effects of smoking, age, smoking allowed in the presence of friends or brothers, and previous smoking were statistically significant determinants of current smoking. CONCLUSIONS: Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences. Religious antipathy toward smoking should be emphasised in any local anti-smoking campaigns. 



PMCID: PMC1759483  PMID: 8795855
2.  The Global Youth Tobacco Survey: 2001–2002 in Riyadh region, the Kingdom of Saudi Arabia 
Background
Tobacco use is a major public health problem, and its prevalence is globally increasing, especially among children and adolescents.
Objective
The Global Youth Tobacco Survey aimed to explore the epidemiological trends and risk factors of tobacco smoking among intermediate school boys in Riyadh region of the Kingdom of Saudi Arabia.
Method
A two-stage cluster sample design was used to produce a representative sample of male students from selected schools. The participants (n = 1830) self recorded their responses on the Global Youth Tobacco Survey questionnaire.
Results
Lifetime prevalence of cigarette smoking was 35%, while 13% of students currently used other tobacco products. About 16% of students currently smoked at home, and 84% of students bought cigarettes without any refusal from storekeepers. Thirty-one percent and 39% of students were exposed to secondhand tobacco smoke inside and outside the house, respectively, which was definitely or probably harmful to health as opined by 87% of participants, and 74% voiced to ban smoking from public places. Among current smokers, 69% intended (without attempt) to quit and 63% attempted (but failed) to quit during the past year. Almost an equal number of students saw antismoking and prosmoking media messages in the last month, and 28% of students were offered free cigarettes by a tobacco company representative. In schools, more than 50% of students were taught about the dangers of cigarette smoking in the last year. Smoking by parents, older brothers, and close friends, watching prosmoking cigarette advertisements, free offer of cigarettes by tobacco company representatives, perception of smoking being not harmful, and continuing smoking which can be easily quit significantly increased the odds of smoking by students.
Conclusion
The common use of tobacco in school populations needs to be addressed by, among other tobacco control measures, a strict ban on cigarette selling to minors and intensive regular tobacco control campaigns involving health and religious messages.
Video abstract
doi:10.2147/SAR.S23626
PMCID: PMC3846322  PMID: 24474857
tobacco use; secondhand tobacco smoke; environmental tobacco smoke; intermediate school boys; Global Youth Tobacco Survey; Saudi Arabia
3.  An analysis of global youth tobacco survey for developing a comprehensive national smoking policy in Timor-Leste 
BMC Public Health  2016;16:65.
Background
Smoking is a global public health concern. Timor-Leste is facing a rapidly growing epidemic of tobacco use. The trend of smoking in Timor-Leste seems to be increasing and the magnitude of the problem affects people who smoke before reaching adulthood. One of the factors implicated in the continuously rising trend of smoking among young people in Timor-Leste is clearly due to unavailability of restrictive laws and regulations. Therefore, our study sought to analyze available dataset from the Global Youth Tobacco Survey (GYTS) for developing a comprehensive national smoking policy in order to lower smoking risks among young people in Timor-Leste.
Methods
We conducted a secondary analysis of the 2009 GYTS in Timor-Leste. The 2009 GYTS assessed 1657 in-school students aged 13–15 years for current smoking prevalence and determinants of tobacco use. We used IBM SPSS version 21 software to analyze the data. Frequency analyses were computed to identify demographic characteristics of study participants. Bivariate logistic regression analysis was performed to examine the association between each demographic characteristic as well as each independent variable and the outcome of being current smokers.
Results
Out of 1657 in-school students, 51 % were of ages less than 15; 53 % were girls; and 45 % were in grade 2. Prevalence of current cigarette smoking was found to be 51 %. The prevalence of current smoking among in-school students increased with ages (from 46 % in less than 15 to 57 % in 15 plus). Boys were more likely to be smokers than girls (59 % versus 28 %). Significant factors positively associated with current smoking included parental smoking; closed-peer smoking; number of days people smoked in the house; having family discussion about harmful effects of smoking; being smoking in areas such as school, public places and home; and having seen cigarette advertisements on billboard.
Conclusion
Timor-Leste has higher prevalence of cigarette smoking among minors, especially among boys. Our analysis provides evidence-based information for developing comprehensive tobacco control programs - both education and policy interventions to reduce smoking rate among young people in Timor-Leste.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-2742-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-016-2742-5
PMCID: PMC4722677  PMID: 26800672
Current smoking prevalence; Tobacco use; Smoking in Timor-Leste; Smoking among minors; Smoking policy; Tobacco control program
4.  Factors associated with commencing smoking in 12-year-old students in Catalonia (Spain): a cross-sectional population-based study 
BMC Public Health  2010;10:665.
Background
Over the last decade notable progress has been made in developed countries on monitoring smoking although experimenting with cigarettes and smoking in young people remains a serious public health problem. This paper reports a cross-sectional study at the beginning of the 3-year follow-up community study TA_BES. The aim was to study the prevalence of smoking in addition to determining predictive factors for when smoking commences in a representative population of 12-year-old first year compulsory secondary education students.
Methods
Twenty-nine secondary schools (N = 29) from an area of Catalonia participated in the study. In these schools 2245 students answered a questionnaire to study the attitudes, behaviors, and tobacco consumption in the subject's surrounding circle and family in relation to smoking; carbon monoxide measurements were taken by means of co-oximetry on 2 different occasions. A smoker was defined as a student who had smoked daily or occasionally in the last 30 days. For non-smokers the criteria of not considering was set up for those who answered that in the future they would not be smokers and considering those who answered that they did not rule out becoming a smoker in the future.
Results
Among the total 2245 students included in the analysis 157(7%) were classified as smokers. Among non-smokers we differentiated between those not considering smoking 1757 (78.3%) and those considering smoking 288 (12.8%).
Age is among the factors related to commencing smoking. The risk of becoming a smoker increases 2.27 times/year. The influence of the group of friends with a very high risk for boys OR 149.5 and lower, albeit high, in girls OR 38.1. Tobacco consumption of parents produces different effects in young people. A smoking father does not produce alterations in the smoking behavior of young people. However having a smoking mother or former smoking is a risk factor for boys and a protective factor for girls.
We detected a gradual risk of becoming a smoker by means of the co-oximetry test. A boy/girl with a test between 6 p.p.m and 10 p.p.m increased the probability of smoking by 2.29 and co-oximetry values > 10 p.p.m multiplied the risk 4 times over.
Conclusions
Results indicate that the age of commencing smoking is maintained in spite of prevalence having decreased in the last few years. The risk factors identified should be used to involve families and the educational community by offering them tobacco weaning programmes.
doi:10.1186/1471-2458-10-665
PMCID: PMC3091575  PMID: 21044344
5.  Predicting tobacco use among high school students by using the global youth tobacco survey in Riyadh, Saudi Arabia 
Annals of Thoracic Medicine  2012;7(3):122-129.
OBJECTIVE:
To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA).
METHODS:
A cross-sectional study was conducted among high school students (grades 10–12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010.
RESULTS:
The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1–2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). “Ever smoked” status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28–3.63), parent smoking (OR = 1.70, CI: 1.25–2.30) or other member of the household smoking (OR = 2.11, CI: 1.59–2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56–12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09–15.48).
CONCLUSION:
Several predictors of cigarette smoking among high school students were identified.
doi:10.4103/1817-1737.98843
PMCID: PMC3425042  PMID: 22924068
Adolescents; cigarettes; Saudi Arabia; tobacco
6.  Prevalence and correlates of tobacco use amongst junior collegiates in twin cities of western Nepal: A cross-sectional, questionnaire-based survey 
BMC Public Health  2008;8:97.
Background
College students are vulnerable to tobacco addiction. Tobacco industries often target college students for marketing. Studies about prevalence of tobacco use and its correlates among college students in Nepal are lacking.
Methods
A cross-sectional survey was carried out in two cities of western Nepal during January-March, 2007. A pre-tested, anonymous, self-administered questionnaire (in Nepali) adapted from Global Youth Tobacco Survey (GYTS) and a World Bank study was administered to a representative sample of 1600 students selected from 13 junior colleges by two-stage stratified random sampling.
Results
Overall prevalence of 'ever users' of tobacco products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9% respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%, smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per day. Most (67.8%) 'Current users' purchased tobacco products by themselves from stores or got them from friends. Most of them (66.7%) smoked in tea stalls or restaurants followed by other public places (13.2%). The average daily expenditure was 20 Nepalese rupees (~0.3 USD) and most (59%) students reported of having adequate money to buy tobacco products. Majority (82%) of the students were exposed to tobacco advertisements through magazines/newspapers, and advertising hoardings during a period of 30 days prior to survey. The correlates of tobacco use were: age, gender, household asset score and knowledge about health risks, family members, teachers and friends using tobacco products, and purchasing tobacco products for family members.
Conclusion
School/college-based interventions like counseling to promote cessation among current users and tobacco education to prevent initiation are necessary. Enforcement of legislations to decrease availability, accessibility and affordability of tobacco products and policies to change social norms of tobacco use among parents and teachers are necessary to curb the tobacco use among college students.
doi:10.1186/1471-2458-8-97
PMCID: PMC2292712  PMID: 18366781
7.  Anti-smoking initiatives and current smoking among 19,643 adolescents in South Asia: findings from the Global Youth Tobacco Survey 
Background
Cigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region.
Methods
This is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13–15 years. We examined the association of different ways of delivering anti-smoking messages with students’ current smoking status.
Results
A total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4% with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95% confidence interval (CI) 0.84–2.89, p value 0.152; boys: OR 1.37, 95% CI 1.04–1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95% CI 1.58–5.28, p value <0.001; boys: OR 1.32, 95% CI 0.91–1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95% CI 0.95–4.21, p value 0.066; boys: OR 1.89, 95% CI 1.44–2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment.
Conclusion
School-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts.
doi:10.1186/1477-7517-11-8
PMCID: PMC3938898  PMID: 24568532
Smoking; Adolescents; Anti-smoking initiatives; South Asia
8.  Cigarette smoking among female students in five medical and nonmedical colleges 
Objectives
This study was conducted to determine the prevalence of smoking, knowledge about the ill effects of smoking on health, and the influence of family members’ smoking habits among Saudi female students.
Methods
This is a type of cross-sectional study. A sample of 1,070 female students was selected by a nonrandom and convenient sampling method from five colleges (Medicine, Business and Administration, Computer Sciences, Education, and Languages and Translation) of King Saud University, Riyadh, Saudi Arabia. A self-administrated questionnaire was used to determine the personal, social, and educational characteristics of the respondents. In addition, questions about their smoking types, status, duration of smoking, knowledge about the ill effects of smoking, daily cigarette consumption, and reasons for quitting smoking were included.
Results
The students’ response rate was 85%. The prevalence of current smoking was 4.3% and 5.6% for cigarettes and water-pipes, respectively, whereas 3.9% of the participants were ex-smokers. The prevalence of current smoking was highest in the College of Business and Administration (10.81%) and lowest in the College of Medicine (0.86%). The majority (77%) of the smokers’ parents (current and ex-smokers) were also smokers. More than half (54%) of the smokers started their smoking habit for entertainment, and 44.4% of the participants did not know that smoking causes serious health problems. The most common factors for quitting smoking were health concerns (54%), religious beliefs (29%), and parent’s advice (17%).
Conclusion
The study concludes that the prevalence of smoking varies in different subject streams and that family and friends have a great influence on individuals starting or stopping smoking. Extensive health education programs are needed to educate young women on the health hazards of smoking and help stop them from smoking.
doi:10.2147/IJGM.S48630
PMCID: PMC3754488  PMID: 23986648
smoking prevalence; quitting smoking; female students; cigarettes per day
9.  Prevalence and predictors of adolescents’ cigarette smoking in Madinah, Saudi Arabia: a school-based cross-sectional study 
BMC Public Health  2015;15:17.
Background
Although the prevalence of adolescents’ cigarette smoking has increased in recent decades, little is known regarding its epidemiology in certain Saudi regions, including the Madinah region. The aim of this study was to determine the prevalence and predictors of adolescent cigarette smoking in Madinah, Saudi Arabia.
Methods
A school-based cross-sectional study was carried out in the Madinah region during 2013. A multistage stratified cluster sample was taken and included 3400 students (11–19 years) from 34 intermediate and secondary schools. Data concerning sociodemographic and smoking-related factors were collected using a valid and reliable self-administered questionnaire. The prevalence of smoking was estimated, and appropriate statistical analyses were performed, including univariate, predictive and multivariate regression analyses.
Results
The overall response rate was 97.7%. The prevalence of cigarette smoking in the respondents’ 3322 adolescents was 15.17% (95% CI = 13.95-16.39) with significant differences in sociodemographic factors. The most important predictors were most or all friends smoking (OR = 12.5; 95% CI = 9.40-16.8). Other significant less important factors were parental smoking, belief in the harmful effects of smoking, cigarette advertisement in mass media, and pocket money.
Conclusions
Cigarette smoking prevalence is a relatively low among adolescents in Madinah region. However, friends and parents smoking play an important role in the increased risk of smoking in the studied adolescents. These predictors must be included in any antismoking education programs targeting to this sector of population in the region.
doi:10.1186/s12889-015-1363-8
PMCID: PMC4310193  PMID: 25604704
Adolescents; Prevalence; Risk factors; Smoking; Saudi Arabia
10.  Use of electronic cigarettes among secondary and high school students from a socially disadvantaged rural area in Poland 
BMC Public Health  2016;16:703.
Background
The use of e-cigarettes has been growing and has become a significant public health concern. Prevention of the youth access to, initiation and continuous use of e-cigarettes with special attention to vulnerable groups is a subject of a health debate. However, still little is known about characteristics of the underage e-cigarette users from different geographic and socio-economic backgrounds as well as other potential factors associated with the use of e-cigarettes, including simultaneous use with tobacco products or alcohol. The aim of the study was to investigate the prevalence and factors associated with ever and continued e-cigarette use among the secondary and high school students from a socially disadvantaged rural area in Poland.
Methods
The study sample consisted of 3552 students aged 13–19 years from Piotrkowski district. The anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey was implemented to collect relevant information. The uni- and multivariate logistic regression analyses were applied to identify factors associated with ever, current (in the previous 30 days) and continued e-cigarette use.
Results
Almost 22 % of the sample reported ever e-cigarettes use and 27 % of the respondents indicated e-cigarettes use in the past month. Boys, in comparison with girls, were more likely to report current e-cigarette use (OR = 1.7; p < 0.001). Current e-cigarette use was strongly associated with alcohol consumption (OR = 4.3; p < 0.001), current (OR = 32.5; p < 0.001) and ever tobacco smoking (OR = 7.5; p < 0.001) as well as smoking parents (OR = 1.4; p < 0.05) and friends (OR = 4.5; p < 0.05). The use of e-cigarettes was also significantly associated with harm perception (p < 0.001). A similar pattern was observed among ever e-cigarette users. Male gender (OR = 1.4; p < 0.05), current tobacco smoking (OR = 3.0; p < 0.01) and lack of knowledge about a ban on smoking in the school (OR = 1.4; p < 0.05) were predictors of the continued e-cigarette use. Higher paternal education (OR = 0.5; p < 0.001) and perception of e-cigarettes as more harmful comparing to tobacco (OR = 0.2; p < 0.001) protected from the continued e-cigarette use.
Conclusions
E-cigarette use is widespread in the investigated population, especially among boys, those with other risky behaviors and with smoking parents or friends. There is a need for further research and preventive policies to protect the youth from that exposure.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-3417-y) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-016-3417-y
PMCID: PMC4973054  PMID: 27488357
E-cigarettes; Smoking; Tobacco; Youth; Socially disadvantaged rural areas
11.  Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9–10 year old children from deprived neighbourhoods: a cross-sectional study 
BMC Public Health  2015;15:225.
Background
Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.
Methods
Cross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.
Results
Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health.
Conclusion
This study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.
doi:10.1186/s12889-015-1513-z
PMCID: PMC4359391  PMID: 25885000
Smoking; Children; Mother smoking; Father smoking; Sibling smoking; Peer smoking
12.  FACTORS ASSOCIATED WITH TOBACCO SMOKING AND THE BELIEF ABOUT WEIGHT CONTROL EFFECT OF SMOKING AMONG HUNGARIAN ADOLESCENTS 
SUMMARY
Introduction
The relationship between body weight and smoking has been well-documented among adult populations, but the data among youth are inconsistent. This study explores the relationship among social, behavioural, body weight-related factors and adolescent smoking while identifying factors associated with the belief that smoking controls weight.
Materials and methods
Baseline data from a three-year, prospective cohort study started in 2009 in Hungary’s six metropolitan cities. Randomly selected 6th and 9th grade students completed a self-administered questionnaire during the 2009–2010 school year (n=1445; 45% boys, mean age of 6th graders: 12.06 years, SD=0.63; mean age of 9th graders: 15.06 years, SD=0.63). Calculations of Body Mass Index (BMI) were based on objectively measured weight and height data of participants. Appetite-Weight Control Scale of the Short Form of Smoking Consequences Questionnaire was used to measure the belief that smoking supports weight control. Bivariate and multivariate logistic regression analyses were performed to examine the association between the perception of weight control and smoking, while controlling for potential confounding variables (e.g., gender).
Results
24.8% of participants smoked cigarettes within the past 30 days. The odds of smoking were increased among students who were older, had smoking friends, were exposed to parental smoking, and had poorer academic performance. BMI showed positive association with smoking (increases in BMI were associated with higher odds of smoking), and the belief that smoking controls weight mediated this association. There was no difference in smoking prevalence among those motivated either to lose or gain weight (~30%), but was considerably lower among adolescents satisfied with their body weight (19%). The belief that smoking supports weight control was more common for girls, older students, and those who perceived themselves as overweight.
Conclusions
Dissatisfaction with body weight and the belief that smoking has weight controlling effects are associated with an increased likelihood of adolescent smoking, therefore they must be considered in smoking prevention programmes among youth.
PMCID: PMC3821967  PMID: 22571010
smoking; adolescence; weight control belief; BMI; perceived body shape
13.  Determinants of Cigarette Smoking Initiation in Jordanian Schoolchildren: Longitudinal Analysis 
Nicotine & Tobacco Research  2014;17(5):552-558.
Objective:
To identify determinants of cigarette smoking initiation, by gender, among schoolchildren in Irbid, Jordan.
Methods:
Between 2008 and 2011, data were collected annually using self-reported questionnaires over 4-years in a prospective cohort of 1,781 students recruited from all 7th grade classes in 19 secondary schools, selected out of a total 60, using probability-proportionate-to-size method. Independent predictors of smoking initiation were identified among the cigarette naïve participants (N = 1,454) with mixed-effect multivariable logistic regression.
Results:
Participants were 12.6 years of age on average at baseline. 29.8% of the 1,454 students (37.2% of boys and 23.7% of girls) initiated cigarette smoking by 10th grade. Of those who initiated (n = 498), 47.2% of boys and 37.2% of girls initiated smoking in the 8th grade. Determinants of cigarette smoking initiation included ever smoking a waterpipe, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends who smoked. For girls, familial smoking was also predictive of cigarette initiation.
Conclusion:
This study shows that many Jordanian youth have an intention to initiate cigarette smoking and are susceptible to cigarette smoking modeled by peers and that girls are influenced as well by familial cigarette smoking. Prevention efforts should be tailored to address culturally relevant gender norms, help strengthen adolescents’ self-efficacy to refuse cigarettes, and foster strong non-smoking social norms.
doi:10.1093/ntr/ntu165
PMCID: PMC4432393  PMID: 25143297
14.  Cigarette and waterpipe smoking among adolescents in Estonia: HBSC survey results, 1994–2006 
BMC Public Health  2008;8:392.
Background
Smoking is a major single cause of preventable morbidity and premature mortality. Tobacco use among adolescents is a significant public health problem as smoking behaviour is undeniably established in adolescence. While cigarette smoking among adolescents has been a significant public health problem for years, waterpipe smoking is considered to be a new global public health threat. The objectives of this study were to describe trends of cigarette smoking and the prevalence of waterpipe smoking and to study the association between cigarette and waterpipe smoking among adolescents in Estonia.
Methods
This study was based on a four-yearly HBSC survey of health behaviour among school-aged children conducted in 1994–2006 in Estonia. It was a school-based survey of a nationally representative sample using standardized methodology. The target group of the survey were 11-, 13-, and 15-year-old schoolchildren (N = 13826), 6656 boys and 7170 girls. Cigarette and waterpipe smoking was determined on a 4-stage scale: every day, at least once a week, less than once a week, not smoking. Logistic regression analysis was applied to examine gender- and age-specific smoking trends and to study the association between cigarette and waterpipe smoking.
Results
Prevalence of smoking was higher among boys than girls in all age groups during the whole study period. The prevalence of cigarette smoking increased in 1994–2002 and then slightly decreased in both genders. The increase in smoking was larger among girls. Among girls, daily smoking increased during the whole study period. Among 15-year-old schoolchildren one-third of the boys and one quarter of the girls were cigarette smokers, 21% of the boys and 12% of the girls were daily smokers in 2006. One fourth of the boys and one sixth of the girls were waterpipe smokers. A logistic regression analysis revealed a strong association between cigarette and waterpipe smoking among schoolchildren.
Conclusion
The results of this study can significantly enhance the capacity to develop and implement tobacco prevention and control programmes among the youth in Estonia.
doi:10.1186/1471-2458-8-392
PMCID: PMC2613150  PMID: 19032756
15.  Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland 
Background
To prevent adolescents from becoming smokers, it is essential to understand factors that cause them to become susceptible to smoking (SS). The aim of this study was to examine association between individual and school characteristics and susceptibility to smoking initiation and experimentation in the youth.
Methods
We collected cross-sectional survey data from students aged 13–19 years attending 21 schools from Piotrkowski district. Of 4050 students, 3552 respondents, including 2508 non-smokers, filled in an anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey. The univariate and multivariate logistic regression analyses were applied to the study factors linked to SS among the never and ever smoking youth.
Results
About 22 % of the never smoking and 57 % of the ever smoking students were found to be vulnerable to smoking. The youth who were males (OR = 1.4; p = 0.001), who were older (OR = 1.1; p = 0.002) and those, whose mothers had medium (OR = 1.8; p < 0.001) and lower (OR = 4.1; p < 0.001) educational levels were more prone regarding future smoking compared to the females, younger ones and those whose mothers were highly educated. The students who lived in households with no smoking ban (OR = 1.4; p = 0.001) and those who had ever tried cigarettes (OR = 3.5; p < 0.001) were more susceptible to smoking comparing to those who indicated smoke-free home and who had never smoked. In addition, having smoking friends (OR = 2.3; p < 0.001), seeing school personnel smoking on the premises of the school (OR = 1.8; p < 0.001) and perceiving smoking girls more attractive than the non-smokers (OR = 3.8; p < 0.001) were the correlates of smoking susceptibility. Finally, the separate analysis among the never smokers indicated that no school training on tobacco harm (OR = 1.3; p = 0.04) is the additional significant factor for susceptibility to smoking initiation.
Conclusions
SS is prevalent in secondary and high school students in Poland. Personal, social and environmental factors are strongly correlated with SS. When addressing the youth, efforts should be focused on the groups at risk, with a comprehensive approach including multiple factors and involving school personnel, parents and the group leaders in tobacco control activities. Projects aimed at changing social norms around smoking and providing the youth with knowledge and skills to resist smoking are also needed. This may help to implement an effective approach to prevent smoking susceptibility and initiation of tobacco use among the youth.
Electronic supplementary material
The online version of this article (doi:10.1186/s12971-016-0092-9) contains supplementary material, which is available to authorized users.
doi:10.1186/s12971-016-0092-9
PMCID: PMC4986373  PMID: 27531970
Susceptibility to smoking; Adolescents; Students; Socially disadvantaged rural area; Poland
16.  Prevalence of smoking among secondary school male students in Jeddah, Saudi Arabia: a survey study 
BMC Public Health  2013;13:1010.
Background
This study was conducted to examine the prevalence of smoking and the smoking habits among male secondary school students in Jeddah, Kingdom of Saudi Arabia and to assess their knowledge and attitudes towards smoking.
Methods
A cross-sectional study was conducted in Jeddah, using a two-stage cluster sample that randomly selected four schools from 85 public secondary schools for males. Data were obtained through a self-administered questionnaire containing questions on personal background, smoking behavior, knowledge, and behavior and attitudes towards smoking. A total of 695 students responded to the questionnaires with an 87.4% response rate.
Results
The age range of this student sample was 16–22 years. Two hundred fifty-eight (37%) of the study group were current smokers. The most common reasons given for smoking were personal choice (50.8%) and the peer pressure from smoker friends (32.8%). Many students researched the smoking hazards (68.1%), but only 47.6% knew about the bad effects of passive smoking. Two thirds of the smoking students wanted to quit smoking (63.2%), especially if suitable help was available, and 75.1% tried to quit. A third of the smoking students (36.8%) found it difficult to stop smoking in no-smoking areas.
Conclusion
A well-planned integrated antismoking campaign is urgently required, especially among students and teachers. Our study revealed that smoking prevalence was high, which will lead to future high smoking-related health problems if proper preventive measures are not taken accordingly.
doi:10.1186/1471-2458-13-1010
PMCID: PMC3840679  PMID: 24160571
Smoking; Prevalence; Male students; Secondary schools; Saudi Arabia
17.  Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008–11 
Background: Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting. Methods: Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking. Results: Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P < 0.001). Smoking prevalence increased every year after year 2 for current smoking (P < 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P < 0.001). Conclusion: This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking.
doi:10.1093/eurpub/ckt140
PMCID: PMC3784799  PMID: 24078649
18.  Prevalence of Smoking and its Related Behaviors and Beliefs Among Secondary School Students in Riyadh, Saudi Arabia 
Objective:
To estimate the prevalence of smoking among secondary school students in National Guard area of Riyadh, and explore the reasons for the smoking and the attitude of non-smoker toward smoking habit.
Design:
A cross-sectional study was conducted in June 2009. By random sampling technique 255 students were enrolled from secondary school of National Guard area, Riyadh, Saudi Arabia. A self-administered questionnaire was used for data collection.
Results:
Current smokers represented 28.6% of the students. The most common reasons for smoking were: having free time (81.6%), for the relief of stress (63.2%) and seeing some of their teachers smoking (61.8%).
Most of the smokers started the habit before the age of 15 years old (89%). 84% of non-smokers suggested to ban smoking in public places. 42.2% of students were planning to start smoking in future.
Religion was the most important reason for not smoking among non smokers.
Conclusion:
The prevalence of smoking is big enough a problem to be considered as a warning for an impending epidemic Health education provision should have a greater role in schools Governmental commitment and social support are vital if health education and awareness and especially quit smoking programs are to be implemented and sustained.
PMCID: PMC3312769  PMID: 22489230
Secondary school student; smoking; shisha; magha; Riyadh
19.  Prevalence and social environment of cigarette smoking in Cyprus youth 
BMC Public Health  2008;8:190.
Background
Tobacco use is the single most preventable cause of morbidity and mortality in humans. Limited data exist regarding the extent of the problem among Cyprus youth. We use the Global Youth Tobacco Survey to assess the prevalence of cigarette smoking among middle and high school students as well as the social environment in which this is taking place.
Methods
The survey was conducted by the Cyprus International Institute for the Environment and Public Health in association with Harvard School of Public Health. A two-stage cluster sample design was used to select a representative sample of students from middle and high schools registered with the Republic of Cyprus in 2005–2006. The study questionnaire consisted of 99 questions and participation in the survey was voluntary. Statistical analyses were performed taking into consideration the specific design of the study and the sample weights associated with each completed questionnaire.
Results
The prevalence of current smoking, defined as having smoked cigarettes on one or more days of the past 30 days, is 13% among boys and 7% among girls in middle schools, and 36% among boys and 23% among girls in high schools. Furthermore, 16% of middle school students and more than 24% of high school students that had never smoked indicated that they are likely to initiate smoking within the next year. Exposure to environmental tobacco smoke is also very high with 91% of students reporting being exposed to smoke in places outside home. In addition, more than 95% of current smokers reported that they had bought cigarettes in a store during the past month and were not refused cigarettes because of their age.
Conclusion
Smoking prevalence among Cyprus middle and high school students is high and there are indications of an increase in the prevalence of smoking among girls over the last few years. Susceptibility rates, exposure to second-hand smoke, and access to and availability of cigarettes to youth are also high and concerning. The present survey indicates that the problem of cigarette smoking among youth in Cyprus is significant and requires collective action immediately.
doi:10.1186/1471-2458-8-190
PMCID: PMC2435118  PMID: 18518947
20.  Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia 
Tobacco Control  1996;5(3):215-219.
OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems. 





PMCID: PMC1759520  PMID: 9035357
21.  Correlates of current cigarette smoking among in-school adolescents in the Kurdistan region of Iraq 
Conflict and Health  2007;1:13.
Background
Many adult cigarette smokers initiated the habit as adolescents. Adolescent tobacco use may be a marker of other unhealthy behaviours. There are limited data on the prevalence and correlates of cigarette smoking among in-school adolescents in Iraq. We aimed to estimate the prevalence of, and assess the socio-demographic correlates of current cigarette smoking among in-school adolescents in Kurdistan region of Iraq.
Methods
Secondary data analysis of the Global Youth Tobacco Survey, conducted in the region of Kurdistan, Iraq in 2006. Logistic regression analysis was conducted to assess the association between current cigarette smoking and explanatory variables.
Results
One thousand nine hundred eighty-nine adolescents participated in the Kurdistan-Iraq Global Youth Tobacco Survey. Of these, 58.1% and 41.9% were boys and girls respectively. The overall prevalence of current cigarette smoking was 15.3%; 25.1% and 2.7% in boys and girls respectively. The factors associated with adolescent smoking were: parents' smoking, smoking in closest friends, male gender, having pocket money and perceptions that boys or girls who smoked were attractive.
Conclusion
We suggest that public health interventions aimed to curb adolescent cigarette smoking should be designed, implemented and evaluated with due recognition to the factors that are associated with the habit.
doi:10.1186/1752-1505-1-13
PMCID: PMC2222048  PMID: 18053219
22.  Prevalence of and Susceptibility to Cigarette Smoking Among Female Students Aged 13 to 15 Years in Vietnam, 2007 
Preventing Chronic Disease  2009;7(1):A11.
Introduction
Recent reports show a sharp increase in smoking rates among girls. We describe prevalence of cigarette smoking and susceptibility to cigarette smoking among female students aged 13 to 15 years in Vietnam and examine the associated factors.
Methods
We used data from female secondary school students aged 13 to 15 years (grades 8-10) from the 2007 Global Youth Tobacco Survey that was conducted in 9 provinces in Vietnam. We used multivariate logistic regression analysis to determine associations between independent variables with smoking status and susceptibility to smoking.
Results
Prevalence of cigarette smoking among girls was 1.2% (95% confidence interval [CI], 0.9-1.5), and 1.5% (95% CI, 1.2-1.9) of girls were susceptible to smoking. Having friends who smoke was the strongest predictor of both smoking status and susceptibility to smoking. Attendance at school classes that described the harmful effects of smoking had significant effects in reducing cigarette smoking. Girls who were exposed to billboard cigarette advertising were more likely to be susceptible to smoking than were those who had not seen advertisements.
Conclusion
Our findings highlight the need for pursuing school-based intervention programs in Vietnam and for countering tobacco advertising and marketing practices that target young women.
PMCID: PMC2811506  PMID: 20040226
23.  Correlates of current cigarette smoking among school-going adolescents in Punjab, India: results from the Global Youth Tobacco Survey 2003 
Background
Smoking is a leading cause of morbidity and mortality globally. There is therefore need to identify relevant factors associated with smoking among adolescents in order to better tailor public health interventions aimed at preventing smoking.
Methods
We used data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Punjab, India, on 2014 adolescents of whom 58.9% were males. We conducted a weighted logistic regression analysis, adjusting for age and sex, to determine associations between predictor variables and current tobacco smoking status.
Results
A total of 2014 adolescents participated in the survey in 2003, and of these 58.9% were males. Male respondents tended to be older than females (21.2% of males, and 13.1% of females were of age 16 years or above). The percent of males and females in the other age groups were: 23.0% and 28.6% for <14 years, 27.3% and 31.0% for 14 years, and 28.4% and 27.0% for 15 years, respectively. The following factors were positively associated with smoking: adolescents who received pocket money; adolescents who had parents who smoked, chewed or applied tobacco; adolescents who said that boys or girls who smoke or chew tobacco have more friends; adolescents who said that smoking or chewing tobacco makes boys look less attractive; adolescents who said that there is no difference in weight between smokers and non-smokers; adolescents who said that smoking makes one gain weight; and adolescents who had most or all of their closest friends who smoked. The factors that were negatively associated with smoking were: adolescents who said that boys or girls who smoke or chew tobacco have less number of friends; adolescents who said that girls who smoke or chew tobacco are less attractive; and adolescents who had some of their closest friends who smoked.
Conclusion
The observed associations between current smoking on one hand and peer smoking, and perception that boys who smoke are less attractive on the other, deserve further studies. The factors reported in the current study should be considered in the design of public health interventions aimed to reduce adolescent cigarette smoking.
doi:10.1186/1472-698X-8-1
PMCID: PMC2244596  PMID: 18194550
24.  Prevalence of smoking among male secondary school students in Jeddah, Saudi Arabia 
Objectives:
This study was conducted to examine the prevalence of smoking and habits of smoking among male secondary school students in Jeddah, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes toward it.
Materials and Methods:
A cross-sectional study was conducted in Jeddah, using a two-stage cluster sampling, randomly selecting 4 out of 85 government male secondary schools. Data were obtained through a self-administered questionnaire eliciting responses to questions on personal background, smoking behavior, knowledge, behavior, and attitude toward smoking. A total of 695 students responded to the questionnaires with 87.4% response rate.
Results:
Of the studied group, 258 (37%) currently smoked, and of these, 83.7% had started smoking at the age of 14 years or less. The most common reason for smoking was the influence of family, especially the presence of someone at home who smoked (65, 9%) and friends who smoked (42.5%). Many of the students search for information on the risks of smoking (66.3%), and only (45.3%) knew about the bad effects of passive smoking on others. Two-third of the students who smoked wanted to quit smoking (63.2%), especially if suitable help was offered, whereas (60.9%) had tried to quit. While 50% of students smoked for recreation and entertainment, and (33.6%) had difficulty avoiding smoking in no smoking areas.
Conclusion:
A well-planned integrated antismoking campaign is urgently required, especially among students and teachers. The study revealed that the prevalence of smoking was high. This will contribute to an increase in smoking-related health problems in the future if proper preventive measures are not taken.
doi:10.4103/2230-8229.121993
PMCID: PMC3957170  PMID: 24672274
Smoking; male students; secondary school; prevalence; behavior
25.  Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire 
BMC Public Health  2012;12:239.
Background
Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.
Methods
A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.
Results
Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).
Conclusions
The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.
doi:10.1186/1471-2458-12-239
PMCID: PMC3384472  PMID: 22443305

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