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

Drug Alcohol Depend. 2014 Sep 1;142:307-13. doi: 10.1016/j.drugalcdep.2014.06.038. Epub 2014 Jul 9.


Objective: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: Cohort; Gender; Initiation; Jordan; School children; Waterpipe smoking.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age of Onset
  • Child
  • Female
  • Humans
  • Incidence
  • Jordan / epidemiology
  • Longitudinal Studies
  • Male
  • Schools
  • Self Efficacy*
  • Smoking / epidemiology*
  • Smoking / psychology*
  • Students*
  • Surveys and Questionnaires