Factors associated with smoking contemplation and maintenance among Iranian adolescents

Background: Evidence is scarce on which factors contribute to cigarette and waterpipe contemplation and no previous study has examined the factors associated with waterpipe maintenance. Aims: This study aimed to determine the factors associated with cigarette and waterpipe smoking contemplation and maintenance among Iranian adolescents. Methods: Factors including depression, risky behaviour, family conflict, attitude to smoking acceptability and self-efficacy were examined using a questionnaire for 5500 adolescents at the smoking contemplation or maintenance stage. Results: Students with depression had nearly double the chance [95% confidence interval (CI): 1.41-2.72] of cigarette smoking contemplation. Risk takers had odds of 2.13 (95% CI: 1.51-2.94) and 1.49 (1.22-1.85) of cigarette and waterpipe (hookah) smoking contemplation, respectively. Those facing family conflict had odds of 1.87 (95% CI:1.38-2.53) and 1.53 for cigarette and waterpipe smoking contemplation, respectively. The contemplation odds for students with more positive attitude to smoking acceptability were 2.12 (95% CI: 1.51-2.97) and 1.72 for cigarette and waterpipe smoking, respectively. Higher self-efficacy was associated with lower cigarette and waterpipe smoking contemplation. Risky behaviour was related to smoking maintenance. A more positive attitude to smoking acceptability was related to higher waterpipe maintenance (odds ratio = 1.57 95% CI:1.03-2.40). Conclusions: Depression, attitude to smoking acceptability and risky behaviour are factors associated with smoking contemplation and maintenance.