Better view on attitudes and perceived parental reactions behind waterpipe smoking among Iranian students

Background: Because of the increasing usage of waterpipe globally, we need to know more about the diff erent factors related to waterpipe and cigarette smoking. Th erefore, the present study aims at gaining more insight on waterpipe and cigarette smoking based on perceived parental reaction and appeal and repellent of smoking among adolescents. Materials and Methods: A cross-sectional survey entitled “Isfahan Tobacco Use Prevention Program” (ITUPP) was conducted among 5,500 adolescents in Isfahan Province, Iran in 2010 using a  selfadministered anonymous questionnaire. Demographic factors, cigarette and waterpipe smoking status, appeal and  repellent of smoking,perceived parental reactions, and the main reasons behind the increase in waterpipe smoking were measured. Chi-square, univariate logistic regression, and multiple logistic regression were used. For all analyses, we defi ned statistical signifi cance a priori with a two-tailed alpha of 0.05. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 15. Results: 50% of the sample was female and 89% lived in urban areas. Th e average age of the respondents was 14.37 ± 1. 70 years. While a majority of cigarette smokers (70.9%) were waterpipe smokers, only 35.7% of waterpipe smokers smoked cigarettes. The incidence of smoking was high in those who expected less extensive parental reaction with odds ratio (OR) = 1.89 [95% confi dence interval (CI): 1.35-2.63] (P < 0.001) among cigarette smokers and OR = 2.75 (95% CI: 2.16-3.50) (P < 0.001) among waterpipe smokers. “Taste” was rated the most attractive feature by waterpipe and cigarette smokers 2.83-fold (95% CI: 2.06, 3.90) (P < 0.001). Most waterpipe smokers compared to nonsmokers believed that the main reason behind waterpipe popularity was habit. Conclusion: The factors related to waterpipe smoking were diff erent from those in cigarette smoking; so we need to implement diff erent interventions to overcome the surging usage of tobacco use. Key words: Adolescents, attitude, Eastern Mediterranean Region (EMR), hookah, parent reaction, parents, perception, smoking, students, waterpipe