Smoking Stages in an Iranian Adolescent Population

  • Asghar Mohammadpoorasl Department of Public Health, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran.
  • Sahrnaz Nedjat Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Fakhari Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Kamran Yazdani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Abbas Rahimi Foroushani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Akbar Fotouhi Mail Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Adolescents, Personal-environmental factors, Prevalence, Smoking stages, Tabriz


The aim of this study is determining the prevalence of smoking stages in adolescents of Tabriz city (northwest of Iran) and identifying the personal, environmental, and psychological factors relating to cigarette smoking. Fifty-seven high schools were randomly selected, and 4903 students were completed a self-administered questionnaire about cigarette smoking and the related risk factors. The association of independent variables with cigarette smoking was evaluated using the ordinal logistic regression model. In total, 17.3% of the participants were experimenters (95% CI: 15.8-18.9) and 5.0% were regular smokers (95% CI: 3.7-6.2). The results showed that the male gender (OR=2.92; CI: 1.94-4.77), age (OR=1.27; CI: 1.02-1.64), having general risk taking behavior (OR=1.50; CI: 1.02-2.21), presence of a cigarette smoker in the family (OR=1.78; CI: 1.23-2.54), friendship with close cigarette smoker friends (OR=2.52; CI: 1.65-3.86), substance abuse experience (OR=8.27; CI: 2.61-25.61), attitude toward cigarette smoking (OR=1.22; CI: 1.10-1.27) and positive thinking about cigarette smoking (OR=1.05; CI: 1.01-1.14) are associated to cigarette smoking in adolescents. The cigarette smoking prevalence is minimal in Tabriz city adolescents, especially in girls; but the experimenter prevalence is considerable. Findings of this study justifies adopting more serious measures in the pre-adolescence and adolescence period.


NovotnyTE. Tobacco use. In: Brownson RC RP, DavisJR. editors, editor. Chronic Disease Epidemiology and Control. Baltimore: American Public Health Association 1993. p. 199-220.

Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tob Control 1998; 7(4):409-20.

Breslau N, Peterson EL. Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences. Am J Public Health 1996; 86(2):214-20.

Chassin L, Presson CC, Sherman SJ, Edwards DA. The natural history of cigarette smoking: predicting youngadultsmoking outcomes from adolescent smoking patterns. Health Psychol 1990; 9(6):701-16.

Huang M, Hollis J, Polen M, Lapidus J, Austin D. Stages of smoking acquisition versus susceptibility as predictors of smoking initiation in adolescents in primary care. Addict Behav 2005; 30(6):1183-94.

Best D, Rawaf S, Rowley J, Floyd K, Manning V, Strang J. Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents. Drug Alcohol Depend 2000; 60(3):319-21.

Bender E. Trends in Teen Drinking, Smoking Continue Gradual Decline. Psychiatric News 2006;41(2):9. icleid=109658

Scollo MM, Winstanley MH. Tobacco in Australia: Facts and Issues. Edition T, editor. Melbourne 2008.

Alireza Ayatollahi S, Mohammadpoorasl A, Rajaeifard A. Predicting the stages of smoking acquisition in the male students of Shiraz's high schools, 2003. Nicotine Tob Res7(6):845-51.

Mohammadpoorasl A, Fakhari A, Shamsipour M, Rostami F, Rashidian H. Transitions between the stages of smoking in Iranian adolescents. Prev Med 2011;52(2):136-8.

Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Delavari A, Heshmat R, Mokhtari MR, Razaghi EM,Motaghian M, Ahangar-Nazari I, Mahmood-Arabi MS, Barekati H; CASPIAN Study Group. Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study. Prev Med. 2006 Jun;42(6):423-6.

Ramezankhani A, Sarbandi Zaboli F, A. Z, Heydari G, Masjedi MR. Pattern of cigarette smoking in adolescent students in Tehran. Pejouhandeh 2010;15(75):115-22. (Persian).,

Namakin K, Sharifzadeh GR, Miri MR. Prevalence of cigarette smoking and evaluation of attitude and knowledge in its high school boys in Birjand, 2005. Journal of Birjand University of Medical Sciences 2008; 15(1):66-70. (Persian). 260&slc_lang=en&sid=1&sw=Evaluation

Agha Molaei T, Zare S. Cigarette and hookah using pattern in over-15 population of Bandar Abbas, a population basedstudy. Medical Journal of Hormozgan University 2008;11(4):241-6. (Persian).

Ziaee P, Hatamizadeh N, Vameghi R, Dolatabadi S. A study on prevalence of cigarette smoking and the age of first smoking in senior high school students in Tehran 1998-99. Hakim 2001;4(2):78-84. (Persian).

Kaplan CP, Napoles-Springer A, Stewart SL, Perez- Stable EJ. Smoking acquisition among adolescents and young Latinas: the role of socioenvironmental and personal factors. Addict Behav 2001 26(4):531-50.

Turner L, Mermelstein R, Flay B. Individual and contextual influences on adolescent smoking. Ann N Y Acad Sci 2004;1021:175-97.

Novak SP, Clayton RR. The influence of school environment and self-regulation on transitions between stages of cigarette smoking: a multilevel analysis. Health Psychol 2001;20(3):196-207.

Rosenberg M. Society and the Adolescent Self-Image: Princeton University Press, Princeton, NJ; 1965.

Hill AJ, Boudreau F, Amyot E, Dery D, Godin G. Predicting the stages of smoking acquisition according to the theory of planned behavior. J Adolesc Health 1997;21(2):107-15.

Centers for Disease Control and Prevention. Cigarette Use Among High School Students—United States, 1991–2007 . MMWR Morb Mortal Wkly Rep 2008;57(25):686-8..

Lam TH, Stewart SM, Ho LM: Youth Sexuality Study Task Force 1996, The Family Planning Association of HongKong. Prevalence and correlates of smoking and sexual activity among Hong Kong adolescents. J Adolesc Health 2001;29(5):352-8.

White V, Hayman J. Smoking behaviours of Australian secondary students in 2005. Melbourne: Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria 2006.

Warren CW, Jones NR, Eriksen MP, Asma S; Global Tobacco Surveillance System (GTSS) collaborative group. Patterns of global tobacco use in young people and implications for future chronic disease burden in adults. Lancet 2006;367(9512):749-53.

Morley KI, Hall WD. Explaining the convergence of male and female smoking prevalence in Australia. Addiction 2008;103(3):487-95.

Mayhew KP, Flay BR, Mott JA. Stages in the development of adolescent smoking. Drug Alcohol Depend 2000;59 Suppl 1:S61-81.

Komro KA, McCarty MC, Forster JL, Blaine TM, Chen V.Parental, family, and home characteristics associated with cigarette smoking among adolescents. Am J Health Promot2003;17(5):291-9.

Simons-Morton B, Chen R, Abroms L, Haynie DL. Latent growth curve analyses of peer and parent influences on smoking progression among early adolescents. Health Psychol 2004;23(6):612-21.

Chen X, Stanton B, Fang X, Li X, Lin D, Zhang J, Liu H, Yang H. Perceived smoking norms, socioenvironmentalfactors, personal attitudes and adolescent smoking in China: a mediation analysis with longitudinal data. J Adolesc Health 2006;38(4):359-68.

Andrews JA, Duncan SC. The effect of attitude on thedevelopment of adolescent cigarette use. J Subst Abuse 1998;10(1):1-7.

Hanson MJ. The theory of planned behavior applied to cigarette smoking in African-American, Puerto Rican, and non-Hispanic white teenage females. Nurs Res 1997 46(3):155-62.

Jackson C. Initial and experimental stages of tobacco and alcohol use during late childhood: relation to peer, parent, and personal risk factors. Addict Behav 1997;22(5):685-98.

How to Cite
Mohammadpoorasl A, Nedjat S, Fakhari A, Yazdani K, Rahimi Foroushani A, Fotouhi A. Smoking Stages in an Iranian Adolescent Population. Acta Med Iran. 50(11):746-754.