title: The determinants of high school students smoking habits with special focus on teachers smoking in Iran: a population based study.
abstract: BACKGROUND
  Approval of smoking by friends and teachers is likely to increase the probability of smoking by the students. This study aims to determine whether adolescent smoking is associated with teachers or other students smoking, after controlling for confounders.
  
  
  METHODS
  In a cross sectional study, a representative sample of 4599 students in the third grade were selected from high schools in Tehran. A 21 item questionnaire was administered consisting of demographic and tobacco smoking habit questions. Pattern of adolescent tobacco smoking was compared between two sexes. Association between smoking behavior and perceived exposure to teachers smoking were assessed using bivariate and multivariate analyses, adjusting for parental, best friends and sibling smoking and sex. A multivariate logistic regression model was constructed and adjusted Odds Ratios were estimated.
  
  
  RESULTS
  In total, 4591 students, aged 17 to 19 years, consisting of 2092 (45.6%) boys and 2499 (54.4%) girls, with the overall mean age of 17.53 +/- 0.59 years, were recruited. Of the students studied, 250 (12.1%) of boys and 131 (5.3%) of girls reported being current smokers (p = 0.001). The proportion of smoker and non-smoker students reporting to have been exposed to teachers smoking inside the school building was 209 (55.7%) and 1191 (29.3%), respectively (p = 0.001). Of those reporting being exposed to teachers smoking outdoors on school premises, 220 (58.7%) were smokers and 1205 (29.2%) were non-smokers (p = 0.001). After adjusting for sex, smoking habit of father, mother, brothers, sisters and best friends, adolescent perceived exposure to teachers smoking on school premises, but not inside school, was significantly associated with current smoking (OR = 2.1, 95 % CI:1. 7-2. 7). Adolescent exposure to best friend smoking was strongly associated with current smoking after adjusting for above variables (OR=6. 7, 95 % CI:5-9).
  
  
  CONCLUSIONS
  Teachers smoking during school hours and best friend smoking are the two important determinants to be considered in any project aiming to establish tobacco-free schools.
authors.affiliation: Tobacco Prevention and Control Research Center (TPCRC), Masih Daneshvari Hospital, Shaheed Beheshti Medical Science University, Tehran, Iran.
authors.forename: Emami
authors.initials: E
authors.lastname: Habib
authors.forename: Amir Soha Rezai
authors.initials: AS
authors.lastname: Shiraz
authors.forename: Ghazal
authors.initials: G
authors.lastname: Naseri-Kouzehgarani
authors.forename: Sharifi
authors.initials: S
authors.lastname: Hooman
authors.forename: Masjedi Mohammad
authors.initials: MM
authors.lastname: Reza
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000465:Algorithms; D005178:Faculty / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012494:Sampling Studies; D012574:Schools; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires