Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008-11.
BACKGROUND
Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting.


METHODS
Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking.


RESULTS
Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P < 0.001). Smoking prevalence increased every year after year 2 for current smoking (P < 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P < 0.001).


CONCLUSIONS
This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking.
1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
Karma L
KL
McKelvey
Meredith L
ML
Wilcox
Purnima
P
Madhivanan
Fawaz
F
Mzayek
Yousef S
YS
Khader
Wasim
W
Maziak
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D012574:Schools; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000639:trends*; D000074606:Smoking Prevention; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D062789:Tobacco Products; D014029:Tobacco Use Disorder