title: Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis.
abstract: OBJECTIVE
  Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.
  
  
  METHODS
  A school-based cohort of all 7th grade students (N=1781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1243).
  
  
  RESULTS
  During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: odds ratio 7.41; 95% confidence interval 4.05-12.92 and girls: 8.48; 4.34-16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80-51.53 and girls: 11.49; 6.42-20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14-4.64) or teachers (2.07; 1.12-3.84) who smoked and girls if they had friends (2.96; 1.59-5.54) who smoked.
  
  
  CONCLUSIONS
  There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II - Room 595-1, Miami, FL 33099, USA. Electronic address: kscot005@fiu.edu.
authors: Karma
authors: K
authors: McKelvey
authors: Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II - Room 595, Miami, FL 33099, USA.
authors: Jennifer
authors: J
authors: Attonito
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II - Room 595-1, Miami, FL 33099, USA.
authors: Purnima
authors: P
authors: Madhivanan
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II - Room 595-1, Miami, FL 33099, USA.
authors: Rana
authors: R
authors: Jaber
authors: ScienceDocs Inc., 10940 SW Barnes Rd. #270, Portland, OR 97225, USA.
authors: Qilong
authors: Q
authors: Yi
authors: Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, 3720 Alumni Avenue, Memphis, TN 38152, USA.
authors: Fawaz
authors: F
authors: Mzayek
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II - Room 595-1, Miami, FL 33099, USA; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors: Wasim
authors: W
authors: Maziak
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007597:Jordan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D012574:Schools; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D013334:Students; D011795:Surveys and Questionnaires
keywords: Cohort; Gender; Initiation; Jordan; School children; Waterpipe smoking