title: Determinants of cigarette smoking initiation in Jordanian schoolchildren: longitudinal analysis.
abstract: OBJECTIVE
  To identify determinants of cigarette smoking initiation, by gender, among schoolchildren in Irbid, Jordan.
  
  
  METHODS
  Between 2008 and 2011, data were collected annually using self-reported questionnaires over 4-years in a prospective cohort of 1,781 students recruited from all 7th grade classes in 19 secondary schools, selected out of a total 60, using probability-proportionate-to-size method. Independent predictors of smoking initiation were identified among the cigarette naïve participants (N = 1,454) with mixed-effect multivariable logistic regression.
  
  
  RESULTS
  Participants were 12.6 years of age on average at baseline. 29.8% of the 1,454 students (37.2% of boys and 23.7% of girls) initiated cigarette smoking by 10th grade. Of those who initiated (n = 498), 47.2% of boys and 37.2% of girls initiated smoking in the 8th grade. Determinants of cigarette smoking initiation included ever smoking a waterpipe, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends who smoked. For girls, familial smoking was also predictive of cigarette initiation.
  
  
  CONCLUSIONS
  This study shows that many Jordanian youth have an intention to initiate cigarette smoking and are susceptible to cigarette smoking modeled by peers and that girls are influenced as well by familial cigarette smoking. Prevention efforts should be tailored to address culturally relevant gender norms, help strengthen adolescents' self-efficacy to refuse cigarettes, and foster strong non-smoking social norms.
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL; kscot005@fiu.edu.
authors.forename: Karma
authors.initials: K
authors.lastname: McKelvey
authors.affiliation: Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Attonito
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL;
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.affiliation: Department of Biostatistics, ScienceDocs Inc., Portland, OR;
authors.forename: Qilong
authors.initials: Q
authors.lastname: Yi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN;
authors.forename: Fawaz
authors.initials: F
authors.lastname: Mzayek
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005260:Female; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010379:Peer Group; D011446:Prospective Studies; D012574:Schools; D020377:Self Efficacy; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D012919:Social Behavior; D013334:Students; D011795:Surveys and Questionnaires; D062789:Tobacco Products